Hillside

About the service

Hillside is a care home providing personal care and accommodation for 6 people. The home is a house with a garden and access to the local town. Most people who were living at Hillside had physical and learning disabilities, including autistic people. The home can support up to 7 people.

People's experience of using this service and what we found

This was a targeted inspection that focused on the safe use of medicines, risks to people being managed safely, infection control, person centred care and the management of the service. Based on this targeted inspection:

Right Support:

People received safe care at the home and the manager had updated risk assessments and care plans to guide staff how to support people safely. Medicines were administered to people safely, for the most part and immediate action was taken where this was not the case. Staff had a good understanding of people as individuals and external professionals were contacted to support people if this was needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care:

The service looked clean and well looked after and work had started to decorate the service. Staff were confident when supporting people and spoke with them with kindness and compassion. The manager and staff team had started to support people to set goals and achieve their ambitions. Work had also started to collect feedback from people in meaningful ways that made sense to them.

Right Culture:

There was a positive culture at the service. Staff enjoyed their job roles and people were happy and relaxed being supported by staff. The provider and manager had taken the findings from our last inspection seriously and put numerous measures in place to improve the quality of the support people had and the culture of the service. The provider and registered manager acknowledged that improvements could still be made and had plans in place to implement these.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (report published 18 November 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulations 12, 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We had concerns about risk assessment and management, medicines management, infection control. people receiving person-centered care and how the management team were monitoring the quality of the service. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

About the service

Hillside is a care home providing personal care and accommodation to seven people. The home is a house with a garden and access to the local town. Most people who were living at Hillside had physical and learning disabilities, including autistic people. The home can support up to eight people.

People’s experience of using this service and what we found

Right Support:

People did not consistently receive safe care at the home. New and changing needs were not managed in a safe way for people, which put them at risk. Medicines were poorly administered which meant sometimes people did not get their medicines. Managers and staff did not seek advice when one person was possibly having too much of one of their ‘as required’ medicine, or when they were being given this medicine for the wrong reasons. People did not have care plans in place to support staff to look after them. Their personal documents were not protected. People’s independence was not always encouraged at the home. There was enough staff on duty to support people.

Right Care:

No meaningful or effective work had been completed to check if people were happy with the care provided. No work had been completed to look at people’s life goals and aspirations and make plans to try and make these happen. Staff were polite with people, but they did not routinely chat with people as friends and help them follow their interests. Staff did not promote the home as people’s own home. Parts of the home looked tired and were uncared for. Some people’s bedrooms needed decorating and items replaced, to promote their dignity and make it an enjoyable space to be in.

Right Culture:

The leaders of the home had not created a culture which established a safe and person-centred experience for people to live in. Managers had planned for a new person to move into the home in a way which made them and others feel comfortable about this. But managers had not made plans to ensure there were systems to check they were safe and staff had the knowledge and skills to meet their needs. The provider was not effectively assessing the quality of the care at the home. They were not looking at what people’s experiences were like. The provider had made some improvement plans but these lacked detail and no actions had been taken to improve people’s experience of living at the home.

Based on our review of safe and well led the service was not able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 7 August 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to people’s safety, management’s response to safeguarding concerns, person-centred care and failures in the leadership of the home at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Accommodation is provided in one large detached house over two floors. People have access to communal areas.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance however, there were elements of this. Registering the right support ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.

People’s experience of using this service:

The majority of people who lived at the home were able to communicate verbally but for people who were unable to speak to us we observed staff supported them with a range of communication aids. These included sign language and interpreting people’s body language with regards to meeting their needs and wishes.

At the last inspection we found that not all risks had been fully assessed or mitigated and people had been placed at risk. This included the use of a door wedge which would have increased the risk to people if a fire broke out at the home. However, at this inspection we found all risks in relation to people’s health, safety and welfare had been identified and action taken where appropriate. This included risks associated with bathing and the safe administration of medicines. Staffing levels were appropriate to meet the needs of the people using the service. Medicines were safely managed. There were systems in place to monitor incidents and accidents and learn from these.

At the last inspection we found that several areas of the home were in a state of disrepair. However at this inspection we found that the environment had been greatly improved. With several areas of the home being refurbished, which included a newly fitted kitchen, new soft furnishings have been purchased, all bedrooms have been re- decorated, carpets have been replaced throughout and new windows fitted on the first floor of the home. Also, several areas of the home had been re-carpeted and additional skylights have been fitted to provide more natural light into the home.

