Archived: Hillfield

Updated 25 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 2 and 3 October 2017 and was unannounced on the first day which meant the provider did not know that we were going to inspect. The inspection was carried out by one inspector, one bank inspector, one specialist advisor and one expert by experience. A specialist advisor is a person who specialises in a particular area of health and social care, for example medicines, moving and handling or quality assurance. This specialist advisor was a tissue viability nurse specialist. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We reviewed information we held about the service, including the notifications we had received from the provider about deaths, safeguarding incidents, deprivation of liberty applications and serious injuries. We also contacted the local authority commissioners and safeguarding teams for the service, the local Healthwatch and the clinical commissioning group (CCG). Healthwatch is an independent consumer champion which gathers and represents the views of the public about health and social care services. We used their comments to support our planning of the inspection.

On the first day of our inspection we spoke with two visiting GP’s and a community nurse who was visiting the service.

We placed a poster in the reception area of the service to alert visitors to our inspection and invited them to contact us to offer their experiences of the service.

During this inspection we carried out observations using the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with ten people who used the service and seven family members and friends. We also spoke with the regional manager, manager, deputy manager, two nurses, one senior member of care staff, the cook, activity coordinator, maintenance person and six members of care staff. We observed how staff interacted with people and looked at a range of records which included the care records for nine people who used the service, medicines records for 21 people, five staff personnel files, health and safety information and other documents related to the management of the home.

Updated 25 November 2017

The unannounced inspection took place on 2 and 3 October 2017. We last inspected Hillfield in November 2015. At that inspection we found the service was meeting all the regulations that we inspected and rated it good overall. However some improvements were required on the availability of activities to people who lived at the service and also to ensure that all care reviews were completed regularly.

Hillfield provides residential and nursing care for up to 50 people, some of whom are living with dementia. The service is based within a residential area in the west end of Newcastle. At the time of our inspection there were 22 people living at the service.

The service had a manager in post who was in the process of registering with the Care Quality Commission (CQC). The previous registered manager had left the organisation and deregistered in August 2017. A registered manager is a person who has registered with the CQC 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.

Although people and their relatives felt that the service provided safe care, we found a number of issues which needed to be addressed.

We found people’s thickeners where stored in unlocked cabinets within one of the dining room areas. Thickeners are usually powders added to foods and liquids to support people with swallowing difficulties. There is a risk associated with these if digested by people. The management of medicines required improvement, with security of medicines, times of administration, recording and disposal some of the issues we found during our inspection. People were able to access the third floor to the service which was currently out of use. This area was hazardous as it was being used for storage in parts and was not lit well.

Although parts of the service were clean and tidy and people deemed the service as clean, we found issues with infection control. Clinical waste was not secure outside of the building, equipment and rooms were not always satisfactorily cleaned and there were odours in places. We received negative comments on the laundry system and the manager and registered manager said they would look into this.

Quality monitoring systems were in place at the service but they had not been completed for a number of months in most cases and the manager did not have a full oversight of how the service was being delivered on a day to day basis. We found a very large cactus plant in the lounge area of the service which the manager had not seen since they started working at the service in July 2017. Feedback about communication between staff within the service was mixed, and was an area which needed to be improved upon. Staff commented that they were not communicated with very well, particularly in connection with handover.

Staff did not always receive the support they required to help them provide effective care to people. Staff had not always received timely supervision or annual appraisal. Recruitment was not robust, with no checks on the nurse registration requirements taking place. However, the provider had made positive efforts to recruit more permanent staff.

Record keeping was in need of review, with some care plans, risk assessments and other monitoring records, either out of date or not in place at all. A new deputy manager was in the process of reviewing this information. We also found records were not secure in parts of the service.

People on the whole felt that food and refreshments at the service was satisfactory as recent improvements had been made. Although we made one recommendation with regards to the dining experience at the service.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes.

People were supported to have choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People and their relatives felt that the staff at the service kept them up to date with information and enabled them to be involved with planning and review of their care needs.

People and their relatives were extremely positive about the activities available and the improvements made in this area. People had been able to participate in a range of planned events, including being taken out of the service for trips.

People and their relatives felt permanent staff were kind and caring but they were less positive about short cover staff (usually agency). We found some staff practices were not respectful and did not always support people’s dignity. For example, standing over people while supporting them to eat.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safe care and treatment, staffing and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Following our inspection, the provider sent us an action plan of how they were going to address these concerns.