Hillside Care Home

Hillside Care Home accommodates up to 119 people who require personal and nursing care. The service provides accommodation in four separate units over two floors. At the time of the inspection there were 72 people using the service.

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

An assessment of people’s needs was completed, and the outcomes were used to develop their care plan. Care plans clearly set out people’s needs and how they wished them to be met.

People’s health and wellbeing was monitored in line with their care plan and staff responded promptly to any changes. Prompt referrals were made to external health and social care professionals where this was required for people.

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.

Staff were inducted into their role and received ongoing training and support they needed to carry out their role effectively.

People were treated with kindness and their privacy, dignity and independence was respected and promoted. People were involved in decisions about their care and their views and opinions were obtained through regular care reviews and general discussions. Relevant others were involved where this was appropriate.

People received the support they needed to communicate effectively, and they were provided with information in a way they could understand.

The providers complaints procedure was made available to everyone and complaints were listened to and used to improve the quality of the 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 June 2019).

Why we inspected

This was a planned inspection to review the key questions Effective, Caring and Responsive which were rated requires improvement at the last comprehensive inspection carried out in June 2019.

Hillside Care Home accommodates up to 119 people who require personal and nursing care. At the time of the inspection there were 67 people using the service across three separate units over two floors.

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

People felt safe living at the service and family members were confident their relative was kept safe. Risk assessments were completed, and staff had guidance on how to minimise the risk of harm to people. Staff understood their responsibilities for protecting people from the risk of abuse and were confident about reporting any concerns about people’s safety. People received care and support from the right amount of suitably skilled and experienced staff who were safely recruited. Medicines were safely managed by staff who were suitably trained and deemed competent. Accidents, incidents and near misses were reported and responded to appropriately and lessons were learnt and shared across the staff team. Safe infection prevention and control practices were followed to minimise the spread of infection including those related to COVID-19.

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 registered manager had influenced and embedded improvements to the service since the last inspection with the support of a committed and passionate staff team. The providers quality assurance systems and processes were used effectively to assess, monitor and improve performance and the quality and safety of the service. There was good partnership working with other agencies and professionals resulting in good outcomes for people. The culture of the service was positive and inclusive of all. The views of people, family members and staff were listened to and acted upon.

Rating at last inspection

The last rating for this service was requires improvement (published 30 July 2021).

Why we inspected

This was a planned inspection.

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 requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hillside Care Home accommodates up to 119 people who require personal and nursing care. At the time of the inspection there were 55 people using the service. The service provides accommodation in four separate units over two floors. At the time of the inspection two units were in use, Ash and Cedar. Cedar unit is for people with nursing needs. Ash unit is split into two areas, with one area for people living with dementia who also have nursing needs and the other area for young adults with a physical disability.

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

We have made a recommendation about staffing. People were kept safe by the right amount of staff, however, the absence of dedicated staff to facilitate activities for people impacted on care staffs' ability to fully meet people’s needs.

Risk assessments relating to the health and safety of people were completed, however monitoring records for some people were not completed in line with their risk management plans. This was addressed during the inspection. Family members told us staff understood and managed risk well.

Medicines were managed safely, however, there was a lack of guidance for staff about why, how and when to administer medicines prescribed to be given ‘when required’ to some people. This was addressed during the inspection.

Safe recruitment processes were followed. Applicants were subject to a series of pre- employment checks.

Staff knew what constituted abuse and were confident about reporting any safeguarding concerns. People told us they felt safe and were treated well. Family members told us they were confident their relative was kept safe.

Infection prevention and control measures were followed to minimise the spread of infection including those related to COVID-19. The premises were kept clean and hygienic, personal protective equipment was used and disposed of safely.

Improvements made to the service were sustained. Systems for monitoring the quality and safety of the service were effective in identifying and making improvements. Improvement plans were developed, monitored and regularly reviewed to make sure the required improvements were made in a timely way.

There was a culture of openness and learning when things went wrong. People, family members and staff were involved and kept up to date with changes affecting people’s care and the running of the service. The registered manager operated an open-door policy and welcomed the views and ideas of others.

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 29 September 2020).

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Why we inspected

Due to the COVID-19 pandemic, we undertook a focused inspection to only review the key questions of safe and well-led. Our report is only based on the findings in those areas reviewed at this inspection. The ratings from the previous comprehensive inspection for the Effective, Caring and Responsive key questions were not looked at on this occasion. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection and the ratings from the previous comprehensive inspection.

