Hill House

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We identified 2 breaches of the legal regulations. People were not always treated with kindness, dignity and respect, nor were they always treated as individuals. We observed some poor interactions between staff and people and staff did not prioritise spending meaningful time with people. The way the environment was being kept showed a lack of respect for people’s home. Language used when speaking with or describing people was not always kind or respectful. People's care plans had limited information about their preferences. There was no evidence people or relatives were engaged with in a meaningful way to be involved in their support. People were not being given choice and control in a lot of areas of support. This included, when they got up in the mornings, when they were supported for bed rest, what they had to eat and drink or how they spent their time in the day. People had not been consulted in line with the Mental Capacity Act about many areas of their support and were not being asked for consent in areas of their support such as staff members living in their home. Staff were not being supported by the provider with staff meetings or supervisions. However, we also observed some kind and caring interactions between people and staff and people told us they were mainly happy with their support. Staff told us they enjoyed working at the service.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from people and relatives about how kind staff were. One person said, ‘‘I don’t really feel like I matter to staff. They just want to get the job done.’’ Another person told us, ‘‘[Staff] can be a bit rough with me and do not like it when I ask them to slow down.’’ A relative said, ‘‘Most of the staff are there to do a job. There is not much true care going on.’’ Another relative told us, ‘‘It takes staff a long time to sort even little things out so I am not sure how much they really care.’’ Some people also told us they were not always treated with dignity or respect. One person said, ‘‘When staff support me it is a quick process and done quickly. They do not take their time or ask me if it is OK to do things’’ Another person told us, ‘‘I like being by myself in my room but sometimes staff will just walk in and get on with things. I wish they would knock.’’ Some people gave us positive feedback about the staff team. People’s comments included, ‘‘The staff are very nice and have been kind to me.’’ and ‘‘It is lovely here and very peaceful. The staff look after me very well.’’ One relative told us, ‘‘It feels homely here and we feel confident the staff care for [family member]. However, despite people’s comments they were not being treated with kindness, compassion, or dignity. We discuss this further in the rest of this quality statement.

Staff told us they cared for people and enjoyed supporting them. However, staff were unable to tell us about people’s individual likes and dislikes or give specific examples about how they supported people with dignity and respect. Staff described people using disrespectful language such as describing people who needed support to eat and drink as ‘feeders’. As discussed in the rest of this quality statement, staff did not consistently treat people with kindness, compassion, or dignity. The management team spoke with people kindly and compassionately. However, they were not supporting staff to improve in this area and were unaware of how staff were treating people when we fed back our findings.

Feedback from other professionals was that staff seemed to be kind and caring. However, one professional explained how staff stopped some people from getting out of bed during the night as this was ‘easier for them.’ This did not promote dignity and respect for people. However, despite some positive feedback, discussed in the rest of this quality statement, staff did not consistently treat people with kindness, compassion, or dignity.

People were not being consistently treated with kindness and compassion. On several occasions staff spoke with people abruptly and did not give them chance to respond. Staff completed tasks such as serving meals or wiping down tables and did not speak with people when they did this. Sometimes staff members stood directly over people whilst doing this. Staff supporting people to eat and drink stood over them whilst doing this rather than sitting and supporting them where they could see them and have a conversation. People went for long periods of time without any staff interaction and there were missed opportunities to speak with people throughout the day. For example, during meal times staff supported people in silence or did not speak with them whilst the meal was being prepared. Staff sat separately from people when completing documentation. We observed staff speaking to people unkindly. One staff member told a person they ‘should have gone to bed’ in a harsh tone when they had chosen to stay sitting in the lounge overnight. Another staff member stated ‘fine then- be that way’ to a person who had chosen not to sit down for lunch. Staff did not treat people with dignity at all times. We observed staff speaking about people’s personal care needs loudly in front of other people. Staff spoke about people with one another without using their names and instead referred to them by their support needs. For example one staff member said ‘that one needs feeding’ to another staff member in relation to who needed support to eat and drink. The way in which the building was being kept and the dirty environment people were being supported in as discussed in the safe environments and infection prevention control quality statements, showed a lack of dignity and respect towards people.

