CQC report explained · a residential care home
What the CQC found at Hill Farm
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found effective safeguarding, safe recruitment, suitable risk assessments and generally well-managed medicines. They did identify one medicine recording error, some unclean areas and possible pressure on staffing when staff were also doing domestic tasks.
- Effective?
- Good
- Staff had completed mandatory and needs-specific training. People received support with food, healthcare and appointments, and the home followed the principles of the Mental Capacity Act where required.
- Caring?
- Good
- This question was not inspected during this focused visit. No new concern was identified from the information reviewed, but the previous rating was carried forward.
- Responsive?
- Requires improvement
- This question was not inspected during this focused visit. No new concern was identified from the information reviewed, but the previous rating was carried forward.
- Well-led?
- Good
- Audits and action plans were in place and earlier regulatory breaches had been addressed. However, the home was still improving its management arrangements, premises and staff training.
What inspectors found, April 2022
Hill Farm was rated Good; inspectors found safe, effective and well-led care, but noted issues with cleanliness, medicines records and some communication.
Inspectors made an unannounced visit on 6 October 2021. They observed care, spoke with people, staff, a relative and a health professional, and checked care, medicines, recruitment and management records.
The home supported five people with learning disabilities, including people with sensory impairments and autism. Inspectors found that staff knew people well, supported their choices and helped them gain skills. Safeguarding, staff training, risk assessments, healthcare and medicines management were mostly effective.
There were some shortfalls. One medicine had been recorded as given when it had not been, some areas were not completely clean, and staffing arrangements could leave care staff doing cleaning and cooking instead of care. Inspectors also found some communication could be patronising and that a person's wish to go bowling had not been risk assessed.
The overall rating was Good. Safe, Effective and Well-led were rated Good. Caring and Responsive were not inspected during this visit, so their previous ratings were used in the overall result. The rating improved from Requires Improvement after earlier breaches were addressed.
Staff training
Staff had completed both general and needs-specific training to support people with complex needs safely. They also received regular supervision and competency checks.
“Staff had completed the provider's mandatory training to give them the skills and knowledge they needed to support people with complex needs safely.” from the report
Personal development
People were supported to make choices, build skills and take part in activities according to their wishes.
“Right support: Model of care and setting maximises people's choice, control and independence. People had been supported to gain new skills.” from the report
Healthcare support
Staff recognised changes in people's health and worked with a range of healthcare professionals. People were supported to attend appointments and receive treatment when needed.
“People received effective, timely and responsive medical treatment when their health needs changed.” from the report
Safeguarding
The home had safeguarding systems, trained staff and a whistle-blowing process. Inspectors found that staff knew how to identify and report possible abuse.
“The provider had effective safeguarding systems in place to protect people from the risk of abuse.” from the report
Quality improvement
The provider used audits and action plans to identify and address problems. The earlier breaches had been resolved by this inspection.
“At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.” from the report
Medicine recording error
seriousOne person's medicine had not been given because they were asleep, but the record wrongly showed it had been administered. The error was not found for more than 24 hours, although no impact on the person's health was identified.
“They found that the person had not received medicines because they had been sleeping and a staff member had wrongly recorded that they had been given as prescribed.” from the report
Cleanliness
needs fixingSome areas were not completely clean. The provider had arranged deep cleaning and a review of cleaning schedules.
“Some areas of the service were not completely clean, the provider had also identified this and was arranging for some deep cleaning to take place and a review of cleaning schedules.” from the report
Staffing and domestic tasks
needs fixingStaffing was suitable during the visit, partly because extra senior staff were present. Rotas showed that care staff could be taken away from people to cook and clean, creating a risk that care needs might not be met.
“Whilst we did not witness any impact on people of this, because extra staff were on shift when we inspected, there was potential for people to have their care needs unmet because of this.” from the report
Communication
needs fixingInspectors saw both good and poor communication. Some language used by staff could be patronising and did not help people express their own wishes.
“Talking in this manner did not enable the person to communicate their own views and wishes.” from the report
Access to activities
needs fixingA person regularly communicated that they wanted to go bowling, but the home had not completed a risk assessment to see how this could happen safely.
“However, the provider had not carried out a risk assessment to see how the person could be supported to go bowling in a safe way.” from the report
Management arrangements
minorThere was no registered manager when inspectors visited because the previous manager had left. The provider was recruiting a new manager and seeking to provide more consistent management support.
