Wall Hill Care Home Limited

Updated 21 December 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Wall Hill Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Wall Hill Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

During the inspection, we spoke with 7 people who lived at the home, 1 relative and a friend. We spoke with 5 staff including the deputy manager, care staff and kitchen staff. We also spoke with the registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We looked at 6 people’s care records and 5 people’s medicine administration records (MARs). We also viewed 5 staff files and documentation related to the governance of the service.

The provider sent us further documentation we had requested following the site visit including training records and evidence of actions they had taken since the inspection.

Updated 21 December 2023

About the service

Wall Hill Care Home is a residential care home providing regulated activity to up to 35 people. The service provides support to people living with dementia and physical disabilities. At the time of our inspection there were 27 people using the service.

Wall Hill Care Home accommodates people in one adapted building across 2 floors. There are 2 communal lounges and a dining room that people can access.

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

People were not always safeguarded from abuse and avoidable harm. Where safeguarding concerns were identified, they had not always been escalated to the local authority as legally required. Medicines were not always administered safely. For example, 1 person had received an overdose, but it had not been identified by quality checks. The provider did not always learn lessons when things went wrong.

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. However, the policies and systems in the service did not always support this practice as they failed to identify where Deprivation of Liberty Safeguards (DoLS) authorisations were not up to date. The provider addressed this immediately following the inspection and DoLS authorisations have now all been applied for.

The registered manager was not always clear about their role and responsibilities. For example, the provider did not always submit statutory notifications to CQC in line with their regulatory requirements. Audits were not always effective in checking the quality of the service. For example, checks did not identify where statutory notifications and safeguarding referrals had not been submitted. Quality checks of medicines did not always identify medicines errors or where stock counts were high. Systems were not in place to analyse accidents and incidents to enable the provider to identify trends. Staff were given the opportunity to provide feedback through surveys and team meetings, but their feedback was not always acted on quickly. The nominated individual had identified training opportunities, but further delegation was needed to ensure sufficient daily oversight of the home.

People told us they felt safe. Staff knew the types of abuse and understood how to share safeguarding concerns. Controlled drugs were stored and administered safely. Risk assessments were in place to guide staff how to meet people’s needs safely and mitigate risk to them. Staff were knowledgeable about how to manage people’s risks. People were supported by a sufficient number of staff to meet their needs safely and did not have to wait for their care. The home was clean and staff wore Personal Protective Equipment (PPE) in line with current guidance.

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 24 June 2022).

Why we inspected

The inspection was prompted in part due to concerns received about risk management and the governance of the service. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to medicines, safeguarding and the governance of the home at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.