The Care Quality Commission
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Archived: Hillcroft Nursing Home

Overall: Requires improvement read more about inspection ratings

135 High Street, Wordsley, Stourbridge, West Midlands, DY8 5QS (01384) 271317

Provided and run by:
JJB Patel & KJ Patel

Important: The provider of this service changed. See new profile

All Inspections

6 July 2015

During a routine inspection

This inspection took place on 6 July 2015 and was unannounced. At the last inspection in April 2014 we found that the provider was meeting the regulations that we assessed. The home provides accommodation and nursing care for up to 28 people, some of who were living with dementia. On the day of our inspection there 24 people living at the home.

A registered manager is required to manage this service. At the time of our inspection there were interim management arrangements in place. The provider has had interim management arrangements in place since November 2013. The current manager had been appointed in June 2014 but had not been registered with the Care Quality Commission to manage the service. 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 and their relatives told us that they felt safe. Staff had been trained and knew what to do to keep people safe from the risk of harm.

People who lived in the home and their relatives told us that they were happy with the care provided. Risks to people’s health and care had been identified and staff knew how to help reduce risks to people from falling or pressure sores.

We saw that appropriate pre-employment checks had been carried out for new members of staff so that as far as possible staff with the appropriate skills and experience were employed. People said there were enough staff to meet their needs. Our observations showed that a number of people were cared for in bed which impacted on the capacity of staff to spend meaningful time with them.

The staff told us how they had been or were being supported to achieve their vocational qualifications and they valued this opportunity. The staff told us the new manager was very approachable and responsive to requests for training.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff understood the need to ask people for their consent before carrying out care tasks. We saw the provider had followed the correct procedures where people’s liberty needed to be restricted for their safety.

People were complimentary about the choice of foods available to them. People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. People had access to healthcare professionals when this was required. The arrangements in place for people’s medicines meant people received their medicines when they needed them.

We saw staff talking and listening to people in a caring and respectful manner. We observed that staff were courteous and spoke warmly to and about the people they cared for. They all seemed to know the people well. There was an emphasis on protecting people’s dignity.

People had been involved in identifying their care needs and staff knew how to support people’s needs. Care plans provided guidance to staff as to how to do this appropriately. Staff demonstrated an understanding of people’s individual needs and preferences and knew how people communicated their needs. People told us they enjoyed the opportunities provided in the home such as arts and crafts. They also enjoyed trips out for lunch and shopping.

People and relatives told us that they were able to raise their concerns or complaints and were confident that they were listened to.

People who used the service, relatives and staff told us the manager was approachable, listened and was supportive to them. There were systems in place to monitor and improve the quality of the service provided. However these were not always effective. The monitoring of risks to people’s health was not consistent and the nurses did not have a full clinical overview of these risks.

10 September 2014

During an inspection looking at part of the service

We carried out an inspection on the 8 and 9 April 2014 and found that the provider was not meeting standards relating to care and welfare, safety, availability and suitability of equipment, staffing, supporting workers and assessing and monitoring the quality of service provision. The provider wrote to us and told us what actions they were going to take to improve. During this inspection, we looked to see what actions had been taken.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with nine people using the service, seven visiting relatives, four care staff, the activities worker, a nurse and the acting manager. We looked at five people's care records and other records related to the running of the service.

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

Is the service safe?

We found improvements had been made in the delivery of care to people. This resulted in people receiving personal care at the times they needed it to meet their personal hygiene needs.

Care plans and risk assessments had been improved so that staff had the information they needed to care for people safely. For example where people were at risk of choking plans were in place to guide staff as to their dietary requirements and safe seating.

Staffing had been re-arranged so that a member of staff was allocated to the first floor. This meant that people cared for in their bed had access to staff to meet their needs. Action had been taken to ensure people could summon assistance from their bedrooms. Where people were assessed as unable to do so staff carried out hourly checks to ensure people were safe and comfortable. One person said, 'I don't need the bell really ' I am capable and if I need something, I wait because I know they are coming'. A visiting relative told us, 'X can't use the bell but they always have someone monitoring them all the time'.