“The service did not have a manager registered with the Care Quality Commission (CQC).” from the report
- 01What checks are now in place to make sure medicines are counted and recorded correctly every time?
- 02Have the deep cleaning and cleaning schedule changes been completed, and how is cleanliness checked now?
- 03Who carries out cooking and cleaning duties, and how do you make sure enough staff remain available for people's care?
- 04How do staff communicate with people who have limited verbal communication without speaking for them or being patronising?
- 05Has the home completed a risk assessment to support the person who wants to go bowling, and what activities are currently available?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 27 April 2022 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, October 2020
Inspected but not rated; inspectors found safer medicines and risk management, but concerns remained about recruitment, staff training and quality checks.
This was a targeted inspection on 8 September 2020. Inspectors checked actions taken after the previous inspection, including medicines, risk management, staff training and how the service checked its quality. They spoke with relatives and staff, observed people receiving support, and reviewed care, recruitment and management records.
The home had improved medicines management and individual risk assessments. There were enough staff, and relatives said staff knew people well. People appeared relaxed and happy with staff. Meals were offered in ways that supported people's choices and needs.
There were still important shortfalls. Recruitment checks did not fully explore a staff member's work history. Two staff had not completed the provider's mandatory training, and new staff could work shifts before completing required training. Staff were also seen wearing face masks incorrectly on two occasions.
The inspection did not give new ratings. Safe, Effective and Well-led remained recorded as 'Inspected but not rated', and their previous Requires improvement ratings were not changed. The provider was in breach of Regulations 17, 18 and 19.
Safer medicines
Medicines were stored, managed and recorded safely. The provider had improved this since the previous inspection.
“Medicines were now stored, managed and disposed of in line with guidance. Medicines were kept at the correct temperatures to maintain their efficiency.” from the report
Individual risk planning
Risks such as choking, mobility needs and epilepsy were assessed and reviewed. Staff followed the guidance observed during the inspection.
“Risks to people's health, safety and welfare had been assessed, managed and reviewed.” from the report
Enough staff
Inspectors found enough staff to provide the support people needed. Relatives said staff knew people's needs and routines well.
“There were enough staff to provide people with the care and support they needed. People were relaxed in the company of staff and each other.” from the report
Support with food choices
People had healthy meal choices and were supported to choose using pictures and objects. Adaptive cutlery was available where needed.
“People had a choice of healthy balanced meals. Staff used a variety of methods to support people to choose their meals, such as picture cards and objects of reference.” from the report
Unsafe recruitment checks
seriousThe provider did not fully check a staff member's employment history or investigate differences between their application, CV and reference. This was a breach of Regulation 19.
“The failure to ensure staff were recruited safely is a breach of Regulation 19 (Fit and proper persons employed) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Incomplete staff training
needs fixingTwo staff had not completed the provider's mandatory training. New staff could also begin shifts before completing required training, including training about epilepsy, autism and challenging behaviour.
“Both staff had not completed any training the provider considered as mandatory.” from the report
Quality checks missed problems
needs fixingThe home's audits did not identify failures in recruitment or address training shortfalls promptly. This was a breach of Regulation 17.
“The provider had failed to assess, monitor and improve the quality and safety of the service.” from the report
Masks not worn correctly
needs fixingStaff lowered their masks below their chins while supporting people and while in the lounge. Inspectors said this increased the risk of COVID-19 infection.
“This increased the risks of contracting COVID-19 for people and staff.” from the report
- 01What checks do you now complete on every applicant's full employment history, including unexplained gaps and differences between application forms, CVs and references?
- 02Have all staff completed mandatory training, including epilepsy, autism and challenging behaviour, before working shifts?
- 03How do you make sure new staff complete a robust induction before supporting people independently?
- 04What changes have you made to quality audits so that recruitment and training problems are found and corrected promptly?
- 05How do you now monitor correct mask wearing and other infection control arrangements?
This was a targeted inspection of specific concerns about risks, medicines, staff training and quality monitoring; it did not reassess the full key questions, and the previous Requires improvement ratings carried over. This explanation was written from the published report of 13 October 2020 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 Hill Farm
3 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- April 2022Goodcurrent ratingSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- October 2020Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not ratedWell-led: Inspected but not rated
- February 2020Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- November 2018Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- July 2018
Registered with the Care Quality Commission on 6 July 2018.
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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