We received mixed feedback from people and relatives as to whether they were treated as individuals. One person said, ‘‘[Staff] do not seem to really seem to know what to talk with me about. They are kind and polite but that is as far as it goes.’’ Another person told us, ‘‘[Staff] know about my dietary needs but not sure how much goes in to making sure I get more choices than everyone else.’’ One relative said, ‘‘I wouldn’t be able to tell you specifically what [staff] do to support [family member]. They love singing but I cannot recall when I saw staff doing this last.’’ Some people also told us they felt well treated as individuals. One person said, ‘‘[Staff] seem to be interested in me and are always asking how things are going and what they can do to help.’’ A relative told us, ‘‘I think [staff] have made an effort to get to know [family member].’’ However, despite this feedback staff were not being treated as individuals as discussed in the rest of this quality statement.

Staff said they treated people as individuals. However, when we asked staff to explain people’s individual support needs or their likes and dislikes, they were unable to do so. Staff were unable to detail, for example how best to support people living with dementias. Staff were unable to explain what signs to look for if a person living with diabetes were showing signs they were having problems with this support need. Staff told us they had training in these areas, however were unable to explain what they had learned in this training and told us they were not having supervisions or discussions with the management team to discuss this. The management team were not focusing audits on how people were being treated as individuals and whether staff were competent in doing this. The management team told us they had not completed supervisions with staff for some time which would have aided staff knowledge in these areas. The home and registered manager were unable to tell us the measures they had in place to ensure people were treated as individuals.

People were not being treated as individuals. We observed staff did not spend their time sitting and talking with people or involving them in discussions about their preferences, likes or dislikes. Staff did not engage with people based on their interests and social pastimes were either not on offer for people or were not of interest to them. For example, an activity of decorating hats was available for people to take part in however only 3 people took part in this for a short period of time. Activities that would have been of interest to other people were not offered. Staff did not support people with their individual needs in relation to communication. We did not observe staff using tools such as pictures or symbols to support people to communicate. The environment had not been designed to support people living with dementia to orientate. Staff did not respond positively to people’s individual needs. One person became anxious and began verbalising they were unhappy. Staff did not respond to this and left the person to become more anxious. Another person tried to talk with staff about their family and the staff member did not respond and walked away. The way in which the building was being kept and the dirty environment people were being supported in as discussed in the safe environments and infection prevention control quality statements, showed a lack of treating people as individuals.

Processes were not in place to ensure people were treated as individuals. The management team were not completing audits to monitor if people’s individual needs were being met. People’s care and support plans did not contain detailed information about people’s individual needs, their preferences, likes or dislikes. People and their relatives were not being engaged with to discuss their support and have input in to what this looked like. Staff were not being supported to have meetings and supervisions to discuss people’s care. This led to people not being treated as individuals.

We received mixed feedback from people in regard to whether they were supported to be independent. One person said, ‘‘I like to do things myself but usually staff do it all. I think they are worried it would take too much time if I did it.’’ A relative told us, ‘‘I think [family member] could do more but staff don’t really help them to do it.’’ However, one relative said, ‘‘[Family member] is a proud person so it is good [staff] help them keep up their appearances themselves.’’ We received mixed feedback from people in relation to making choices. One person said, ‘‘In the morning [staff] just grab whatever and put it on you. No choices.’’ Another person told us, ‘‘I have not been asked if I want male or female carers and I do feel awkward when men support me but I don’t say anything.’’ A relative said, ‘‘Since [family member health condition] has deteriorated they do not seem to be offered the choices they used to be offered.’’ However other people’s comments included, ‘‘I get up the same time each day but choose when I go to bed and staff respect that.’’ and, ‘‘Good choice of food here and [staff] always make you something else if you want.’’ However, despite what people told us they were not being supported with independence or to have choices as discussed in the rest of this quality statement.

Staff were unable to explain to us how they supported people to be independent. We asked staff to give some examples of this and they explained they did thing for people as they are ‘here to be cared for’ and ‘it is much quicker to get things done if we do it.’ Staff did not understand that promoting people’s independence is important to their health and wellbeing, particularly if they wanted to maintain their independent living skills. Staff and the management team told us they offered choices to people and this was a key value at the service. However, the management team explained they did not feel it necessary to offer choices to people if staff ‘knew what the answer would be’ for example in relation to choosing drinks. Staff also told us they supported people based on what they already knew about them rather than offering them choices indicating that this was a culture at the service. Staff had training in the Mental Capacity Act (MCA) however were unable to tell us what this meant in relation to their job roles. They were unable to explain the processes in place to help people who may lack capacity to make decisions in their best interests. The management team were not checking this training to make sure it had been effective and staff were competent to support people in line with the MCA.

