Hill House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Changes to people’s support needs were not always documented clearly in their care plans and in some cases there were multiple care plans regarding a persons support on file mean leading to a risk of staff supporting them unsafely. Care plans and assessments did not focus on people’s individual preferences, likes and dislikes making it difficult for staff to support people in a person-centred way. Staff were not competent to raise concerns with other services if people needed support. Information about how best to support people based on feedback from other services was not always shared with the staff team or used to update people’s care plans. People were not being supported in line with best practice such as being supported to live with dementia or being supported to communicate their needs effectively. Staff were not competent or knowledgeable to follow people’s care plans and risk assessments in relation to supporting them to stay healthy and live healthy lives. They were not making sure people were eating and drinking in line with their care plans, nor were they competent to support people with support needs such as moving and handling. There was limited evidence of people being supported to achieve their desired outcomes. These were not discussed with people in a meaningful way and staff did not prioritise conversing with people in a meaningful way, limiting the opportunities for positive outcomes to be discussed and achieved with people. Staff were not competent in supporting people to maintain and achieve outcomes in relation to being supported safely in relation to upkeep of the building or reporting if people were not being supported in line with their assessed risks. However, people and relatives mostly told us they were happy with their support.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives were not being supported to discuss their needs on a regular basis or in a meaningful way. One person said, ‘‘I have never discussed how things are going. The staff just help me and I go with the flow.’’ A relative told us, ‘‘We had a chat when [family member] started living here but nothing since then.’’ People and relatives were not involved in reviews of care plans to make sure people’s needs were reassessed and current. One person said, ‘‘I would like to see the care records but have not been asked about this.’’ A relative told us, ‘‘[Staff] could be doing anything and I would not know about it.’’ People had their needs assessed when they started using the service, however these assessments did not focus on their preferences, likes and dislikes.

Staff were unable to tell us how they would find out about people’s needs if they changed. Staff told us they did not notify the management team if people’s needs changed as the records would be checked to show the management team this. However, these were not being checked by the management team. Staff were not being supported to have meetings or supervisions to discuss people’s changing needs. The home manager told us how they completed assessments of people’s needs before they started using the service. They also spoke about people being involved to feed back about their care if they were the ‘resident of the day’. However, there was no evidence the feedback collected from people was meaningful or recorded in their care plans.

Processes were not in place to effectively reassess peoples needs when they changed. People’s care plans were either not updated in a timely manner or old care plans were left in their file in front of new support plans. This meant staff may support people unsafely. There was no evidence to show how people living with different communication needs or relatives of people were being supported to discuss changes in support needs. Assessments and care plans did not contain detailed information about people’s life histories, preferences likes or dislikes, limiting the opportunities for staff to support people in a person centred way.

People were not being supported in line with best practice in areas such as supporting people living with dementia. For example, there was no signage or decoration at the service to help people living with dementia to orientate and people were not being supported with information in accessible information such as pictures. People were not being supported in a person centred way to identify their likes and interests and be supported with these. People and relatives told us staff did not support them in line with what was important to them. One person said, ‘‘[Staff] do not really know what I like. They do what is easiest at the time.’’ A relative explained, ‘‘I was disappointed when we bought [activity] in for [family member] to try but the staff never really helped them take part in this. It is something they used to enjoy doing.’’

The management team were not keeping up to date with best practice. They were unable to tell us how they researched and kept up to date with current guidance and legislation. Best practice was not being discussed with staff members in team meetings or supervisions. The way the service was being managed and the poor experiences people were having as discussed through this report shows this. Staff were unable to tell us about how to support people living with conditions such as dementia. They did not know what accessible information was or how to communicate with people who found it difficult to communicate verbally. Staff told us they did not speak with people about what they would like to do on a day to day basis. One staff member said, ‘‘It is pointless asking people what they want as we know they like things a certain way.’’