We saw staff used equipment to transfer people safely and that guidance for checking the safety of equipment was available and known by staff. We saw that when people were assisted with the use of equipment staff talked to them about the process to ensure they felt safe.

We monitor the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. We saw that people's care records did include information about their mental capacity and the involvement of other professionals in determining this was clear. We heard that a DoLS application had been submitted for one person and staff were aware why this was considered. This should ensure that potential risks to the person are the least restrictive. The training record showed that not all of the staff had training to help promote people's human rights and their liberty.

Is the service effective?

People's health and care needs were assessed and included visiting health professionals. We heard people had been involved in developing their care plans. One person said, 'They offer me options and let me choose for myself'. People also told us they had attended reviews concerning their care. A visiting relative said, 'We attended a review meeting to discuss the changes'. We saw care plans had been reviewed regularly and provided staff with the guidance to meet people's needs.

People at risk of falling or sliding from chairs had plans in place to reduce this risk and appropriate seating had been purchased.

The acting manager had re-established a staff supervision programme to manage the performance of staff and identify staff training needs to ensure the on-going development of staff skills.

Is the service caring?

People spoke positively about staff, 'They are wonderful carers', and a relative told us, 'Always speak in a caring manner'. We saw staff were attentive, patient and encouraged people.

Is the service responsive?

We saw that the availability of staff had improved because staff had been allocated to the first floor to ensure people cared for in bed had their needs met. Staff we spoke with told us their improved availability meant they could respond to people's needs. One member of staff told us, 'It's much better now, we are not rushing around and we know who is allocated to do what'. This meant that staff responses to people's needs had improved.

Is the service well-led?

The service has had three different managers in the last year this had resulted in a period of transition and uncertainty. The current manager is an acting manager who is applying to register as the registered manager. Feedback from people using the service, relatives and staff indicate that improvements have been made and that they felt comfortable approaching the acting manager.

People using the service and their relatives told us of their growing positive experiences when raising concerns. One visiting relative said, 'The new manager is great, she will answer all questions ' she never fobbed us off!' This meant that people and their representatives felt their concerns were taken into account.

Staff meetings, supervisions and group training sessions had been re-established to ensure staff knew how to support people safely and consistently.

The service has a quality assurance system, records seen by us showed that the shortfalls identified at our previous inspection in April 2014 had been addressed. Staff told us their views were listened to, for example one told us, 'She gets things done, and she's always at handovers, knows the residents and is keen to make changes'. The acting manager told us they had identified from their audits areas they could improve on further, for example daily care records. We also saw they had introduced a written 'spot check' regarding staff practices, appearance and attitude. This meant they were striving to make improvements.

8, 9 April 2014

During a routine inspection

We completed a scheduled inspection to gather evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We found that policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards were in place. At the time of our inspection no applications to deprive people of their liberty had been made.

Procedures for reporting safeguarding concerns were in place. However we found an alert did not include all the relevant information when reported to the local authority. This could affect how the local authority would make a decision on the investigation. The operational manager told us they would address this matter.

There was evidence that learning from events such as accidents and incidents were not fully established to help reduce the risks to people.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events in relation to minimising accidents and injuries.

Risk management plans were not up-to-date and staff were not aware of people's changed needs. People were put at unnecessary risk when seated, when eating or transferred with equipment.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to identifying and responding to risks to people's safety when eating, being transferred or seated..

Is the service effective?

People's health and care needs were assessed but the lack of detail and failure to follow risk assessments meant people did not receive effective care to meet their needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and ensuring staff provide the care they need.

Is the service caring?

We spoke with eleven people who used the service and asked them for their opinions about the staff that supported them. We received some positive feedback from people who told us, 'Staff are nice and friendly'. Everybody we spoke with told us that staff were 'very busy'. We saw that staff failed to recognise or check the safety or basic comfort needs of people.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing sufficient numbers of staff to meet people's needs.

We overheard derogatory comments from one staff member which did not demonstrate a caring culture.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to managing staff performance.

People's preferences, interests and diverse needs had not been fully recorded so that care and support could be provided in accordance their wishes.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people's preferences, interests and diverse needs are captured and planned for.

