CQC report explained · a residential care home
What the CQC found at Hill House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People felt safe, there were enough staff, and care plans and risk assessments were reviewed. Medicines were administered safely, although some prescribed cream instructions in the records were not consistent and were corrected during the inspection.
- Effective?
- Good
- Staff supported people to access health services, follow professional guidance and make choices. Guidance about how much fluid some people should drink was not clear at first, but documentation was updated during the inspection.
- Caring?
- Good
- People and relatives said they felt listened to and supported. Inspectors found that staff respected privacy, dignity, equality and personal choices, and encouraged people to be independent.
- Responsive?
- Good
- The report does not give a rating for Responsive.
- Well-led?
- Good
- Staff and relatives expressed confidence in the management team. However, staff were still not always recording when care tasks had been offered or completed, so documentation was changed during the inspection.
What inspectors found, March 2021
Rated Good; inspectors found safe, kind and effective care, with some records and environmental issues needing attention.
The inspection was unannounced and took place over five days in February 2021. One inspector visited the home, while both inspectors reviewed records and spoke by telephone with staff, families and professionals. They also checked infection prevention and control measures.
The home was rated Good overall. Safe, Effective, Caring and Well-led were all rated Good. Inspectors found that people felt safe, staff understood their needs, medicines were given safely, and people were treated with kindness, dignity and respect.
The inspection followed whistleblowing and safeguarding concerns about possible neglect, abuse, medicines, waste and the environment. Inspectors found no evidence that people were at risk of harm from these concerns. Some issues were identified and dealt with during the inspection or through planned action.
People felt safe
People and relatives said they felt safe. Staff knew how to recognise and report abuse, and risk assessments reflected people's individual needs.
“Care plans and risk assessments identified people's individual support needs and ways to help people stay safe.” from the report
Kind and respectful care
Inspectors found that people were treated with compassion and respect. Staff supported privacy, dignity, choice and independence.
“People were treated with kindness and compassion. People's privacy and dignity was maintained.” from the report
Good health support
People had access to health appointments, annual health checks and support from community professionals. Staff followed professional guidance about food, fluids and care.
“There was good involvement with community professionals. Staff knew how to raise concerns.” from the report
Choice and control
People were supported to make choices and to live as independently as possible. Mental capacity assessments and best-interest decisions were completed where needed.
“People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests;” from the report
Improved management
The rating improved from Requires Improvement to Good. Audits and action plans were being used to identify and track improvements.
“Systems were effective for monitoring the quality and safety of the services provided.” from the report
Care tasks were not always recorded
needs fixingInspectors found the same recording problem as at the previous inspection. Staff were not always recording whether care had been offered, declined or provided, although the paperwork was changed during this inspection.
“During the last inspection we found staff were not always recording when they had supported a person with care tasks. We found the same issue at this inspection.” from the report
Medicine records needed correction
needs fixingSome medicine records, including instructions for prescribed creams, were not accurate or consistent. The records were corrected during the inspection and inspectors found no harm had resulted.
“We found some records were not always accurate, for example prescribed cream instructions were not consistent but these issues were resolved during the inspection and there had been no harm caused to people.” from the report
Waste and environmental upkeep
needs fixingThe outside bin area was overflowing and contained debris, including a clinical waste bag outside the clinical waste bins. The area was cordoned off, and the home said it had been cleared and that a waste removal contract had been agreed. Inspectors also noted marks, stains and general wear and tear inside.
“There was also debris such as kitchen equipment and cardboard boxes in the areas and a clinical waste bag that had not been put into the clinical waste bins.” from the report
Some policies and guidance were unclear
minorThe infection control policy did not point clearly to the COVID-19 risk assessments and procedures. Guidance on daily fluid amounts was also unclear for some people, but the documentation was updated during the inspection.
“There was an infection prevention control policy in place, however this did not signpost to the COVID-19 risk assessments and procedures that had been put in place.” from the report
- 01How do you now check that staff record when personal care has been offered, declined or provided?
- 02How are medicine records, including prescribed cream instructions, checked for accuracy?
- 03Has the outside waste area stayed clear, and how does the new waste removal contract work?
- 04What daily fluid guidance applies to my relative, and how is their intake monitored?
