Archived: Hillview Nursing Home

Updated 5 October 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors and a member of the CQC medicines team. Information was also gathered by an inspection manager and the national enforcement team.

Service and service type

Hillview Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Hillview Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.

During the inspection

We looked at a range of care and nursing records. We checked 13 people’s medicines records and looked at arrangements for administering, storing and managing medicines. We also looked at the medicines policy. We spoke with four people living at the service. We spoke with five members of staff and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with a range of professionals visiting the service. We used 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.

After the inspection

We requested records and information relevant to the running and monitoring of the service. We reviewed reports from the local authority safeguarding team, the district nursing team and paramedic reports.

Updated 5 October 2022

About the service

Hillview Nursing Home is a residential care home providing personal and nursing care to up to 40 people. The service provides support to older adults. At the time of our inspection there were 36 people using the service.

Hillview Nursing Home is registered to accommodate up to 40 people in one adapted building.

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

People experienced poor care which resulted in harm. A number of people had preventable wounds from lack of pressure care. A significant number of people had unexplained bruising. Staff had not followed safeguarding procedures and concerns had not been documented or reported to the relevant authorities. Risks to people were not assessed and monitored. The provider did not have any mechanism in place to learn from incidents.

Medicine was not always managed safely. The provider had not ensured medicines were stored safely and administered as directed. People whose health conditions needed to be monitored did not always have this done.

People’s needs had not been fully or accurately assessed. There were significant shortfalls in the assessment of people’s skin integrity and wounds. Equipment intended to support people such as pressure relieving mattresses were malfunctioning and some mattresses were found to be deflated. Care plans were not always person-centred; they did not contain information about people’s individual preferences.

Staff had not been fully trained or supervised. There were shortfalls in all areas of staff training. There were no records of supervision available. People were not always supported in line with the Mental Capacity Act (2008); decisions recorded were often dated several weeks after admission and showed no evidence people or their families had been consulted about decisions.

Staff did not work effectively with other professionals. Several people had no records of any health visits and staff did not always follow the guidance of health professionals.

People were not always treated with dignity and respect at the service. We observed a number of interactions where staff did not behave in a caring way. We saw that some staff lacked the ability to interact with people living with dementia. However, we saw other members of staff who treated people with kindness, warmth and respect.

The provider did not have effective systems in place to monitor the safety and effectiveness of the service. Shortfalls found at the inspection had not been identified by the provider. There was no system in place of regular audits to monitor the quality of the service. The provider had failed to identify that incidents and safeguarding concerns had not been reported.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support 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 good (published 28 September 2017). This has now changed to inadequate.

Why we inspected

The inspection was prompted due to concerns received about wound care and unexplained bruising for several people living at the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We expanded the inspection to include the caring and responsive domains.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection. 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.

Despite being fully informed of the risks and actual harm to people living at the service the provider took no action to mitigate these risks.

You can see what action we have asked the provider to take at the end of this full report.

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

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 monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, dignity and respect, safe care and treatment, monitoring the quality of the service and staff training and recruitment at this inspection.

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

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 to varying the conditions the 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.