CQC report explained · a residential care home
What the CQC found at Hilton House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found problems with room sensors, staffing deployment, risk records and temperature monitoring. Medicines, recruitment checks and infection control were generally managed safely.
- Effective?
- Good
- This question was not inspected during this visit. The previous comprehensive inspection rating was used.
- Caring?
- Good
- This question was not inspected during this visit. The previous comprehensive inspection rating was used.
- Responsive?
- Good
- This question was not inspected during this visit. The previous comprehensive inspection rating was used.
- Well-led?
- Requires improvement
- Management oversight was not always strong enough to control risks. New audits and monitoring systems had been introduced, but they had not been in place long enough to show whether they were effective.
What inspectors found, January 2022
Hilton House was rated Requires Improvement; inspectors found risks were not always managed safely, although medicines and infection controls were generally satisfactory.
This was an unannounced focused inspection on 17 November 2021. Inspectors looked at Safe and Well-led, spoke with relatives and staff, and reviewed care, medicines, recruitment and management records.
The home was not always safe. Room sensors were sometimes set incorrectly, staffing on one floor was insufficient, and care records did not always explain how risks such as poor eating, drinking or repositioning were managed. Temperature checks were also not recorded twice daily as expected.
There were positive findings. Medicines were managed safely, infection control was adequate, staff recruitment checks were completed, and relatives generally said people felt safe. New managers and new quality systems had started improvements, but inspectors said it was too soon to know whether these changes would work.
The overall rating remained Requires Improvement. Safe and Well-led were both rated Requires Improvement. The home had held this rating for the last two inspections.
Medicines
Inspectors found that medicines were stored, administered and checked safely. Regular audits were described as robust.
“Medicines were managed, stored and administered in a safe way.” from the report
Infection control
The home was clean and had measures to reduce the spread of COVID-19 and other infections. Visitors received checks before entering.
“There were processes in place to protect people from the risk of the spread of infection and measures were in place to mitigate the risks associated with COVID-19.” from the report
Recruitment and safeguarding
Staff had safeguarding training and knew how to report concerns. Recruitment records showed the required checks had been completed.
“Staff were recruited safely, and the registered manager ensured all relevant staffing checks were conducted prior to employment.” from the report
Openness and learning
The home told relatives when things went wrong and took action after concerns about medicines and stained bedding. Staff and relatives described an open culture.
“There was a culture of openness when things went wrong.” from the report
Working with health professionals
The home worked with district nurses and other health and social care professionals to support people's needs.
“The service worked in partnership with other health and social care professionals to achieve good outcomes for people.” from the report
Room alarms and risk records
seriousSome room monitoring alarms were set incorrectly, so staff might not know when someone needed help. Care plans and daily records did not always give enough detail about meals, drinking and repositioning.
“This meant staff members were not aware when people were out of their beds or chairs and may need assistance.” from the report
Temperature monitoring
seriousPeople's temperatures were not being recorded twice daily in line with government guidance. This could make it harder to identify illness, particularly for people unable to communicate symptoms.
“Individual temperatures were not being taken twice daily in accordance with government guidance.” from the report
New quality systems not yet proven
needs fixingThe home had introduced new audits and monitoring systems, but they had not been running long enough to show whether they had improved safety or quality.
“Although, these had not been in operation long enough to influence change and to assess whether they have been successful.” from the report
- 01How do you now check that every room sensor is correctly set and working?
- 02What staffing levels are guaranteed on each floor, and how do you respond if staff are absent?
- 03How do you make sure care plans clearly record support with eating, drinking and repositioning?
- 04Are twice-daily temperature checks now completed for every person, and how are missed checks followed up?
- 05What evidence can you show that the new audits and quality systems have led to lasting improvements?
This was a focused inspection of Safe and Well-led only; the other key question ratings carried over from the previous comprehensive inspection. This explanation was written from the published report of 8 January 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, August 2021
Hilton House was rated Requires Improvement; inspectors found unsafe medicines records and weak checks, although staffing, safeguarding and infection control were reassuring.
This was an unannounced focused inspection on 14 July 2021. Inspectors looked only at Safe and Well-led because concerns had been raised about medicines and care needs. They spoke with people, relatives and staff, and checked records and quality checks.
Medicines were not always recorded or stored safely. Stock records did not always match electronic records, and temperature checks for medicine storage were inconsistent. Some care plans also did not contain enough up-to-date information, including for people with diabetes.
There were enough safely recruited staff. Staff understood safeguarding, and inspectors were assured about infection control and COVID-19 measures. People and relatives were generally consulted and staff felt positive about recent management changes.
The ratings for Safe and Well-led fell from Good to Requires Improvement. The other three areas were not inspected, so their previous ratings were used in the overall rating. The home had an action plan, and CQC said it would continue to monitor the service.
Staffing
Inspectors found enough staff to meet people's needs. Recruitment checks were completed before staff started working independently.
“There were sufficient numbers of staff to support people living at Hilton House.” from the report
Safeguarding
Staff had safeguarding training and understood how to report concerns. People told inspectors they felt safe.
“People were supported by staff who had received safeguarding training and knew how to keep people safe from the risk of harm and abuse.” from the report
Infection control
Inspectors were assured that the home had measures for preventing and managing infection, including safe visiting, PPE and testing.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Positive management changes
The new management team had introduced an action plan and staff described feeling more supported and positive about the changes.
“Staff we spoke with felt positive about the changes which were being made.” from the report
Medicine records and storage
seriousMedicine stock did not always match electronic records. Temperature monitoring was inconsistent, so staff could not reliably tell whether some medicines remained suitable for use.
“Medicines were not always stored and recorded in a safe way.” from the report
Incomplete care plans
seriousSome care plans did not contain enough current information about people's health needs. This included diabetes care and could lead to ineffective support.
“Care plan documentation did not always reflect people's current needs, and this had not been identified by systems in place.” from the report
Weak quality checks
needs fixingAudits and other checks did not always find problems or make sure they were put right. The provider was working to strengthen these systems.
“The quality and safety assurance processes were not always effective in identifying and addressing risk.” from the report
- 01What changes have been completed to make medicine stock records match the electronic records?
- 02How are medicine room and refrigerator temperatures now checked, recorded and acted on?
- 03Have all care plans, particularly diabetes care plans, been updated and reviewed?
- 04How does management now make sure audits identify problems and confirm that actions have been completed?
- 05Who is currently responsible for managing the home while the application for a registered manager is completed?
This was a focused inspection of Safe and Well-led, with infection control included under Safe; Effective, Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 19 August 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 Hilton House
6 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- January 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- February 2019Goodup from Requires improvementSafe: GoodWell-led: Good
- January 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2014
Report published without a new overall rating.
- October 2013
Registered with the Care Quality Commission on 30 October 2013.
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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