Processes were not in place to deliver evidence-based care and treatment. Audits were not being completed in this area to see if improvements could be made. There were limited opportunities for people to talk about their support and actively feed into this discussion. There was no evidence the management team attended meetings or forums to discuss best practice. There was no evidence to show the management team had connected with partners such as the local authority to help make sure they were following best practice guidance and legislation. There was limited or no evidence to show people and relatives were involved in discussing what was important to them or their family member.

People told us they were supported to see other services if they needed this support. One person said, ‘‘I think the staff would make sure I saw who I needed to see.’’ A relative explained how staff had contacted a professional when their family member needed more support with eating and drinking. However, despite what people told us, information from health professionals and appointments were not always recorded in people’s care plans. Information was also not shared with staff members in meetings or supervisions to make sure they were aware of people’s new support needs. This meant there was a potential for staff to support people unsafely and not in line with advice from health professionals.

Staff told us they would wait for senior staff or the management team to make referrals to health professionals if people needed this support. They were unable to tell us who they would contact in the case of people needing support such as a GP. Staff were not reporting changes to people’s health needs, such as a person not eating or drinking enough in line with their assessed needs, to the management team so they could be referred to health professionals as necessary.

Professionals told us the service contacted them if people needed support. However discussions or advice from professionals was not recorded in people’s care plans or shared with the staff team in meetings or supervisions

Processes were not in place to record visits or advice from health care professionals in people’s care plans. Staff recorded if people saw professionals in their daily records, but these were not being reviewed by the management team to see if any updates needed to be made to people’s care plans. Staff were not competent in noticing changes in people’s support needs which may indicate they needed further support. The management team did not have processes in place to discuss this with staff and help them improve their practice.

People told us they were supported to live healthily, for example in relation to having food to eat and drink when they wanted it. One person said, ‘‘I always have so much to eat at meal times but there is always fresh fruit and vegetables on hand if you want them.’’ A relative explained that staff had contacted a health professional to discuss how best to support their family member to walk and maintain their mobility. However, people were at risk of not being supported to live healthy lives in line with their support needs as discussed in the rest of this quality statement.

Staff said they would support people to eat and drink to stay healthy. However, this was not the case and staff were not reporting concerns where people did not eat or drink enough. Staff were not supporting people to move about regularly or to be engaged in meaningful interactions or past times throughout the day. This increased the risk of people’s mental health and wellbeing being negatively impacted. The management team were not checking care plans and records to ensure people were being supported to stay healthy in line with their support needs. The way the building was kept and IPC concerns discussed in the safe key question were not being picked up as issues by the management team leading to a high risk of people not being supported to live healthy lives.

Processes were not in place to help people live healthy lives. Audits were not being completed in areas such as the environment people were living in, care records being in line with support needs, or how frequently people were being supported to exercise or take part in meaningful past times. There was no evidence people’s health support needs had been discussed with them to help them understand how to stay healthy or why this was important.

People and their relatives told us they were not involved in discussions relating to them identifying or achieving their outcomes. One person said, ‘‘[Staff] ask me if I am OK or if I need anything, but we don’t really talk about what I would like to do.’’ A relative said, ‘‘There used to be things going on at the service and we would be asked if there was anything we wanted to happen for [family member] but this does not happen anymore. As people were not being supported to discuss this in a meaningful way, it limited the opportunities for them to identify and achieve their individual outcomes. Staff did not speak with people throughout the day apart from to support them with immediate support needs, further limiting the opportunities to do this.

Staff were unable to talk with us about what people might like to do with their time or what they were doing to support people to follow their interests and achieve their outcomes. Staff did not speak with people about this throughout the day. Staff were not being supported to discuss this area in meetings or supervisions. The management team did not prioritise identifying what outcomes people might like to achieve or put plans in place to support them to achieve these. There was no evidence of this in people’s care and support plans.

Processes were not in place to support people to discuss and put plans in place to achieve their desired outcomes. There were no audits being completed to monitor if people were being supported to do this. There was no evidence this was discussed with people or their relatives. The way the building was kept and IPC concerns discussed in the safe key question were not being picked up as issues by the management team leading to a high risk of people not being supported to achieve their desired outcomes.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.