Archived: Hilldales Residential Care Home

We found the following examples of good practice.

Staff were following current infection prevention and control guidance to help people to stay safe. There were suitable risk assessments and an up to date infection control policy and procedure in place. The registered manager ensured staff understood why every measure was in place.

Personal Protective Equipment (PPE) was readily available around the building. We saw there was a good supply of PPE for staff to use. Staff were observed to be wearing PPE appropriately and disposed of it in clinical waste bins. Whole home testing was undertaken, with frequency of testing people and staff in line with current guidance.

Staff had completed training to ensure staff knew how to keep people safe during the Covid-19 pandemic. Staff had also been supported by outside health professionals to ensure safe infection prevention and control measures were in place.

Infection prevention and control audits were carried out to ensure the premises was meeting infection control measures. A cleaning schedule for all areas of the home was in place and implemented to ensure the whole home was effectively cleaned on a regular basis.

Staff supported people to occupy themselves whilst maintaining their safety. Staff helped people to stay in touch with their friends and family. Alternative forms of maintaining social contact were used for friends and relatives; for example: keeping in touch using video calls.

Facilities were in place to wash hands or use hand sanitiser on entering and leaving the home. Visitors were supported to wear a face covering when visiting, and wash hands before/after mask use. All visitors were screened for symptoms of acute respiratory infection before being allowed to enter the home and other signs of Covid-19. There was prominent signage and instructions to explain what people should do to ensure safety. Information was easily accessible on arrival or before visits to ensure visitors followed guidance, procedures or protocols to ensure compliance with infection prevention control.

The registered manager communicated with people, staff and health and social care professionals regularly to make sure everyone had an understanding of precautions being taken, and how to keep people safe.

Following the last inspection in February 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key question Is the service well-led? This was because we found a breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection we found people were not protected as quality monitoring systems were not fully effective and people’s care plans lacked up to date information about their care and treatment needs.

The provider submitted an improvement action plan on the 1 June 2017 to address these concerns, stating what they intended to do and when this would be achieved.

At this inspection we found improvements had been made so all the regulations had been met in respect to the breaches found at the previous inspection.

Hilldales Residential Care Home is a large three storey building, originally built as four houses around the turn of the twentieth century. Modifications have been made so that the properties are interconnected internally. There are communal areas on the ground floor and bedrooms on all floors of the building. Externally there is a paved area to the front of the houses and small courtyards to the side and rear which people have access to.

The home provides accommodation and personal care for up to 56 adults who have needs arising from alcohol problems or mental health issues. Some people are also living with a physical disability. At this inspection 33 people were living at the home when we visited.

There was a manager in post who had registered with the Care Quality Commission in May 2016. 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. The registered manager was supported by a team of senior staff. Together they shared a vision of the service which was described in the home’s statement of purpose: “The aim of Hilldales Care Home is to offer men and women over the age of 25 who may have mental health problems and/or alcohol problems the opportunity to live in a caring environment with support from our care staff.”

To support these aims, the registered manager and senior team had worked with staff to ensure they had the necessary skills and knowledge necessary to meet people’s needs. Staff were well trained and knew people well. This enabled them to work with people confidently, showing care and compassion. Staff were alert to changes in people’s presentation and contacted health and social care professionals when necessary to support the person. Staff understood how to protect people and knew what to do if they thought someone was being abused.

People were really positive about living at Hilldales, many commented on the improvements that had been made over the last few years. They now described the home as comfortable, clean, well maintained and nice to live in. They were also positive about the meals they received. People were supported to do activities of their choice both in the home and in the local community.

People’s risks, needs and preferences had been assessed and, where possible, discussed with them to ensure that care plans were developed to meet these assessments. Medicines were stored, administered and recorded correctly.

Health professionals commented on how the service had improved and how they felt that staff were very responsive to people’s needs. Care plans were up to date and had been reviewed regularly, including when a person’s needs had changed.