Hillside Care Home accommodates up to 119 people who require personal and nursing care. At the time of the inspection there were 36 people using the service. The service provides accommodation in four separate units over two floors. At the time of the inspection two units were in use. One unit is for people with nursing needs. The second unit is split into two areas, with one area for people living with dementia who also have nursing needs and the other area for young adults with a physical disability.

At our previous inspection in July 2019 the provider was in breach of regulations. At this inspection we found enough improvement had been made and the provider was no longer in breach of regulations. The evidence that inspectors could review was limited as many of the improvements were recently made and improvements made needed to be embedded and sustained over a longer period of time to achieve a rating of good.

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

Risks to people were assessed and their safety was monitored. Regular checks were carried out on the safety and cleanliness of the environment and equipment and prompt action was taken to mitigate any risk identified. Risks in relation to aspects of people direct care was assessed and measures put in place to guide staff on how to keep people safe. People’s safety was monitored, and outcomes recorded in line with risk management guidance.

People were safeguarded from the risk of abuse. People told us they felt safe and were treated well and family members told us they were confident their relatives were safe. The manager and staff were knowledgeable about the different types and indicators of abuse. Allegations of abuse were managed in line with the providers and the local authority safeguarding procedures. Clear records of incidents of a safeguarding nature were maintained.

Safe recruitment processes were followed. A series of pre-employment checks were carried out on applicants to assess their suitability and fitness before an offer of employment was made. Where it was required information was followed up and verified.

The providers systems and processes for assessing, monitoring and improving the quality and safety of the service were used effectively. Checks and audits were completed in line with the providers quality assurance framework and areas for improvements were made. Records were regularly reviewed, kept up to date and checked for accuracy. People, staff and family members told us they were engaged and involved in the running of the service and they were provided with opportunities to feedback about their experiences of the care provided. There was good partnership working with others including external health and social care professionals.

Medicines were safely managed by staff with the right training and skills. Medication administration records were kept up to date with details of people’s prescribed medicines and instructions for use.

Risks relating to infection prevention and control (IPC), including in relation to COVID-19 were assessed and managed. Staff followed good infection, prevention and control (IPC) practices. They had access to the required personal protective equipment (PPE), and they used and disposed of it safely.

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 inadequate (published 02 April 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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

Why we inspected

A decision was made for us to inspect, examine and follow up what improvements had been made since the last inspection in February 2020. Due to the COVID-19 pandemic, we undertook a focused inspection to only review the key questions of Safe and Well-led. Our report is only based on the findings in those areas reviewed at this inspection. The ratings from the previous comprehensive inspection for the Effective, Caring and Responsive key questions were not looked at on this occasion. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

Follow up

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.

Special Measures

This service has been in special measures since 02 April 2020. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in special measures.

Hillside Care Home accommodates up to 119 people who require personal and nursing care. At the time of the inspection there were 66 people using the service. The service provides accommodation in four separate units over two floors. At the time of the inspection three units were in use, the fourth unit was closed to admissions when the registered provider took over the service and they made the decision not to re-open it. One unit is for people with nursing needs, the second unit is for people living with dementia who also have nursing needs and the third unit is for young adults with a physical disability.

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

Parts of the environment and equipment used by people was not regularly monitored to ensure they were safe and clean. Boxes were left on corridors and in a bathroom increasing the risk of trips, slips and falls and sofas and falls mats used by people were unclean. Risk assessments for aspects of some people’s care had not been completed when required. Air flow mattresses were not checked to make sure they were set correctly for people who were at risk of developing pressure wounds. Whilst we did not evidence any impact on people, this placed them at risk of receiving unsafe care.

People were not always safeguarded from the risk of abuse. The registered manager was made aware of three incidents of a safeguarding nature but failed to recognise them as such. This resulted in the incidents not being referred to the relevant agency. The registered manager was reluctant to follow guidance from the local authority safeguarding team to keep people safe from further risk of abuse.

Safe recruitment processes were not always followed. Checks on some applicant’s suitability and fitness had not been carried out before they started work at the service. There were gaps in applicant’s employment history, and some background information and references had not been followed up and verified.

The providers systems and processes for assessing, monitoring and improving the quality and safety of the service had not been used effectively. Some audits and checks were not carried out as required and others failed to identify concerns and bring about areas for improvement. Required records were not always accurate and kept up-to-date.

Care plans for some people were not always reviewed and updated when their needs changed and some people’s needs were not monitored as required. Staff knew people’s preferences and offered them choices to meet their needs.

