Archived: Hillingdon House

Hillingdon House is a residential care home providing personal care for up to 22 people aged 65 and over. At the time of our inspection, the service was supporting 19 people, some of whom were living with dementia. The home is established over three floors and a separate annex building next door with seven bedrooms and a small communal area.

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

People did not always have the appropriate and correct equipment for staff to move them safely. People did not always have risk assessments and care plans in place that reflected their current needs. There was not always enough staff to meet people’s needs. This placed people at risk of harm

The heating system was not fit for purpose. There was no external fire risk assessment in place. Infection Prevention and Control (IPC) guidance was not always followed to ensure people were supported to reduce the risk of exposure and transmission of COVID-19.

Staff did not always follow isolation guidance that was in place for the COVID-19 pandemic.

The covid-19 contingency plan was not effective and there was no one to run the home in the absence of the registered manager. There was no oversight of the home during the COVID-19 outbreak. People’s care records were not reflective of current needs. The registered manager had audits in place. However, these were not always effective in identifying and addressing concerns.

Staff were aware of how and when to report abuse. People received their medication as prescribed. People told us they felt safe and were happy at Hillingdon House. Staff knew people well and had a good relationship with them.

People, staff and relatives told us they found the registered manager and provider approachable and they were encouraged to give feedback.

Rating at the last inspection

The last rating for this service was good (published 28 March 2019).

Why we inspected

We received concerns in relation to the management of medicines, infection control, and people’s safety. We also received further concerns from the local authority whilst the home was having a COVID-19 outbreak. Due to the COVID-19 outbreak, the registered manager required support from the local authority due to insufficient staff being available to support people. The local authority funded a consultancy company and the Care Home Intensive Support Team (CHIST) were deployed to support the home. These teams raised concerns including staffing levels, people’s safety and the management and oversight of the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hillingdon House on 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 coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified breaches in relation to people not receiving safe care and treatment and quality assurance systems not being completed to identify concerns and drive improvements.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hillingdon House is a care home that provides nursing and personal care for older people, some of whom are living with dementia. At the time of the inspection, 21 people lived at the service. The home is established over three floors, with a range of communal areas included dining spaces, a garden and a large lounge. There is also an annexe next door to the main property with six bedrooms and a small lounge.

People’s experience of using this service:

There had been a number of improvements in the home since the last inspection. People were now safer as they were now being moved safely and staffing levels had increased. The provider was now notifying us of all incidents as required and people’s dignity and privacy was consistently respected.

Some improvements had been made to the management of medicines but records showed that some people had not been given their medications as prescribed. The provider gave us assurances that further improvements would be made.

People told us they felt safe and well looked after in the home and this was supported by the views of relatives. Checks were made to ensure staff were suitable to work in the home and they received regular training and support to ensure they could deliver effective care.

People were supported in line with the Mental Capacity Act 2005 and consent was obtained, where possible before care and support was given. People enjoyed the food on offer and had access to health care services when needed. Improvements had been made to the layout of communal areas and people enjoyed siting in spacious and comfortable rooms.

Staff treated people with kindness and respect and were patient when people became anxious or upset. People were supported to do things for themselves where possible and relatives told us they were made to feel welcome in the home.

People’s needs and preferences were assessed and catered for by staff who knew people well. There was a range of activities on offer which people could choose to take part in. Further improvements had been planned to ensure activities were provided in line with people’s wishes.

People, relatives and staff were happy with the way the service was led and managed. The registered and manager were both visible and demonstrated to the staff team how people should be treated with care and compassion. Audits and checks were effective in identifying areas for improvement and prompt action was taken as a result.

More information is in the detailed findings below.

Rating at last inspection: Requires improvement (report published 13 January 2018). The overall rating has now improved to Good.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement:

No enforcement action was required.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Hillingdon House 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. Some of the people living in the home were living with dementia. At the time of our inspection 21 people were using the service. Hillingdon House accommodates people in one main building and a separate building which they call the ‘Annexe’ and which we will refer to as the ‘Annexe’ throughout the report. In the main building there is a communal lounge, a dining area, and a garden area that people can access. There is also a communal lounge and a small dining area in the ‘Annexe’ and seven bedrooms.

The service had 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.

Risks to people’s health and wellbeing were not always assessed and managed. They were not always assisted to move safely. The night time arrangements to respond to emergencies had not been assessed and to ensure that there were adequate staff. The provider hadn’t always considered the rights and wellbeing of their staff when deploying them at night time. There were not always enough staff available to meet people’s needs during the day. This meant that people were left at risk of harm at times. When accidents were reviewed the provider had not considered the time they happened and whether the staffing levels could have impacted on them.

Staff did not always recognise some incidents as potentially harmful situations. These had not been shared with the responsible external agencies to ensure that people were safeguarded against harm. The risks associated with medicines were not always managed to ensure that people received them as prescribed. The management systems which were in place to monitor the quality of the home were not always effective in highlighting and addressing errors. We were not notified of all of the changes in the home that we require as part of the registration so that we can monitor how it is managed.

People’s dignity and privacy were not always upheld and this had an impact on their independence. They did not always have enough interesting and stimulating activities to engage them.

People’s capacity to make their own decisions was assessed to ensure that they were able to do so. This meant that people were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People had a choice of good quality food; including specialist meals when required. The provider had developed working relationships with other healthcare professional to ensure that people’s health and wellbeing were monitored and managed.

Staff understood people’s preferences for care and their care plans were up to date and reflected their current needs. Staff received training to do their jobs, including induction training. They felt supported through staff meetings and supervisions. They had caring relationships with people and their families who were always welcomed.

Safe recruitment procedures were followed to ensure that staff were safe to work with people. The provider’s previous rating was displayed in the home as required.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service had 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.

People told us that they were supported to keep safe. We saw that medicine was administered and managed safely. Risk was assessed and reduced so that people could be supported to live as independently as possible. There were sufficient staff employed to ensure that people could do this safely. People were supported to make choices and were encouraged to participate in a range of activities. People had their plans reviewed regularly and where relevant families were involved.

The staff team understood the Mental Capacity Act 2005 and were able to explain how people’s capacity had been assessed and how they supported them in line with this. They were aware of the principles of the Deprivation of Liberty Safeguards and this had been applied within the home to protect people’s human rights.

People were supported by staff who had training and line management to provide an effective service. Staff were knowledgeable about protecting people from abuse and knew how to report any concerns. They had their competency checked by senior staff, for example in administering medicines. Safe recruitment procedures were followed when employing new staff.

People had their nutritional needs met and care was taken to ensure that people’s preferences were included in meals. If there were concerns about their health or wellbeing then specialist support and advice was sought from healthcare professionals.

Staff developed caring, respectful relationships with people. Important occasions were celebrated and people were made to feel valued. There were regular meetings so that people and their relatives could feedback any concerns or suggestions to help to improve the service. We saw that quality checks were in place to audit the effectiveness of the service. People and their relatives told us that the registered manager was approachable and supportive.

We observed interactions and saw that people were relaxed with staff. Staff had a good knowledge of people's support needs and were respectful to people when providing this support.

People using the service had care records which recorded how they wanted to be supported. The information we read in the care records matched the care, support and treatment we saw being delivered to people.

People told us they could make choices about their food and drink. People told us they were provided with a choice of food and refreshments. Snacks and drinks were available throughout the day.

We saw that there was enough skilled staff on duty at all times. This ensured that people received the care and treatment they required.