CQC report explained · a nursing home
What the CQC found at Hilderstone Hall
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People told inspectors they felt safe. Risks, medicines, staffing, recruitment, infection control and learning from incidents were managed safely.
- Effective?
- Good
- People's needs were assessed and reviewed, staff were trained, and people received suitable support with food, healthcare and decisions about their care.
- Caring?
- Good
- Staff treated people with kindness, dignity and respect. People were involved in decisions and encouraged to remain independent.
- Responsive?
- Good
- Care was planned around people's preferences and interests. People knew how to complain, and records showed complaints were responded to.
- Well-led?
- Good
- The home had effective quality checks, approachable management and opportunities for people, relatives and staff to give feedback. There was no registered manager in post during the visit, but interim arrangements were judged suitable.
What inspectors found, May 2019
Rated Good; inspectors found safe, kind and personalised care, with suitable management arrangements while a new manager was being recruited.
Inspectors visited unannounced on 16 April 2019. They spoke with people, relatives, staff and managers, observed care, checked six care records and reviewed staffing, complaints and quality records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines systems, accurate care records and staff who knew people's needs and preferences.
People were involved in choices about their care, food and activities. The home had improved since the previous inspection, when it was rated Requires Improvement, and now met the standard for Good in every area.
People felt safe
People and relatives told inspectors they felt safe. Staff understood how to recognise and report abuse and how to manage risks.
“People told us they felt safe. One person said, "Yes I feel safe here. I have no reason to feel otherwise.” from the report
Personalised care
Staff knew people's likes, dislikes and preferences. Care records were up to date and people were involved in regular reviews.
“People told us staff knew them well and respected their choices. One person said, "Yes they know me well.” from the report
Kind and respectful staff
Inspectors observed staff treating people with kindness and compassion. People said their privacy, dignity and independence were respected.
“We saw staff treated people with kindness and compassion when speaking with them throughout the day.” from the report
Good food and nutrition support
People had choices at mealtimes and enjoyed the food. Staff followed specialist advice for people with complex nutritional needs.
“We observed a positive mealtime experience where people were offered three courses, choices and alternatives to the menu and a comprehensive choice of drinks including wine and sherry.” from the report
Improvement since the last inspection
The home improved from Requires Improvement at the previous inspection to Good in all five areas at this inspection.
“The service had made improvements since the last inspection and now met the characteristics of Good in all areas” from the report
No registered manager at the visit
minorA registered manager was not in post when inspectors visited. The provider had recruited a new manager and had suitable interim cover, but families should check the current management arrangements.
“There was no registered manager in post at the time of the inspection.” from the report
- 01Is there now a registered manager in post, and how long have they been in the role?
- 02How many staff are on duty at different times, and how do you make sure staffing levels meet people's needs?
- 03How are each person's risks, care needs and preferences reviewed when they change?
- 04How do you support people with complex nutrition needs and follow advice from healthcare professionals?
- 05What changes were made after the previous Requires Improvement rating, and how do you check that these improvements continue?
This was an unannounced inspection covering all five key questions; the previous rating was Requires Improvement in a report published on 28 April 2018. This explanation was written from the published report of 10 May 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, April 2018
Rated Requires Improvement; inspectors found major progress and kind care, but some risks were not managed consistently, and the home had only recently left special measures.
This was an unannounced inspection on 16 March 2018. Inspectors spoke with people, visitors, managers, staff and a healthcare professional. They observed care and checked care records, medicines records, staff training, complaints, accidents and quality checks.
The home had improved significantly since the previous inspection in September 2017, when it was rated Inadequate and placed in special measures. It was no longer Inadequate in any area and had left special measures.
Inspectors found enough staff, safer medicines systems, clean premises and trained staff. People received kind and respectful care, had personalised care plans, suitable activities and access to healthcare.
The overall rating was Requires Improvement. Safe and well-led were also Requires Improvement because risk assessments and management checks were not yet consistently effective or proven to be sustainable. Effective, caring and responsive were rated Good.
Kind and respectful care
People were treated with kindness and respect. Staff knew people well and made time to support them.
“Staff were kind, caring and compassionate with people.” from the report
Enough staff
Inspectors found staffing levels had improved and staff were available to help people. The home had recruited suitable staff and had no vacant posts at the time.
“People told us there were enough staff on duty to meet their needs and we observed that staff were nearby to assist people when needed.” from the report
Improved medicines management
Medicines were administered safely, records confirmed people received prescribed medicines, and systems were in place for ordering and stock control.
“This showed that improvements had been made to ensure the proper and safe use of medicines.” from the report
Personalised activities and care
Care plans reflected people's preferences and a range of activities was offered every day of the week. One-to-one activities were also available.
“Additional activities staff had been recruited which meant that activities were on offer seven days per week and that there was more support available for people who needed help or encouragement to participate.” from the report
Risk assessments were not always accurate
seriousA transfer risk was not assessed to reflect that a person pushed backwards, even though staff knew this happened. The wheelchair nearly tipped during the inspection.
“The service was not consistently safe.” from the report
Choking guidance was not followed
seriousOne person was meant to eat using a teaspoon because of a high choking risk, but inspectors saw staff use a fork instead.
“we observed that they were supported using a fork which was not in line with professional guidance.” from the report
Improvements needed to last
needs fixingThe provider had improved its systems, but inspectors could not yet be assured that these changes would continue as the home changed.
“However, further work was required to ensure this was sustainable.” from the report
Some end of life wishes missing
needs fixingSome people's wishes about end of life care were recorded, but this information was missing from some care plans. The home had started work to address this.
“However some people's plans did not include this information.” from the report
- 01How do you now assess and update risks for people who push backwards or may fall during transfers?
- 02How will you make sure staff follow professional guidance about the correct utensils and textures for people at risk of choking?
- 03What checks are now used to make sure risk assessments and care plans are accurate and up to date?
- 04Have all residents' end of life wishes now been discussed and recorded in their care plans?
- 05How are you checking that the improvements found at this inspection are continuing?
This was an unannounced inspection covering all five key questions, including the premises, care, records, medicines, staffing and management systems. This explanation was written from the published report of 28 April 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Hilderstone Hall
4 rated inspections over 4 years: the service has held its Good rating throughout.
- May 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2018Requires improvementup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2018Inadequatedown from GoodSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- May 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 15 February 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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