There was a quality assurance and governance system which checked the quality and safety of the service. Where areas for improvement were identified, actions were taken to address the issues.

Since the inspection a company is now providing management support and is running the home. Dr Kywe is still the registered provider.

Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.

Hilldales Residential Care Home is a large three storey building, originally built as four houses around the turn of the twentieth century. Modifications have been made so that the properties are interconnected internally. There are communal areas on the ground floor and bedrooms on all floors of the building. Externally there is a paved area to the front of the houses and small yards to the side and rear which people have access to.

The home provides accommodation and personal care for up to 56 adults who have needs arising from drug, alcohol or mental health problems. At this inspection 28 people were living at the home when we visited.

After an inspection in September 2015, the home was placed in special measures as there were ongoing breaches of regulations, which meant that some aspects of the service continued to be found inadequate.

The service was inspected again in July 2016 when the service was rated as requiring improvement overall. However, although improvements had been made, the Safe domain was still found inadequate. The home therefore continued to be in special measures. At the July 2016 inspection we found six breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the provider not having adequately trained staff to support people safely. This included staff being able to safely support people with moving and handling; a lack of systems to protect people from the risk of financial abuse; people’s needs and risks had not been fully assessed and conditions of people’s Deprivation of Liberty Safeguards (DoLS) authorisations had not been met. We also found people had not been adequately assessed for the risks when undertaking cleaning activities and there were moving and handling risks for staff in a laundry area. We found there was a lack of systems to assess and monitor the quality of the services provided. Although some aspects had improved, the home was rated as requiring improvement.

We reported that we would continue to keep the service in ‘special measures’ and consider what further action we would take. Following our inspection in July 2016, we met with the provider, the registered manager and senior staff in October 2016. At this meeting, they discussed the actions they had taken to address the breaches of regulations. After the meeting, we agreed to re-inspect the home in early 2017 before taking further action.

We found significant improvements at this inspection had been made which meant a number of the breaches had been addressed. However we found a continuing breach of regulation 17. Care plans and risk assessments were not updated to reflect people’s current needs and risks. There was still insufficient evidence to demonstrate that there were robust quality assurance systems in place. Although some systems were in place to monitor the service, there were still concerns and issues which they had not identified or addressed. For example, care record audits had not identified that care plans and risk assessments were not up to date. The system had also not identified that staff had not received regular supervision.

The registered manager was working on improvements with health and social care professionals including staff from the local authority’s quality assurance and improvement team. Senior local authority staff were providing mentorship to the registered manager. Both the registered manager and another senior member of staff had started to study for a Level 5 qualification in management.

People said they liked the registered manager and other senior staff and felt the home had been improved by them. People said they were treated with dignity and respect. People were able to have privacy and friends and family could visit when they wanted. People were supported to undertake activities of their choice both in and away from the home. Some activities supported people to develop independent life skills.

The home appeared clean and well maintained. The refurbishment of the home had continued since the previous inspection and a new laundry area had been set up, which provided staff with sufficient space to safely manage laundry for the home and for people. A second laundry had been changed to provide laundry facilities for people which supported the development of their independent living skills.

Staffing levels were sufficient to meet people’s needs. Staff had been received some training and support to provide them with the skills and knowledge to undertake their role. This included a better understanding about how to ensure that they worked within the legal requirements of the Mental Capacity Act (2005). Staff also used safe moving and handling techniques when they supported someone to move. However staff still did not fully understand the importance of maintaining accurate and up-to-date records which included the current risks and needs of people and how these should be addressed. Although staff had received training to support them in their role, there was some evidence that further work was needed to ensure that staff understood how to maintain accurate and current care records. Further training was planned for the coming year.

Health and social care professionals’ support and advice was sought appropriately. Professionals said that they had confidence that staff contacted them when necessary and followed their advice appropriately. Professionals also described how the home had made huge improvements, both in the building and in the ways people were supported.