Is the service responsive?

Staff were observed to be unaware of people at times during the day. This meant they did not respond to people's needs as they should have. One person told us, 'I don't like to complain as staff are busy'. We saw staff worked hard but it was task based. Staff told us and we saw they were rushed and this meant people did not always get the care or checks they needed to keep them well.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing enough staff to ensure people receive the care or checks they need to keep them well.

Is the service well-led?

The service had an acting manager in place who was not yet registered with CQC. Immediately following the inspection we were informed the acting manager had left the service. Post inspection the operational manager informed us about interim management cover but this did not include week ends.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation management cover for the service.

Staff reported low morale. We found that staff did not have regular opportunities to receive supervision or get support and areas of their practice evidenced they were not being managed effectively.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation providing staff with regular recorded supervision and support.

The service had a quality assurance system. However this did not identify a number of issues related to people's care and safety. As a result the quality of the service was not improving in relation to care and safety of people.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation providing and effective quality assurance system.

25 June 2013

During a routine inspection

We spoke with 10 of the 27 people who lived at the home, the home manager, the operational manager, a nurse, a senior care staff and three care staff. We looked to see how nine people who were nursed in bed and who were unable to tell us their experiences were cared for. One person said, 'I depend on staff to come to me in my bedroom and they do make time, they are caring and patient'.

Appropriate action was taken when people lacked capacity to make decisions.

People had care plans that provided guidance to staff as to how their health needs, personal care needs and risks should be managed.

Arrangements were in place to ensure appropriate information was shared with external professionals so that the immediate needs of people were known, should they have to go to hospital.

People received their medicines as prescribed although written guidance was needed to ensure consistency in the administration of specific medicines.

We found that staff members were complimentary about the support they had to do their job and people who lived there were complimentary about staff ability and attitude. One person living there said, "The staff are very kind, they can be busy but they are friendly and do look after me well'.

During a check to make sure that the improvements required had been made

We found that improvements had been made in the way that people received their nutritional supplements. This was because they had them at the times they were prescribed and following their meal.

We found that improvements had been made in the way that people who required their drinks to be thickened to help them swallow safely, had been improved.

We found that improvements had been made in facilitating people's choice of food and their or ability to self serve. Improvements had been made so as to avoid delays in serving people their meals.

17 October 2012

During a routine inspection

Our inspection was unannounced no one knew we would be visiting. There were 22 people living there on the day of our inspection. We spoke with four people and four staff to find out their views about the service provided. People told us positive things about the service that they received. One person told us "The staff are kind, and work really hard, we are well looked after, although we might have to wait a bit'.

We saw that staff treated people with respect and dignity. Staff interacted positively with people but there were some occasions where people's choice was compromised, namely through lengthy waits for meals and assistance.

People's needs had been assessed by a range of health professionals which meant their health care needs had been monitored and met.

People who needed dietary supplements were not being given these in the recommended way which could affect their health and wellbeing. There was little evidence that everyone had choices regarding what they ate and drank.

Staff knew how to safeguard people from harm and felt confident that if they had to report any abuse, action would be taken to protect people.

There were enough care and nursing staff to meet people's needs. Staff knew how to meet people's needs, and understood the needs of people living with dementia.

People's complaints were listened to and resolved to their satisfaction.

26 July 2011

During an inspection looking at part of the service

We spoke to six people who live at the home and three relatives. People told us that they were happy living at the home. They said:

" Its my home and I am happy here".

People told us that staff were kind and caring and that they gave them the care they needed.

People told us about improvements that have been made since the new manager came to the home. They told us that the manager was approachable and that:

"She sorts things".

People told us about how much they enjoyed spending time in the garden and appreciated the pots of flowers that people had grown for the home. A relative told us:

"The garden is lovely my relative loves the time they spend there and are so proud of the vegetables they have produced". They told us that they were looking forward to the new activity organiser starting employment at the home as more activities would be available for them to do.

28 January and 1 February 2011

During a routine inspection

People we spoke to said that staff respected their privacy and always knocked when they entered their bedroom or bathroom. One person we spoke to said:

"Staff always ask if it is convenient to attend to my wife. They know I like to be private."