- 05What changes have been made to the proposed management structure, and how were families kept informed?
This unannounced inspection covered the overall service, including Safe, Effective, Caring and Well-led, as well as infection control; the report does not give a Responsive rating. This explanation was written from the published report of 17 March 2021 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 2020
Rated Requires Improvement; inspectors found clear progress after an inadequate rating, but medicine records, health follow-up and management checks still needed strengthening.
Inspectors visited without notice on 20 and 26 February 2020. They spoke with people, relatives and staff, and checked care records, medicines, recruitment files and management records.
The home had improved since its previous inspection, which was rated Inadequate. Risk assessments, care plans, safeguarding and staffing had improved. People were generally supported to make choices, join activities and access the community.
There were still shortfalls. Inspectors found errors in medicine records, one missed or unrecorded health appointment, some care support that was not recorded, and language in records that was not always respectful. Management checks had not found some of these issues.
The overall rating was Requires Improvement. Safe, Effective, Caring and Well-led were also Requires Improvement. Responsive was Good. The home was no longer in breach of regulations or Special Measures, but CQC said improvements needed to be sustained.
Updated risk planning
Care plans and risk assessments had been reviewed. Inspectors found that identified risks had been reduced and staff understood how to keep people safe.
“Since the last inspection, care plans and risk assessments had been reviewed and areas of risk have been identified and mitigated for people.” from the report
Improved safeguarding
The manager had investigated recent incidents and made referrals to relevant authorities. Staff understood how to report concerns, including outside the home.
“We reviewed incidents that had occurred since the last inspection and saw they had been investigated and appropriate referrals had been made to relevant authorities.” from the report
Kind interactions
People appeared happy and relaxed with staff. Inspectors saw people being treated with dignity and respect, and relatives described staff as kind.
“During this inspection we observed people living at Hill House were treated with dignity and respect and observed positive interactions between staff and people.” from the report
Personalised support
Care plans included people's preferences and information about what made a good or bad day. People could choose their clothes, food and activities.
“This showed care was planned and personalised to meet people's needs.” from the report
Medicine recording errors
needs fixingThe stock balance for one person's paracetamol did not match the expected amount. A medicine administration entry was also recorded incorrectly.
“There was one occasion where the balance of a person's paracetamol did not match with what should have been left in stock.” from the report
Care support not always recorded
needs fixingStaff did not always record three-hourly personal care support intended to prevent sore skin. New paperwork had been introduced after inspectors raised this.
“Staff were not always recording when they had supported the person.” from the report
Health appointment follow-up
needs fixingOne medical appointment was not recorded, and a follow-up optician appointment had not been booked. The appointments were arranged during the inspection.
“In addition, a follow up opticians' appointment had not been booked for the person even though it had been recorded they needed one.” from the report
Respectful record keeping
needs fixingSome descriptions of people's behaviour in daily records were not respectful. The manager said this had been raised with staff and was being addressed.
“The language staff used, when they were recording how people's days had been, was not always respectful.” from the report
Management checks missed issues
needs fixingAudits had not identified the medicine recording problems or the missing health appointment information. Some actions from feedback surveys were also not documented.
“The systems in place to audit medicine had not identified issues we found with the recording and stock balances of medicines.” from the report
- 01What daily and management checks now make sure medicine stock and administration records are accurate?
- 02How do you make sure every health appointment, referral and follow-up is recorded and completed?
- 03How do you check that planned personal care, such as three-hourly support, is provided and recorded?
- 04What training and checks are in place to ensure people's daily records use respectful language?
- 05How are improvements from the action plan and risk register being monitored since the home left Special Measures?
This was an unannounced inspection covering all five key questions, but it did not examine the circumstances of the serious injury incident because that matter was subject to a criminal investigation. This explanation was written from the published report of 22 April 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 House
7 rated inspections over 5 years: the service has improved, from Requires improvement to Good.
- March 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2020Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementWell-led: Requires improvement
- February 2020Inadequatedown from GoodSafe: InadequateEffective: InadequateCaring: InadequateResponsive: Requires improvementWell-led: Inadequate
- April 2019Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2017Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2017Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- June 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- June 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 25 November 2010.
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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