The home had a happy, positive atmosphere with friendly interactions between people and staff. Staff knew people well and were able to support them in a caring way. People were supported by staff who showed compassion and empathy during difficult times such as illness or bereavement.

People said they liked the food and were able to choose what they ate. People were involved in developing the menus by making suggestions at resident meetings. Comments included “The food is great.” People were able to access hot and cold drinks as well as snacks at all times of the day. Specialist diets such as meals for diabetics were also provided.

There were systems in place to reduce the risk of financial abuse of people. The registered manager had supported most people to open their own bank accounts which had also helped to support their independence. Where items were bought by the home for people there were systems to record the receipt and value of these goods. However some of the recording systems needed to be improved in order to ensure that people were kept informed about their expenditure when purchases were made on their behalf. People were also protected from the risk of other types of abuse by staff who understood their responsibilities. Staff were able to describe what action they would take if they thought there was a risk of someone being abused.

People had opportunities to voice opinions and preferences at resident meetings and informally with the staff. People said staff would respond to their requests. There was a complaints policy and system which people were aware of. There had not been any formal complaints since the last inspection.

Medicines were stored, administered and recorded safely. Audits of medicines were carried out monthly. Staff had been trained to administer medicines and were observed following correct practices and procedures. However risks related to people’s health needs were not always recorded along with clear actions for staff to take in order to mitigate risks.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Although improvements had been made, an ongoing breach of regulation was identified at this inspection. Please see the end of the report for action we are taking.

Hilldales Residential Care Home is a large three storey building, originally built as four houses around the turn of the twentieth century. Modifications have been made so that the properties are interconnected internally. There are communal areas on the ground floor and bedrooms on all floors of the building. Externally there is a paved area to the front of the houses and small yards to the side and rear which people have access to.

The home provides accommodation and personal care for up to 56 adults who have needs arising from drug, alcohol or mental health problems.

The service was previously inspected in September and October 2015 when the service was rated as inadequate overall. At that inspection we found breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the provider not having adequately trained staff to protect people from the risk of fire; a lack of suitable systems in place to protect people from unsafe management and administration of medicines; a lack of systems to ensure people were protected from the risk of financial abuse; people’s needs and risks had not been fully assessed and care plans did not describe how to support people; people who lacked mental capacity to make particular decisions were not protected, people were being deprived of their liberty without appropriate Deprivation of Liberty Safeguards (DoLS) applications or authorisations in place. We also found some areas of the home and practices posed infection control risks and there were a lack of systems to assess and monitor the quality of the services provided. Although some improvements had been made, these were not sufficient to improve the overall rating of inadequate.

After the inspection, we reported that we were taking further action, which included placing the service in ‘special measures’.

Following our inspection in September 2015, we imposed a condition on the provider to have a registered manager for the service. A registered manager is a person who has registered with the Care Quality Commission (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.

Following the September 2015 inspection, we also issued a warning notice in respect of Regulation 11 of the Health and Social Care Act (2008) Regulations 2014. This was because people’s consent to care had not always been obtained before care was given. The warning notice required the provider to be compliant by 31 January 2016.

In March 2016, we undertook a focussed inspection to check whether the home was now compliant with Regulation 11. Although some improvements had been made, we found the home was still in breach of the regulation and therefore the warning notice remained in place.

A new manager had been appointed by the provider and had registered with the CQC on 6 May 2016. However this registered manager was inexperienced in the role. They said they met with the provider most weeks to discuss issues. However they also said did not have any support or mentoring from anyone such as a more experienced registered manager. They described how they were learning ‘on the job’ but were aware that they “didn’t know what they didn’t know.” This meant they did not have sufficient knowledge, skills and experience to carry out their role effectively and had not been supported to gain these as soon as they were appointed into post.

At this inspection 32 people were living at the home when we visited on the first day, but one person had moved to another home by the second day of inspection.