People and family members commented that the staff were kind and caring in their approach and we observed examples of this. Staff knew people well and showed them compassion. However, people’s dignity was not always fully respected. People’s personal belongings were not always treated with respect and some items of equipment in use was unclean. There were limited opportunities for people to express their views and be involved in decisions about their care.

Staff received the training and support they needed for their role. People were supported to maintain a balanced diet and they enjoyed a variety of food and drink. People received the support they needed to access healthcare professionals and services. 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.

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 June 2019).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding people from the risk of abuse. A decision was made for us to inspect and examine those risks. We found evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

We have identified breaches in relation to keeping people safe and the leadership and oversight of the service at this inspection.

Prompt action was taken by the registered provider during and after the inspection to safeguard people and mitigate risks to them in response to the concerns we found during our inspection.

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

Follow up

We will meet 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 also request an action plan from the provider to understand what they will do to improve the standards of quality and safety.

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.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.

This will usually lead to cancellation of their registration or varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Hillside Care Home accommodates up to 119 people who require personal and nursing care. At the time of the inspection there were 66 people using the service. The service provides accommodation in four separate units over two floors. At the time of the inspection three units were in use, the fourth unit was closed to admissions when the registered provider took over the service and they made the decision not to re-open it. One unit is for people with nursing needs, the second unit is for people living with dementia who also have nursing needs and the third unit is for young adults with a physical disability.

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

At our previous inspection in November 2018 the service was in breach of Regulations. At this inspection we found enough improvement had been made and the provider was no longer in breach of regulations. However, we found some further improvements were required for the service to achieve an overall rating of good.

Supplementary care records for monitoring aspects of people’s care were in place in line with care plans, however they did not always contain information and guidance for staff to follow and they had not been consistently completed to reflect the actual care and support provided. Whilst we did not evidence any impact on people, this placed them at risk of receiving ineffective care and support.

The service did not have a manager registered with the Care Quality Commission (CQC). There was a manager in post who was in the process of applying to CQC to become the registered manager.

Safeguarding processes and procedures were now followed. Safeguarding alerts were made to the local authority safeguarding team in a timely way and action was taken to protect people from any further risk of abuse. People’s mental capacity to consent was assessed in line with the Mental Capacity Act 2005 and decisions made on behalf of those who lacked capacity were made in line with the law.

Risks to people were now identified and mitigated. Risks people faced were assessed and control measures were put in place to minimise the risk of harm to people. People had access to call bells and regular checks were carried out to ensure people who could not use them, were safe. Records were now available at the service confirming the safe recruitment of staff.

All parts of the environment and equipment were now safe and hygienic. Environmental hazards and equipment which posed a risk to people’s health and safety were regularly monitored to ensure they were safe and clean.

The deployment of staff had improved, and people now received care and support from staff with the right skills, knowledge and experience. Staff had received further training in dementia care and dignity and respect and their learning had been effective.

Care plans were more detailed based on assessments and they provided clearer guidance for staff on how to meet people’s needs in a person-centred way. People living with dementia now received effective care and support which was responsive to their needs and personal to them.

Parts of the environment had been improved to better meet the needs of people living with dementia. Signage had been put in place which helped people find their way around more independently and focal points had been introduced and provided interest to people. Plans were in place to further improve the environment for people living with dementia.

People were now treated with kindness and compassion and their privacy and dignity was respected. Staff were more understanding of people’s needs and how best to support them through periods of upset and anxiety. We saw examples where staff approached people in a caring way and used techniques to reassure and comfort people with positive outcomes for them. Staff were more considerate about their practice during meal times and language used when referring to people. Their language was more dignified, and mealtimes were a more positive experience for people. Personal information about people was now treated in confidence.

The systems and processes in place for assessing, monitoring and improving the quality and safety of the service were more effective. Risks to the health safety and welfare of people were now identified and mitigated in a timely way and records were better maintained. The culture of the service had improved and was more person-centred, positive, open and empowering.

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 inadequate (published December 2018) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since December 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

This was the first inspection of the service since it was registered with CQC under the new provider Qualia Care Limited.

During this inspection we identified breaches of regulations 9, 10, 11, 12, 13, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

You can see what action we told the provider to take at the back of the full version of the report.

Hillside is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hillside Care Home accommodates up to 119 people who require nursing and personal care. At the time of the inspection there were 66 people using the service.

The service provides accommodation in four separate units over two floors. At the time of the inspection three units were in use, the fourth unit was closed to admissions when the registered provider took over the service and they made the decision not to re-open it. Cedar unit is for people with nursing needs, Ash unit is for people living with dementia who also have nursing needs and Rowan unit is for young adults with a physical disability.