People were not being supported to make choices throughout the day. People who were on specific diets did not get the choice of a fresh meal but were instead served pureed food from the day before. Staff explained this was because they did not like waste. This was discriminatory towards people on specific diets and did not allow them to have choices in regard to what they had to eat and drink. At mealtimes every person’s meal was covered in condiments, without asking people if this is what they wanted. Staff made people drinks based on what they thought people would want instead of asking people what they wanted. One person refused their drink and staff gave the drink to another person without asking them if this is what they wanted. Some people were supported to wake up and get out of bed early in the morning. We observed these people to be asleep in chairs in the early morning. We asked staff why people were up if they were still tired and they told us they supported people depending on If they were awake or not rather than asking them if they wanted to get up. Staff supported one person to bed in the early afternoon. When we asked if this was the persons choice staff told us they supported the person back to bed if they needed repositioning at the time but if not they could stay in the communal, lounges. The person did not have a choice in this matter. There were limited choices available with regards to how people could spend their time in the day. There were few activities available for people to take part in. Most people spent their time sitting in chairs or in their rooms as they were not being offered choices about how to spend their time.

People were not always being supported in line with the MCA. Some staff members lived at the service, however this had not been discussed with people to see if they were happy with this arrangement or to see if this was in their best interests. On our second visit to the service, a staff member was living next door to a person and they had not been consulted to see if they were happy for this to happen. Some people were being supported to take their medicines covertly. However, capacity assessments and best interest decisions had not been completed to make sure this was the least restrictive option for people. The management team were not completing audits to make sure people were being offered choices or if these choices were being adhered to. People and relatives were not supported to discuss support and make choices or changes to this if they chose to do so.

We received mixed feedback from people about being supported with their immediate needs. One person said, ‘‘I sometimes have to wait a long time to be seen to. It is worse at night time.’’ Another person told us, ‘‘It is sometimes easier not to ask for things as staff do not always have the time to help you.’’ A relative explained, ‘‘I worry staff do not make sure [family member] is eating and drinking. They became very dehydrated recently.’’ However, people’s comments also included, ‘‘There is always someone about to help out.’’ and, ‘‘I feel safe because I know staff would help me if I got in any bother.’’ However, despite people’s comments, people were at risk of not having their immediate needs met or noticed by staff as explained in the rest of this quality statement.

Staff told us they helped people by giving them a drink or supporting them with personal care if they needed this. However, they were unable to tell us the signs to look out for if a person was becoming unwell because of their health condition. For example, although staff had training in supporting people living with diabetes, they were unable to tell us what signs may indicate a person needed immediate support with this. The management team updated people’s care plans if their needs changed, however did not always do this in a timely manner, meaning people’s immediate changing needs were not being addressed. The management team were not reviewing people’s daily care and support records to ensure people’s immediate needs would be responded to.

People’s immediate needs were not responded to in a timely fashion. One person was observed asking to go to the bathroom for an extended period of time before staff responded. Another person was calling for staff support as another person had entered their room for an extended period of time. Another person was visibly needing support with personal care but staff did not respond to this. In each of these circumstances we had to alert staff to support people. Peoples immediate needs in relation to mental health and well being and being engaged with were not being met as staff did not speak with people unless supporting them with personal care tasks. There were know issues with the building as discussed in the safe environments and infection prevention control quality statements. These had not been dealt with and posed a risk to people’s immediate care needs.

Staff told us they enjoyed working at the service. However, staff were not being supported with supervisions or meetings to discuss and potentially improve their practice. The management team were not able to tell us about how they supported staff in their job roles.

Processes were not in place to support staff in their job roles. Staff were not supported to have supervisions or staff meetings to discuss and potentially improve in their job roles. Competency checks were not in place to help make sure staff were confident in their job roles. We discuss this in full under the Safe Staffing quality statement.