Staff and people said they liked the registered manager and other senior staff and felt supported by them. The registered manager was keen to improve the service and had been working on this with health and social care professionals including staff from the local authority’s quality assurance and improvement team.

The registered manager had made changes to the way the service listened to people and staff. This had led to some improvements which people said they benefitted from. The registered manager was also adapting policies and procedures to meet the needs of the home, although this work was still in progress.

Some quality assurance systems were in place to monitor the care delivered as well as the building itself. Although some of these systems were an improvement, there were still concerns and issues which they had not identified or addressed. For example, care record audits had not identified that care plans and risk assessments were not updated to reflect people’s current needs and risks.

Staffing levels were sufficient to meet people’s needs. Staff had been trained and supported through supervision to support them with the skills and knowledge to undertake their role. This included understanding about how to ensure that they worked within the legal requirements of the Mental Capacity Act (2005). However, there was evidence that staff did not always put their training into practice. For example, staff did not consider a person’s best interests when an issue arose. There was also evidence that staff did not fully understand the importance of maintaining accurate and up-to-date records which included the current risks and needs of people and how these should be addressed. Staff did not always use safe moving and handling techniques when they supported someone to transfer to a chair. Staff had received training to support them in their role, but there was some evidence that further work was needed to ensure that staff understood how to put training into practice.

People who had significant health needs, which required staff help, were not always supported to fully meet their needs. Risks to individual people were not always documented and did not fully describe what staff should do to minimise the risks. Although the service involved and worked with health and social care professionals, their advice was not always fully followed

There was a happy, friendly atmosphere in the home. Staff and people interacted with each other in positive ways. Staff clearly knew people well and were able to discuss their history and family with them. People appeared happy and relaxed throughout the inspection and said they liked living at Hilldales. Staff were trained how recognise signs of abuse and were able to describe what actions they would take if they had a concern.

There was a complaints policy and procedure. People knew how to complain, but said they had not needed to formally raise any concerns.

People were supported to have healthy balanced diets. People were able to access drinks and snacks at all times of the day. Comments included “The food is really good.” and “I can get coffee whenever I want.” People were involved in menu planning and choice of food.

There had been significant improvements to the premises which meant that it was comfortable and hygienically maintained. However, a new laundry area had not been environmentally risk assessed. Due to the limited space in this area for moving and handling, staff and people who used the laundry were at potential risk of injury.

We recommend the provider consider recording and analysing incidents when people were found to be smoking in their bedrooms to see if the risks could be further reduced. We also recommend that the provider clarifies the reason for the practice of searches of bedrooms including its purpose.

Medicines were administered safely by staff who had received medicine administration training. Medicine administration records were well maintained. Where people self-administered medicines, this had been risk assessed. Non-prescription, homely remedies were used by staff on occasions although the registered manager said he would advise staff to stop this practice.

At the last comprehensive inspection in September and October 2015, this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures. We found breaches of the Health and Social Care Act (2008) Regulations 2014.

CQC met with the provider, the registered manager and other senior staff to discuss the findings and their action plan. Following this meeting, CQC decided to carry out another comprehensive inspection before the end of January 2017. CQC has told the provider that if there is not enough improvement and any domain is inadequate, we will move to close the service by cancelling the provider's registration.

Hilldales Residential Care Home is a large three storey building, originally built as four houses around the turn of the twentieth century. Modifications have been made so that the properties are interconnected internally. There are communal areas on the ground floor and bedrooms on all floors of the building. Externally there is a paved area to the front of the houses and small yards to the side and rear which people have access to.

The home provides accommodation and personal care for up to 56 adults who have needs arising from drug, alcohol or mental health problems.

