CQC report explained · a residential care home
What the CQC found at Hill View
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, June 2023
Rated Requires Improvement; care was kind and person-centred, but safety and leadership needed improvement, although special measures ended.
This was an unannounced follow-up inspection. Inspectors visited on 3 May 2023 and reviewed care, medicines, staffing, records, infection control and how the home was managed. They spoke with relatives and staff, observed care and reviewed records.
The home had improved greatly since its previous inadequate rating. Inspectors found good care, effective support and personalised activities. People were supported to make choices, stay independent and use local community services.
Safety and leadership were still rated Requires Improvement. Inspectors found risks were not always managed properly, staffing at night did not always reduce risks, and some records were unclear or out of date. The home was no longer in special measures, but it remained in breach of Regulation 12.
Kind, personalised care
Inspectors saw positive relationships between staff and people. Care was adapted to individual needs, preferences and communication styles.
“People received kind and compassionate care and were supported in a person-centred way.” from the report
Detailed care planning
Care plans contained useful information about people's current needs, communication and personal goals.
“Care plans were well written and contained a high level of detail, and reflected people's current needs.” from the report
Community activities
People were supported to use local services and take part in activities such as clubs, walks, shopping and day trips.
“We saw people were supported to regularly access community services.” from the report
Improvement since the last inspection
The provider had addressed several earlier problems, including training, medicines, infection control, consent arrangements and complaints.
“Since the last inspection, there had been many improvements in the service.” from the report
Risks were not always controlled
seriousSome risks were still not properly assessed or reduced. This included unclear food guidance, unsupervised epilepsy monitors and failures to learn from some incidents.
“Risks relating to the health and safety of people had not always been established, assessed and mitigated.” from the report
Night staffing
seriousThree staff supported eight people overnight, including two people needing one-to-one support. Inspectors were not assured that staffing was enough to keep people safe.
“[Person] or [person] gets left on their own a while, during evening personal care, pad changes, repositioning of other service users.” from the report
Unsupervised epilepsy monitors
seriousMonitors were left switched on and unsupervised in shared areas. Inspectors said this increased the risk if someone had a seizure.
“Leaving epilepsy monitors unsupervised left people at increased risk should they have a seizure.” from the report
Records and oversight
needs fixingSome records were not accurate or up to date, although managers corrected issues found during the visit. A new manager had started but was not yet registered.
“The service also needed to ensure all records were accurate and up to date.” from the report
- 01What is the current night staffing arrangement, and how do you make sure people needing one-to-one support are not left alone?
- 02How are food texture and thickener instructions checked so that every staff member follows the same guidance?
- 03Where are epilepsy monitors used, and how do you make sure they are supervised appropriately?
- 04How are accidents and incidents now recorded, reviewed and used to prevent similar events?
- 05Who is currently responsible for management, and what is the progress of the new manager's registration?
This was an unannounced follow-up inspection covering the service's overall quality, with particular follow-up of earlier concerns and infection prevention and control; all five key-question ratings were given. This explanation was written from the published report of 14 June 2023 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, February 2023
Rated Inadequate and remains in special measures; a follow-up found some improvements but unresolved safety and governance breaches.
This was a targeted inspection on 19 December 2022 and 09 January 2023. It followed two warning notices about safe care and treatment and good governance. The inspector reviewed records, risk assessments, audits and policies, spoke with staff and managers, and observed interactions with people.
Some improvements had been made. Staff understood people's needs, arrangements had improved for protecting skin, and medicine storage was safer. However, important risks were still not managed consistently. These included choking, catheter care, epilepsy, fire safety and legionella linked to the hot tub.
Records and management checks were still not reliable enough. Some care plans lacked clear guidance, medicine records had a gap, and audits had not found all the problems. The home had no registered manager in post, although an operations manager and other managers were supporting improvements.
The overall rating remains Inadequate and the home remains in special measures. Safe and Well-led were inspected but not rated because this was not a full review of either question. The previous inadequate ratings were used for the overall rating.
Staff understood people
Staff showed a good understanding of people's needs. Staff were also working to provide safe and good-quality support.
“Staff showed a good understanding of people's needs and an operations manager was in place to support the provider to make the required improvements.” from the report
Skin care improvements
The management team had made arrangements to help protect people's skin. Health professionals had visited and suitable equipment was in place.
“At this inspection, we found the management team had made the necessary arrangements and amendments to ensure people's skin integrity was maintained safely.” from the report
Infection control practices
The inspector was assured that protective equipment, hygiene and responses to infection risks were being managed effectively.
“We were assured that the provider was using PPE effectively and safely in line with national guidance.” from the report
Additional management support
A new operations manager had been recruited to oversee improvements across the provider's homes and had regular contact with the CQC.
“The provider had recruited a new operations manager in October 2022 who had experience of managing care homes.” from the report
Incomplete risk guidance
seriousCare plans and records did not consistently explain the risks or the action staff should take. This affected choking, catheter care, epilepsy and pressure damage.
“We found a care plan still referred to choking and dysphagia guidance which was difficult to locate in the records.” from the report
Fire and hot tub risks
seriousSome fire risk recommendations had not been completed, including reliable smoke detection in the annexes. The provider had not supplied evidence that hot tub maintenance controlled legionella risks.
“We also found there was not a reliable system of smoke detection in the annexes.” from the report
Medicine recording gap
seriousNot all PRN medicine protocols had been reviewed, and an audit had missed a gap in a medicine administration record.
“We found a gap in a MAR chart that the provider's auditing system and processes had not identified.” from the report
Weak governance and records
seriousQuality checks had not identified or resolved all the problems. Daily records and care plans were not always complete, accurate or clear.
“There continued to be a lack of accurate, complete and contemporaneous records in respect of each person.” from the report
No registered manager
needs fixingThere was no registered manager in post, despite a registration condition requiring one. Other managers were covering the service while recruitment was under way.
“At the time of our inspection there was not a registered manager in post.” from the report
- 01What has been done to provide clear choking and thickened-fluid guidance in every relevant care plan and kitchen?
- 02How are catheter output, epilepsy monitoring and pressure-area risks now recorded and reviewed?
- 03Have the fire alarm links, smoke detection in the annexes and the laundry evacuation route been fixed?
- 04What service agreement is now in place to manage the hot tub and legionella risk?
- 05Who is currently responsible for managing the home, and when will a registered manager be appointed?
This was a targeted inspection of specific parts of Safe and Well-led to follow up warning notices; it did not assess the whole of either question, and the other ratings carried over from the previous inspection. This explanation was written from the published report of 10 February 2023 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 View
5 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- June 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2023Inadequatestayed InadequateSafe: Inspected but not ratedWell-led: Inspected but not rated
- October 2022InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- December 2020Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not ratedCaring: Inspected but not ratedResponsive: Inspected but not ratedWell-led: Inspected but not rated
- August 2018Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2017Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2015
Registered with the Care Quality Commission on 8 July 2015.
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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Most charge £990 to £1,280 a week. 34 can care for a couple. 12 years' experience on average.
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