At the time of our inspection the service was not managed by a person registered with the Care Quality Commission (CQC). 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. There was a manager in post and they had applied to CQC to become the registered manager however their application remained pending at the time of this inspection.

The registered providers safeguarding processes and procedures were not followed to ensure people were protected from abuse. There was a delay in alerting the relevant safeguarding authority about an allegation of abuse made about a person using the service. A person was put at risk of harm because there was a failure to assess their mental capacity to consent in line with the Mental Capacity Act 2005.

Risks to people were not always identified and mitigated. We saw multiple examples on Cedar and Ash units were people were in bed and their call bells were out of reach. Risk assessments were completed for aspects of people’s care, however care plans lacked information about identified risks and how they were to be managed safely.

Some parts of the environment and equipment were unsafe and unhygienic. Rooms which were unlocked posed a risk to people’s health and safety. This included a sluice room on Rowan unit where there was access to hot water which had the potential to scald, and store rooms on Cedar unit which contained items which posed a trip hazard. Some items of equipment used by people were unclean including crash mats, and hoist slings were unhygienically stored.

The number of staff across the service were maintained in line with the calculations worked out using a dependency tool. However staffing levels and skill mix on Ash unit were insufficient to meet the needs of people and keep them safe. We observed multiple examples where peoples call and requests for assistance were not responded to in a timely way and where staff lacked the skills needed to support the needs of people living with dementia. The deployment of staff on Cedar unit was not always effective in meeting people’s needs at mealtimes.

A series of checks were carried out on applicants including a check with the Disclosure and Barring Service (DBS) to check on applicant’s criminal back ground. However, references for some staff were not obtained from the applicant's most previous employer although the details were recorded on their application form, and there was no explanation for this.

Peoples needs were not always effectively assessed and planned for and people did not always receive care and support which was responsive to their needs. Care plans failed to identify people’s needs and how they were to be met. There was no guidance available to staff on how to manage aspects of people’s care such as dementia related behaviours.

Supplementary care records for monitoring aspects of people’s care also lacked information and guidance for staff to follow and they had not been consistently completed to reflect the actual care and support provided.

Staff lacked the skills and knowledge about how to support to people when they exhibited behaviours which caused them distress. There was a lack of information for people on Ash unit about their hobbies and interests and how to keep them occupied and they were provided with little opportunity to engage in meaningful and stimulating activities.

Processes were not always followed in line with the Mental Capacity Act 2005 to ensure decisions were made in people’s best interests. Care records lacked information around people’s ability to consent and where authorisations placed restrictions on people to keep them safe, they were not understood and followed.

Parts of the environment were not suitably adapted to meet the needs of people. There was a lack of stimulus and wayfinding on Ash unit to help people living with dementia find their way around. There had also been a lack of consideration given to people’s needs when colour schemes and contrasts were chosen prior to people moving onto Ash unit.

People were not always treated with kindness and compassion and their privacy and dignity was not always respected. Staff on Ash unit showed a lack of compassion towards people who were anxious and upset. Some terms used by staff on Ash and Cedar units when referring to people were undignified. Personal records were not always kept secure in line with data protection laws, putting people's confidentiality at risk.

The systems and processes in place for assessing, monitoring and improving the quality and safety of the service were not always effective. Risks to the health safety and welfare of people were not always identified and mitigated. Records were not properly maintained, accurate and kept up to date and there were many examples where records had not been signed and dated. The management of the service did not always promote an open and positive culture amongst the staff team. The registered provider's policies and procedures were not always followed to ensure people's health, safety and welfare.

Regular safety checks were carried out on equipment and utilities used at the service and a record of the checks were maintained.

People received the support they needed to maintain good nutrition and hydration. Meals and were modified in line with professional guidance for people who were at risk of choking and people were supported and encouraged to take prescribed food supplements when they needed them. People told us they got enough to eat and drink and that they enjoyed the food. Some meals however were not freshly prepared or served to people at the right temperature.

Not all people who used the service were able to comment about their experiences of using the service, however people spoken with told us they received the right care and support and that staff were kind and caring. Family members told us that they were happy with the care their relatives received and that they were made to feel welcome when visiting. Family members complimented staff for the high standard of care they provided people with and for love and excellent care they showed people.

Following the first and third days of inspection visit the registered provider shared details with us of the action taken in response to the concerns we raised during inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.