The service was previously inspected in September and October 2015 when the service was rated as inadequate overall. At that inspection we found breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the provider not having adequately trained staff place to protect people from the risk of fire; a lack of suitable systems in place to protect people from unsafe management and administration of medicines; a lack of systems to ensure people were protected from the risk of financial abuse; people’s needs and risks had not been fully assessed and care plans did not describe how to support people; people who lacked mental capacity to make particular decisions were not protected, people were being deprived of their liberty without appropriate Deprivation of Liberty Safeguards (DoLS) applications or authorisations in place, some areas of the home and practices posed infection control risks and there were a lack of systems to assess and monitor the quality of the services provided.

After the inspection, we reported that we were taking further action, which included placing the service 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.

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.

At the inspection in September and October 2015, we found best interests decision-making had not been undertaken to confirm the actions were in a person’s best interests. People had signed to give consent for staff to undertake action, for example where staff were managing people’s money. However there was no evidence that where there were concerns about the person’s capacity to understand what they were signing, this had been assessed.

At the inspection in September and October 2015, we found the provider and the staff were not able to demonstrate they understood their responsibilities in relation to the MCA. The provider and staff did not show an understanding that lack of capacity may not be a permanent condition or that assessments of capacity should be time and decision-specific. They did not understand that people, who have not been assessed to lack capacity to make a particular decision, have the right to make what others might regard as an unwise or eccentric decision.

We served a Warning Notice on Hilldales in respect of a breach of Regulation 11 (Need for Consent) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The warning notice stated there was no evidence of how staff had assessed people’s ability to give consent to decisions about their care and treatment. Care plans did not incorporate the two stage assessment of capacity as required by the Mental Capacity Act (MCA) 2005. The warning notice required the provider to become compliant with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 31 January 2016.

At this inspection, there were 34 people staying at the home, all of whom had lived at Hilldales Residential Care Home for a number of years.

We found the service had undertaken some work towards addressing the concerns identified in the warning notice. People’s capacity or otherwise to consent had been considered. There were records for most people which included assessments of people’s capacity to manage their own finances and manage their own medicines. However staff had not always put taken steps to ensure that people who did not have capacity to manage their own money were protected from the risk of abuse.

Where appropriate, people’s lack of capacity to consent to care and treatment had been recorded. However, the assessments had not provided sufficient detail about what aspects of their care they did not have capacity to make a decision about.

Staff had completed some training about the Mental Capacity Act (2005). However staff were not able to fully describe what impact this might have on people.

We found a continued breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities), Regulations 2014.

We spoke with the manager, who is not registered with CQC, with the office manager, senior carer and care staff member. We heard how the new forms had been developed to ensure compliance, and these were sent to the registered provider on a weekly basis for their assurance they were being completed.

We saw fortnightly audits had been completed on fire safety within the home. All staff had received updated training in fire safety in August and all names of staff who attended were recorded.

The senior care staff were completing monthly audit of cleaning work completed and each cleaner had a set routine of areas to be cleaned each day and what was needed weekly.

People we spoke with gave a varied view of their experience of living at the service. One person told us they were most unhappy. We heard they had been drinking heavily outside of the home and this affected their mental well-being. Most people said they were treated well by staff. Comments included ''You couldn't get a better bunch, most caring and very good.'' Another person told us ''I don't want to be here, but the staff are very good. They are all kind and do their best.''

We saw care and support was well planned and delivered by a staff team who understood the needs of people they cared for. Additional training in mental health, diabetic care, wound care and preventing urinary tract infections had all helped to provide safe and effective care for people.

Systems were in place to review the quality of care provided, but we found some improvements were needed in record keeping.

The expert by experience spent time asking people about how involved they felt in their care and support, as well as checking that people were happy with staffing arrangements, their rooms and the quality of the food they were offered.

We also looked at some key documents, including care plans, risk assessments, contracts and staff recruitment files. We found that most of these were up to date, although some had not been signed and dated.

We saw that people were consulted about the care and support they received and were able to be involved in making choices about how they spend their time and menu planning.

We found that there was a robust recruitment process that helped to protect vulnerable people.