Staff were competent and knew the people they supported well. People’s care, health and cultural needs were identified so staff could meet these. People had their nutritional needs met. People were supported to maintain good health. Staff made referrals to health professionals when required. Staff worked within the principles of the Mental Capacity Act (MCA) 2005 and ensured people consented to their care.

People received care from staff who were kind and caring. People’s privacy and dignity was protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences. One relative said. “[name] loves living at Hillside. The staff are all very proficient and lovely. Its home from home.”

People took part in a range of group; one-to-one activities depending on their preferences and also had the opportunity to enjoy annual holidays away from their home. Information was displayed on how to make a complaint and in a pictorial format, that could be easily understood. Relatives also told us they knew how to complain.

People, visitors and staff told us the service was well managed and had an open and friendly culture. Staff said the service had a family atmosphere and they felt well-supported. The registered manager and staff worked in partnership with other agencies to ensure people got the care and support they needed. One staff member said, "I think the [registered manager] is excellent and gives every ounce of their energy and commitment to the people who live at Hillside as well as supporting all the staff very well.” They are one of us and make us feel valued and respected for the job we all do.”

Rating at last inspection: Requires Improvement (report published 16 May 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Watford and District Mencap Society – Hillside is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection – Watford and District Mencap Society – Hillside accommodates eight people who have a learning need or who live with Autism. The service is not registered to provide nursing care. At the time of this inspection there were six people living at the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People’s relatives told us that they were confident that people were safe living at Hillside.

Risks to people were appropriately assessed but guidelines in place failed to ensure the person’s health and welfare was protected and maintained at all times.

Staff had received training, support and development to enable them to carry out their role effectively. The service is required to update records in relation to meeting the requirements of the Deprivation of Liberty Safeguards (DoLs).People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice. People received appropriate support to maintain healthy nutrition and hydration.

People were treated with kindness by staff who respected their privacy and upheld their dignity. People’s relatives were encouraged to be involved with people’s lives where appropriate, to provide feedback on the service and their views were acted upon.

People received personalised care that met their individual needs. People were given appropriate support and encouragement to access meaningful activities and follow their individual interests.

People’s relatives told us they knew how to complain but had not had occasion to do so. They said they were confident they would be listened to if they wished to make a complaint.

Staff were aware of the risk of cross infection and used personal protective clothing to reduce the risk.

We found that although records were written in a positive and respectful way some records lacked detail and guidance.

The registered manager had created an open and inclusive atmosphere within the service. People’s relatives, staff and external health professionals were invited to contribute their views in relation to further developing the service.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with all said that they felt safe living at the home. People told us that they felt their privacy and dignity were respected. We saw evidence that risk assessments had been undertaken to help minimise the risk to people who lived at the home. The home had a complaints policy and procedure in place and people we spoke with all knew how they could make a complaint.

We saw that the home had a copy of Hertfordshire County Council safeguarding policy and procedure and staff had received training in how to safeguard people from abuse.

Is the service effective?

We looked at the care records of three people who lived at the home. We found these provided details of what support people needed. We noted that people were involved in the care planning process and that their opinions were taken into account and where possible acted upon.

People told us that they were happy with the care that they had received. We saw that staff had regular staff meetings during which they discussed issues relating to the home and people who used the service.

The provider had a clear protocol in place for dealing with Deprivation of Liberty safeguarding (DoLS). We saw evidence that staff had received training in the Mental Capacity Act (MCA) and in the DoLS.

Is the service caring?

People we spoke with all stated that staff were caring and helpful. One person told us that 'Staff are wonderful'. Other people we spoke with all spoke highly of the care and support they had received. Is the service responsive?

People we spoke with all told us that they did not have to wait long for staff to respond to their requests for assistance and that staff were never too busy to assist them to undertake tasks such as laundry or cleaning their bedrooms.

We saw evidence that people were supported to attend medical appointments and relatives where appropriate were always kept informed of any changes to their relatives care and treatment.

Is the service well-led?

The provider had a robust quality assurance system in place which sought the views of people who used the service. We saw evidence that people's views were listened to and, where possible, acted on.

Regular audits were undertaken to ensure that people received the best possible care and that the home was safe for them to reside in. A robust recruitment process was in place to ensure that staff were suitable for the role.

There was a registered manger in place and we found that the service was well-led. The leadership, management and governance of the organisation assure the delivery of high-quality person-centred care, in an open and fair culture.

People had a choice of suitable and nutritious food and were able to access food and drinks at any time. They were encouraged to help with meal preparation and shopping.

Quality assurance procedures were in place to monitor the effectiveness of the care and services provided.

We found that there were appropriate arrangements for the management of medicines.

We found that staff were supervised and trained appropriately to carry out their roles effectively.