Archived: Hillview Nursing Home

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.

Hillview Nursing Home is registered to provide accommodation and nursing care to up to 40 people. The home specialises in the care of people living with dementia. At the time of the inspection there were 24 people living at the home, three of these people were in hospital at the time of the visit.

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

The service had experienced some staffing pressures due to COVID-19, we found however the staff levels did not fall under safe levels. The service used agency staff to cover shifts, there were systems in place to ensure these staff had the correct training. There were systems in place to provide relevant information about people to agency staff. Risks to people were identified and plans were in place to mitigate the risks. Safeguarding systems were in place.

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

Rating at last inspection

The last rating for this service was Good. (Report published 28 September 2017).

Why we inspected

The inspection was prompted in part due to concerns received about risks to people, infection control, safeguarding and staffing. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section 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.

At the last inspection in October 2014 the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good:

People received safe care and treatment in a well maintained premises. Individual risks were assessed and managed because there were effective systems in use which were closely adhered to by staff. Staffing numbers ensured staff were able to meet people’s individual needs. Recruitment, medicine and safeguarding policies and procedures protected people from harm.

People were supported to have maximum 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 received a nutritious diet of their preference. People’s health care needs were understood and met through staff knowledge, skills and appropriate contact with external health care professionals as required. One described the staff as "superb".

Staff received training and supervision which helped them perform their roles to a high standard.

People, their family members and staff had formed close relationships. People were treated with dignity and respect. Families said how welcoming the home was. Family’s knew they could take any question or concern to staff. Many families spent considerable time at the home.

People’s needs were discussed and planned with them or their family members. Care plans were kept under regular review.

All kinds of activities to which people could become involved were available. This included themed events, entertainment and reminiscence. Interaction between staff and people using the service was of a high standard and demonstrated caring and compassion. The highest recommendation had been awarded for end of life care using the ‘Gold Standards Framework’.

The home was effectively managed by a registered manager and team of staff who felt fully supported. There were quality monitoring systems in place to reduce risk and identify ways to improve.

Further information is in the detailed findings below.

We found the manager had taken action to address the non-compliance in all areas. We saw staff treated people with kindness and respect. We saw that people were helped to eat their lunch in a timely and appropriate manner.

We saw that care plans had been reviewed and up-dated and reflected people's current health needs. A new form had been devised to record the food and fluids that people received. The assistance they were given during the day was also recorded. The forms provided information that enabled care requirements to be implemented.

The manager had implemented a contingency plan so that in the event of staff shortage at lunch time all people would receive their meals on time. A "red tray" system monitored more closely the food taken by people who may be at risk of malnourishment.

Questionnaires had been sent to family and friends of people who lived in the home and to health and social care professionals. The responses received indicated that everyone who returned a questionnaire was satisfied with the standard of care delivered in the home.

Many people living in the home were not able to tell us about their experiences of care. One person able to talk to us said they were 'quite happy here.'

We saw from care plans that some people had been in the home for several years. We heard one person who had been very frail and ill had recovered and was 'much better.'

We observed 17 people in the communal lounges of the home and visited 7 people in their bedrooms.

We saw interactions between staff and people who lived in the home were kind and polite.

Three relatives spoke with us and said how pleased they were with the care provided in the home.

We were concerned that some aspects of the service of lunch did not respect people's dignity or meet their nutritional needs. There were not sufficient staff available to provide assistance at lunch time to all people under the current arrangements.

We saw the home had a system of recruitment that resulted in employment of staff who were suitable and safe to care for people in the home. We saw evidence that staff were trained and supervised to assist them to deliver safe, appropriate care.

There were systems in place to maintain the health,welfare and safety of the home. Improvements were required to the way in which the provision of care was assessed and monitored.