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
- Inspectors found that people were safe and protected from avoidable harm. Staffing, training, risk management, medicines and infection control had improved, although some medicine and safety records were incomplete.
- Effective?
- Good
- This key question was not inspected during this focused visit. Its previous rating was used when calculating the overall rating.
- Caring?
- Good
- This key question was not inspected during this focused visit. Its previous rating was used when calculating the overall rating.
- Responsive?
- Good
- This key question was not inspected during this focused visit. Its previous rating was used when calculating the overall rating.
- Well-led?
- Requires improvement
- The new manager had made improvements and people spoke positively about the changes. However, records were not always accurate or up to date, and management systems still needed further embedding.
What inspectors found, August 2022
Hill House is rated Good overall; inspectors found safe care and improvements, but leadership and record-keeping still needed improvement.
Inspectors made an unannounced visit on 9 June 2022. They spoke with people living in the home, visitors, staff and health professionals. They also checked care and medicine records, staff files, safety checks, infection control and management records.
People were generally safe and felt well supported. Staffing levels had increased, staff training had improved, medicines were mostly managed safely and pressure-relieving equipment was checked. Visitors were being supported in line with infection control guidance.
The home was rated Good for Safe. It was rated Requires Improvement for Well-led because quality systems were still being embedded. Some records were incomplete or out of date, and parts of the building needed refurbishment.
This was a focused inspection of Safe and Well-led. The other key question ratings were carried forward from the previous inspection, and the overall rating improved from Requires Improvement to Good.
People felt safe
People, relatives and professionals expressed confidence in the care. Staff knew how to report safeguarding concerns.
“Everyone we spoke with said they felt safe at Hill House.” from the report
Improved staffing and training
Staffing levels had increased and training had improved. More than 90% of staff training was fully up to date, with supervision and appraisals taking place.
“At this inspection improvements had been achieved with over 90% of staff training now fully up to date.” from the report
Safe equipment and risk checks
Pressure mattresses were set correctly and equipment such as hoists and wheelchairs was checked. Staff had guidance about people's risks, diets and fluid needs.
“All pressure mattresses were set at the correct setting; however, a maintenance alert was showing on one mattress.” from the report
Incomplete medicine records
needs fixingSome topical cream administration charts were not completed, so inspectors could not be sure creams had always been applied as prescribed. Fridge temperature records also had gaps.
“However, staff had not completed all administration records so we could not be sure people had their cream applied as prescribed.” from the report
Records needed closer checking
needs fixingSome mattress checks and care plan records were not up to date. One nutrition care plan did not show a change in diet, although staff knew about the change and provided the correct food.
“We found some records were not fully up to date.” from the report
Some call bell delays
needs fixingMost calls were answered quickly, but two people reported delays. One person said they could wait 30 minutes, mainly at busy times.
“Two people felt there were delays at times with staff responding to call bells, one said they could wait 30 minutes for staff.” from the report
Worn communal areas
minorCarpets in communal areas were heavily stained and worn. An environmental improvement plan was being developed.
“Parts of the environment were in need of refurbishment.” from the report
- 01How are you checking that topical cream records are completed every time?
- 02How do you make sure fridge temperatures, mattress checks and care plans are recorded accurately and promptly?
- 03What are the usual and longest call bell response times, especially during busy morning periods?
- 04What is the timetable for replacing the stained and worn communal carpets?
- 05How much agency staff are currently being used, and how are you ensuring they know each resident's needs?
This was an unannounced focused inspection of Safe and Well-led only; the other key question ratings were carried forward from the previous inspection. This explanation was written from the published report of 5 August 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, April 2021
Rated Requires Improvement; inspectors found kind staff, but medicines and risk management were not always safe.
This was a focused inspection after safeguarding concerns. Inspectors visited on 3 and 9 March 2021, spoke with people, relatives, staff and health professionals, and checked care, medicine and management records. They looked mainly at Safe and Well-led, including infection control.
The home was not always safe. Medicines were not consistently managed correctly, and records did not always show that medicines and creams had been given as prescribed. Inspectors also found risks involving pressure-relieving mattresses, falls, food and fluids were not always properly assessed or managed. Some people waited too long for help, including waits of more than 10 minutes for call bells.
The home was not always well-led. Audits and other checks had failed to identify important problems, and improvements identified earlier had been slow. People and relatives spoke positively about staff being kind and caring. The overall rating changed from Good at the previous inspection to Requires Improvement.
Kind and caring staff
People and relatives were positive about the care and said staff were helpful, friendly and kind.
“Staff are lovely, that makes a difference. Everybody is so kind and that makes me feel ok” from the report
Safeguarding awareness
Staff knew about different types of abuse and what to do if they were worried. The provider worked openly with the local authority during the safeguarding investigation.
“Staff knew what they should do if they suspected abuse or had any concerns.” from the report
Equipment safety checks
Checks and maintenance were in place for equipment and installations, including hoists, gas and electrical systems.
“Systems were in place which ensured safety checks and maintenance were completed on equipment such as hoists, gas and electrical installations.” from the report
Learning from incidents
The provider investigated concerns about equipment use and clinical observations, then introduced new policies and procedures.
“As a result, new policies and procedures were put in place and staff made aware of what they needed to do to improve outcomes for people.” from the report
Medicines were not always safe
seriousOne person's weekly medicine was missed for three weeks. Other medicine records were incomplete, and audits had not found these problems.
“Medicines for one person had not been administered as prescribed.” from the report
Risks were not properly managed
seriousAll eight pressure-relieving mattresses checked were set incorrectly. Food and fluid records had significant gaps, and some care plans did not reflect current risks.
“We looked at the setting for eight mattresses and found none were set to the appropriate setting.” from the report
Long waits for assistance
needs fixingCall-bell response times were not consistently within the home's five-minute target. Some people waited between 12 and 15 minutes, and one waited 24 minutes.
“On some occasions people had waited for between 12 and 15 minutes and on one occasion for 24 minutes before they were assisted.” from the report
Weak quality checks
seriousAudits and action plans had not reliably identified or fixed problems with medicines, records and staff training. The report says this breached the good governance regulation.
“Effective robust arrangements were not in place to monitor the service and identify and address shortfalls.” from the report
Infection control records
minorSome cleaning records were incomplete, not all staff were wearing the correct protective equipment, and clean laundry did not have a separate storage area.
“We were somewhat assured that the provider was using PPE effectively and safely.” from the report
- 01What has changed in medicine administration and auditing since the inspection, and how do you check that every dose and cream application is recorded?
- 02How are pressure-relieving mattresses now set, checked and recorded for each person?
- 03What are the current call-bell response times, and how do you make sure people do not wait too long for help?
- 04How are food and fluid intake records checked for people at risk of malnutrition?
- 05Who is currently managing the home, and what progress has been made on the CQC action plan and outstanding staff training?
This was a focused inspection of Safe and Well-led, with infection prevention and control also considered; Caring, Effective and Responsive were not reassessed and their previous ratings carried over. This explanation was written from the published report of 16 April 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.
Every inspection of Hill House
5 rated inspections over 7 years: the service has held its Good rating throughout.
- August 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- September 2018Goodup from Requires improvementSafe: GoodWell-led: Good
- August 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- September 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- January 2012
Registered with the Care Quality Commission on 26 January 2012.
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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