People told us that they were generally satisfied with the care they received. They told us:

"He's looked after well, I have no complaints"

"We are generally very pleased and she is so much better than she was before she came here",

"They do look after her but there are occasions when they do not do everything."

"I only really need them to call the doctor for me, I know that if I needed more help they would give it to me."

People told us that the food was good and that they always had a choice, One person said :

"The food is very good and I know its all home cooked on the premises."

"The records are so much better since the inspection, I can see what she's had to eat and how much she's been awake."

"Yes I feel safe here. When I walk back through the door I breathe a sigh of relief and think I'm home."

"Yes I'm safe here, they look after us."

People were very positive about staff at the home. They told us:

"Staff are nice, there is no one I have had words with," and

"the staff are very friendly and helpful, my mum seems to like them too."

People told us about improvements that have been made since the new manager came to the home. They told us:

"Things are improving, the manager is sorting things but it will take time.'

14 December 2010

During an inspection in response to concerns

We spoke to people who live at Hillcroft Nursing Home and some of their relatives. People told us "staff are good, they do what they can." Visitors commented that staff were helpful and friendly and they were offered drinks at this home, which had not happened at a previous home.

One person told us, "like it here, like staff, most of them." "biggest complaint is timing for women to get to the toilet, often have to wait 45 minutes especially at meal times, and people sometimes want to use the toilet even though its meal time. Staff say they can't deal with food and take people to the toilet. They could organise things better." "Also staffing levels aren't right, the managers say there has to be one staff 'on the floor' at all times but some people need two staff to help them, so they still have to wait."

A person told us they had a disturbed night and were unable to make their buzzer during the night and could not attract the staff's attention, so they used their mobile phone to ring the home to call for assistance from the night staff.

We were told by someone living at the home, "information is not passed along the line."

Another person told us that they had their wound dressed about every three days but often had to ask the nurses to make sure the dressing was changed when needed. The person also told us they had pain but were not asked about pain relief. We saw that the person was given mild pain relieving medication but this may not be entirely effective for their complex conditions.

We spoke to a relative who commented, "the home had a 'strange atmosphere' one afternoon recently, the office was locked, we had not seen the nurse who was on duty before, there were two agency care staff just wandering about, not going to people, while another member of the home's staff was rushing about trying to attend to everyone, the home seemed short of staff that day and there were people needing help upstairs."

It was difficult to speak to some people due to their communication difficulties and their care needs. We saw good interaction between staff and people in the lounge and dining area. People generally smiled when asked if they were comfortable and content.

We spoke to members of staff and they told us they felt generally things were improving. One person told us, "things are getting better now there are five carers in the morning and four in the afternoons". They said the previous new manager "did wonders with d'cor and care for people, then they brought in consultants who cut care staff to three, even in the mornings, which made caring for people hard. We struggled for about three weeks, although we tried to tell them they wouldn't listen but its better again now."

We were told "there is a lot of agency staff, some are good and helpful, others not so good, some just stand about." Staff told us that they were aware that the company were trying to recruit more nurses and care staff.

Staff we spoken to told us that they had not had formal supervision "for a long time" and no annual appraisals. They told us they had access to training and were generally about to attend training provided through the Local Authority.

We spoke to one person who had not received safeguarding training. They told us that they would report any abuse to us but they were not aware that the Local Authority were the lead agency or that concerns and allegations of abuse of vulnerable adults should be reported to contacts there. They said they had not seen the multi-agency procedure 'Safeguard and Protect.' We spoke to the operations manager, currently responsible for the running of the home. She found the 'Safeguard and Protect' procedure in a files cupboard in the dining area. She acknowledged that the staff may not be aware of its contents; and there was no written evidence, such as staff signatures or minutes of meetings, to show it had been discussed with each member of staff. She told us that the business support manager was in the process of obtaining safeguarding leaflets from the Local Authority but these were not at the home yet.

A member of staff told us they felt communication was improving, and gave the example of a recent staff meeting, where the previous responsive review report was discussed. Another person told us communications within the home were 'ok' and that they could go to the operations manager but 'it was difficult without a permanent manager.'

