CQC report explained · a nursing home
What the CQC found at Hulton House Care Residence
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Medicines, risk assessments, safeguarding and infection control had improved. However, there was negative feedback about staffing levels, and inspectors said some aspects of the service were not always safe.
- Effective?
- Requires improvement
- This question was not inspected during this focused inspection. Its previous rating was used in calculating the overall rating.
- Caring?
- Requires improvement
- This question was not inspected during this focused inspection. Its previous rating was used in calculating the overall rating.
- Responsive?
- Requires improvement
- This question was not inspected during this focused inspection. Its previous rating was used in calculating the overall rating.
- Well-led?
- Requires improvement
- People and relatives reported improvements in the culture and leadership. However, management systems were not always followed consistently, and not everyone knew who the manager was.
What inspectors found, August 2023
Rated Requires Improvement after being previously Inadequate and in Special Measures; inspectors found clear progress but ongoing concerns about staffing and oversight.
This was an unannounced focused inspection on 19 July 2023. Inspectors spoke with people, relatives and staff, observed care and medicines, looked around the home, and reviewed care, recruitment, medicines and management records.
The home had improved since the previous inspection. Medicines were given safely, risks were assessed, safeguarding arrangements had improved, and infection prevention was satisfactory. People and relatives also described a more positive culture and better management presence.
However, the overall rating and the ratings for Safe and Well-led were Requires Improvement. Some people, relatives and staff raised concerns about staffing levels. The provider increased staffing after the inspection, but management systems were not always followed consistently.
The previous inspection was rated Inadequate and found breaches of regulations. At this inspection, the provider was no longer in breach and the home was no longer in Special Measures. The other three key-question ratings were not reassessed and carried over from the previous inspection.
Safer medicines
Inspectors found that people received medicines on time from trained staff. Regular audits of medicines were also taking place.
“People received their medicine on time by nurses and staff who were trained in safe administration.” from the report
Improved risk management
Care plans and risk assessments had been reviewed and updated. The management team also reviewed incidents and acted to reduce the chance of them happening again.
“The management team had assessed and recorded risk to keep people safe.” from the report
People felt safe
People told inspectors they felt safe. Staff had training about abuse and understood how to report concerns.
“People told us they felt safe living at Hulton House Care Residence.” from the report
Improved culture
People, relatives and staff described positive changes in the atmosphere and leadership. Inspectors saw more management presence and evidence that feedback was being acted on.
“People, and relatives felt there had been positive improvements in the culture at Hulton House Care Residence.” from the report
Open visiting
The home supported visits from relatives and friends without limits linked to COVID-19 restrictions.
“This meant people could have relatives and friends visit at any time.” from the report
Staffing concerns
seriousPeople, a relative and a staff member said staffing levels were not always enough or safe. The provider increased staffing after the inspection, so families should check whether this has made a lasting difference.
“One staff member said, "The staffing levels are unsafe.” from the report
Checks not always consistent
needs fixingThe home had introduced new monitoring systems, but staff did not always follow them consistently. This means the improvements still needed close oversight.
“However, not all these systems were consistently followed.” from the report
Manager not yet registered
needs fixingThere was no registered manager in post at the inspection. The manager had applied to register, and the application was still being assessed.
“At the time of our inspection there was not a registered manager in post.” from the report
Leadership not clear to everyone
minorManagement changes meant some people did not know who the manager was. This suggests that leadership arrangements were not yet clear to everyone living in the home.
“Management changes meant not everyone knew who the manager was” from the report
- 01What are the current staffing levels on weekdays, nights and weekends, and how do they compare with the levels after the inspection?
- 02How do you check that staffing is enough for people who need one-to-one support?
- 03Which management checks were not being followed consistently, and what evidence shows they are now being completed?
- 04Has the manager's registration application been approved, and who is legally responsible for the home while it is being assessed?
- 05What are the current ratings for Effective, Caring and Responsive, given that they were not reassessed in this inspection?
This was a focused inspection of Safe and Well-led only; the other three key-question ratings carried over from the previous inspection. This explanation was written from the published report of 8 August 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, May 2023
Rated Inadequate and placed in special measures; inspectors found serious risks involving medicines, safeguarding, care records and management.
This was an unannounced focused inspection. Inspectors visited on 9, 10 and 14 November 2022. They spoke with staff, residents and professionals, observed care, and reviewed care records, medicines, recruitment files, audits and management information.
