Hillside House

We found the following examples of good practice.

There was prominent and clear infection prevention and control (IPC) signs which reminded everyone at the point of entry and throughout the home about procedures for IPC.

We observed staff correctly wearing personal protective equipment (PPE). The service was very clean throughout. The registered manager completed daily visual checks to ensure everyone was wearing appropriate PPE.

The home was accessing regular testing for both staff and residents. All residents and staff had received both COVID-19 vaccinations.

Risks in relation to visitors had been assessed. People and relatives were actively encouraged to visit the home as well as skype and phone calls.

People accessed the community and were aware of why they wore masks. One person said, “Yes I wear it all the time it’s safe doing this.” They also told us of how the staff supported their wellbeing around accessing the garden and been actively involved in activities in and out of the home.

Hillside House is a residential care home providing personal care and support for up to eight people with a learning disability and/or mental health needs. Accommodation is provided over two floors in an adapted detached house located in the Leeds suburb of Headingley. At the time of the inspection four people were using the service.

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. This ensures that people who use the service can live as full a life as possible. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. Overall people using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them although some improvements were needed to care planning, evidencing the effectiveness of the service and staff training.

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

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible although documentation needed improving to demonstrate that decisions had consistently been made in people’s best interests. We made a recommendation to ensure the service improves documentation relating to capacity assessments and best interests processes.

Overall the service applied the principles and values of Registering the Right Support and other best practice guidance. The layout of the building promoted people’s control and independence. More robust systems to set and evaluate people's goals had recently been introduced and this would help the service to robustly measure people’s progress and the effectiveness of the service over time.

Some improvements were needed to medicines management processes to ensure that medicines were consistently managed in a safe way. Overall, risks to people’s health and safety were assessed and appropriately mitigated. There were enough staff to ensure people received their required care and support. Staff were recruited safely.

People and relatives provided mixed feedback about the effectiveness of the service, we saw improvements were being made to help improve people’s experiences. Staff training was not consistently up-to-date, we saw a plan was in place to address this. People’s healthcare needs were assessed although in a number of cases more information was needed on how staff should support people’s healthcare needs.

Staff were kind and caring and treated people well. People had developed good relationships with staff, although staff turnover had been a barrier to the development of long-lasting relationships over time. People’s independence was promoted and a new system to robustly review people’s goals and objectives had been introduced.

People’s care needs were assessed and in most cases care plans were appropriate and person centred. A system was in place to log, investigate and respond to complaints. People received a range of activities and social opportunities and this was to be monitored more robustly going forward.

We saw improvements were being made by the new manager and they had introduced a new staff team who all felt well supported and were clear about their roles and responsibilities. Audits and checks were in place although some of these needed to be more robust to ensure a high performing service.

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 requires improvement (published 31 July 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. At this inspection although improvements had been made in some areas, this was not consistently the case and the provider was still in breach of two regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to staff training and governance of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet or hold a video-conference with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hillside House provides accommodation for people living with a learning disability or mental health condition. The home has a mix of small flats and ensuite bedrooms with communal kitchen/diner and lounge areas. The service is registered to support up to eight people. At the time of the inspection six people were living at the home.

The service had been developed with regard to the principles and values that underpin Registering the Right Support and other best practice guidance. This 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. At the time of the inspection people using the service did not always receive planned and co-ordinated person-centred support that met all the Registering the Right Support principles, although staff worked hard to achieve as much of the guidance as possible.

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

Relatives and professionals felt people living at the home were kept safe, although risk assessments had not been thoroughly undertaken and medicines were not always managed effectively.

There was some evidence to show people’s needs had been assessed but it was not always robust. Professionals and relatives felt staff were caring but needed improved knowledge to support people. Staff had access to a range of formal training. People were supported to attend health appointments, although relatives felt staff could take a more encouraging approach to supporting wellbeing.

Relatives felt staff were caring in their approach but said they could sometimes be more proactive in supporting people. This view was also shared by professionals. They told us staff supported people in a way that maintained their dignity.

Care plans contained a range of detail, although professionals felt they could better reflect advice given to the service. Reviews of care were often limited and there was little evidence to suggest people had been actively involved in these reviews. Easy read information was available, although this did not extend to care plans and review documents.

The service did not have a registered manager in place. The service was not robustly overseen or managed consistently. Quality reviews and audits were not followed up or improvements did not take place in a timely manner.

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.

The service didn’t always consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons limited inclusion and participation in decision making e.g. Care records were not presented in a format that made information accessible and there was limited evidence to suggest people were actively involved in reviews.

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 3 December 2016).

At this inspection improvement had not been sustained and the provider is in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe. effective, caring, responsive 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.

The provider has taken some action to mitigate the immediate risk to people who used the service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hillside House on our website at www.cqc.org.uk

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.

Hillside House provides accommodation for persons who require nursing or personal care, learning disabilities or mental health conditions, adults under 65. The home is situated in the Headingley area of Leeds and is close to local amenities. The home has a mix of small flats and bedrooms. There is a communal kitchen/diner and lounge area. There is a small car park to the rear of the home and a garden to the front.

At the time of our inspection there were seven people using the service, and 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.

We found medicines were managed safely. Medicines were stored securely, records were fully completed and people told us they got their medicines when they were needed.

Staff had received training in safeguarding and understood when and how to report any concerns. People told us they felt safe using the service and we saw risks associated with people’s care, support and social activities were effectively documented.

Recruitment of staff was safe, and followed good practice in making background checks in order to ensure staff were not barred from working with vulnerable people. Staff were present in the service in sufficient numbers.

We saw the building was well maintained and service contracts were in place to ensure major fittings such as electrical systems were regularly checked. Staff had taken part in fire drills and were confident they would know what to do in the event of a fire.

Care plans contained decision specific assessments of people’s capacity, in line with the requirements of the Mental Capacity Act (MCA). The provider had applied for Deprivation of Liberty Safeguards (DoLS) where needed, and we saw plans in place to comply with any conditions attached to these.

We found staff received a thorough induction, and there was a rolling programme of training in place. Supervision meetings were held monthly and staff had an annual appraisal.

People received appropriate support with nutrition and hydration. We saw the provider had responded to one person’s elevated risk in this area, and staff were able to tell us how the person received appropriate support to minimise this risk. Staff told us how they promoted healthier eating options. We saw people were supported to access health and social care professionals when needed.

We saw people had a good relationship with staff, and staff told us ways in which they ensured people’s dignity, privacy and rights were respected. Key workers worked closely with people to help build a rapport, and supported people to contribute to their care plans.

We saw care plan information was available in different formats appropriate to the needs and preferences of people who used the service.

Care plans contained a large amount of detail specific to each person, showing how their care and support should be delivered according to their preferences.

People who used the service said they would be able to raise any concerns with staff. There were policies and procedures in place to ensure concerns and complaints were addressed appropriately. The provider held regular meetings with people to ask for suggestions and share information.

People planned activities which reflected how they wanted to spend their time. We saw records which showed these activities took place.

Staff gave good feedback about leadership in the service, and said they worked well together as a team. Staff expressed pride in their work and told us they understood the provider’s philosophy for the service. There were regular team meetings at which open discussion was welcome.

There were systems in place to ensure accidents and incidents were logged and reported as required. The home manager and registered manager undertook regular audits to monitor and drive improvement in the service. There were plans in place to undertake a survey with people who used the service.