We spoke a contract monitoring officer from the Commissioning section of the Local Authority who was visiting the home. We were told that although there were some improvements, for example to the cleanliness of the home, the Local Authority remained concerned about the standards of care and safety of people at the home. They had also noted a high dependency on agency staff, which meant there was a lack of consistency to meet people's needs. For these reasons contract monitoring officers were visiting the home on a daily basis to check on staffing levels and people's safety.

29 November 2010 and 5 September 2012

During an inspection in response to concerns

We spoke to people who live at Hillcroft Nursing Home and some of their relatives. People told us that 'the care staff are nice but things are not right, you never see the same people, there seems to be no proper management, the staff always seem busy and it's hard to ask for things, and tell them things, you get into trouble'. When asked further about what the person meant about getting into trouble he said that he got into trouble.

It was difficult to speak to some people due to their communication difficulties and their care needs. Some people were able to express there satisfaction by nodding their head and smiling.

One relative said that there was a lack of activities for service users and the management of the home is unsettled. They also said that they felt the provider was "tight with money and would not buy things for the home". The relative also said the care staff are 'lovely girls, and they do care'.

We spoke to a family who told us that their relative had been transferred from a residential home 12 months ago because the person's health had deteriorated and needed nursing care. They told us that they were very unhappy with the care provided at this home. They commented, "X has been here 12 months but has spent majority of that time in hospital." We were told that they were assurances by the registered manager, who had recently left the home that specialist monitoring equipment in place at the residential home would be in place before their relative came to Hillcroft Nursing Home. The family stated that their relative had fallen twice and needed hospital treatment for the serious injuries. They then found out that the equipment was not in place and a 'baby monitor' was being used to prevent falls. They were told that the Provider would not pay for the appropriate specialist equipment. The 'baby monitor' was not appropriate equipment for an adult and was not effective to make sure the person was safe from risks of harm.

A family told us they had to prompt staff to seek medical advice when they noticed their relative was unwell; this also resulted in a recent hospital admission. They also told us they were unhappy that they had not had an explanation for an 'unexplained injury'.

A family stated that staff did not understand or meet their relative's preferences, for example times to get up in the morning. They pointed out that it was after 10:00 am when the staff 'wheeled' their relative into the lounge during our visit. They had made the staff aware that X liked to get up before 9:00am. They also told us that their relative was left to sit in the lounge and sleep. This meant the person did not sleep well at night. They commented, "X used to be able to walk and go on outings with us but can't go out now because of the walking frame and can't get into the car or go up and down steps."

Other comments were that the activities person had left allegedly because the previous manager had stopped activities. "People are bored, just sitting around all day."

We confirmed that the activity organiser had left and the home did not currently have any formal arrangements for activities. We saw a care assistant throwing a large 'lightweight ball' to people in the lounge during the visit. However we did not see any other evidence of social stimulation to suit each person.

We spoke to members of staff and asked them about the current environment in the home. They told us that they were worked really hard, that they did not get breaks; that there was no leadership and the staff were just left to sort out their own duties. Tasks were allocated but no one followed anything up. They said they were unhappy with the current management of the home.

We spoke to one member of staff who was generally happy at the home and made positive comments about the people living at the home and the way staff have supported each other, "with matron leaving we all had to pull together to get through". We were also told that when the management consultants 'cut staffing from five care staff to three it was hard'. We were told, "we did our best but people often had to wait".

Two staff who had given notice to leave the home's employ told us that they were very unhappy about the way the home was run and they both told us that what they witnessed had affected their health.

One care assistant who had not previously worked in a care home environment stated, "it's been a horrendous experience", and would not be working in a care role again.

We were told that there was no organisation, equipment was not always available, there were ongoing problems with laundry and on the morning of the visit there were no clean towels at 07:30am. This resulted in people not being cared for appropriately. We were told of people being washed and dressed and brought downstairs into the dinning area for their breakfast until late morning. We saw an example where someone was wheeled into the dining area at 11:30am for breakfast.

Staff told us that lunch would be served at 12:30 and it was often the case that people would not eat their mid-day meal because of late breakfasts.