The home was rated Inadequate for Safe and Well-led. Inspectors found that risks were not properly assessed or reduced. Medicines were not always managed safely, some staff were allocated duties without the right training, and safeguarding and liberty safeguards were not always handled lawfully.
Care records contained conflicting information. Activities were limited, and people’s preferences and changing needs were not consistently used to plan their care. Inspectors also found that audits and management systems had not led to timely improvements.
There were some positive findings. Inspectors found enough staff at the time of the inspection, safe recruitment checks in most cases, suitable infection control arrangements in several areas, and people who could speak with inspectors praised the staff. The overall rating fell from Requires Improvement at the previous inspection, and the home was placed in special measures.
Supportive staff
People who could speak with inspectors spoke positively about staff and felt supported.
“People we could speak with spoke highly of the staff and felt supported.” from the report
Staffing levels
There were enough staff present during the inspection to meet people’s needs, although inspectors raised concerns about how some staff were deployed.
“There were enough staff present at the time of the inspection to meet people's needs.” from the report
Infection control
Inspectors were assured about several infection prevention arrangements, including visitors, admissions and managing outbreaks.
“We were assured that the provider was responding effectively to risks and signs of infection.” from the report
Professional support
The home made referrals to professional teams when people needed additional support.
“Referrals were made as required to professional teams for additional support in meeting people's needs.” from the report
Risk management
seriousRisk assessments did not give enough detail about people’s risks or how staff should respond. Conflicting records about diet, skin and falls could result in inappropriate care.
“Risks to people's health and wellbeing were not suitably assessed, reviewed or mitigated to ensure people were kept safe.” from the report
Medicines
seriousMedicines were not always administered safely or recorded correctly. This included problems with insulin, creams, patches and covert medicines.
“Medicines were not always administered safely and records for administration were not always kept in line with best practice.” from the report
Safeguarding and restrictive practice
seriousStaff did not always understand how to report and escalate possible abuse. Some restrictive practices were used without clear evidence of best-interest decisions or the required legal authorisation.
“We found the service was not working within the principles of the MCA and if needed, appropriate legal authorisations were not in place to deprive a person of their liberty.” from the report
Activities and person-centred care
needs fixingThere were not enough activities to support people’s emotional, social and mental wellbeing. People’s preferences and changing needs were not consistently reflected in care planning.
“The lack of activities to engage people had a detrimental effect on people's wellbeing.” from the report
Management oversight
seriousAudits identified problems repeatedly but action was not taken quickly or effectively. Incident records and other records were not reliable enough to support proper monitoring.
“Senior managers' audits identified concerns and issues month after month but action to improve was not taken in a timely or effective way.” from the report
Staff competence and support
seriousSome staff carrying out increased observations had not received the training needed for that role. The provider also had not completed assessments to consider reasonable adjustments for two staff members with identified health needs.
“A high proportion of the time staff completing increased observations were not suitably trained.” from the report
- 01What urgent registration conditions are currently in place, and how are you showing that they are being followed?
- 02How do you now check that each person’s risks, dietary needs, skin care and falls information are accurate and consistent?
- 03How are medicines, including insulin, creams, patches and covert medicines, now checked and recorded safely?
- 04How do you ensure that staff carrying out increased observations or safe holds have the correct training and competence?
- 05What activities are now available, and how are residents’ preferences and changing needs being used in care plans?
This was a focused inspection of Safe and Well-led, with infection prevention and control also considered; the other key-question ratings were carried over from the previous inspection. This explanation was written from the published report of 31 May 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 Hulton House Care Residence
4 rated inspections over 3 years: the service has improved, from Inadequate to Requires improvement.
- August 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2023InadequateSafe: InadequateWell-led: Inadequate
- January 2022Inspected but not ratedSafe: Inspected but not rated
- May 2021Requires improvementSafe: Requires improvementWell-led: Requires improvement
- March 2021Inspected but not ratedSafe: Inspected but not rated
- October 2020InadequateSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- August 2019
Registered with the Care Quality Commission on 22 August 2019.
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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85 live-in carers within about an hour of Lancashire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 78 can care for a couple. 11 years' experience on average.
“She understands the needs of an elderly person in the early stages of dementia and has treated my mother with great kindness and skill.”
“Thanks to Tracy, Dad was always immaculately dressed and clean, his meals were all home cooked and nutritionally well balanced and his home was always kept really clean and tidy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.