CQC report explained · a residential care home
What the CQC found at Notts Hill 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- Inspectors found gaps in risk management, incomplete food and fluid monitoring, out-of-date care information and one medicine not given as prescribed. They also found suitable staffing, recruitment, safeguarding and infection control arrangements.
- Effective?
- Requires improvement
- Staff had suitable training and people could access healthcare and nutritional support. Improvements were still needed in mental capacity records and in how one modified meal was presented.
- Caring?
- Good
- No rating for Caring is shown in this report.
- Responsive?
- Good
- Care plans reflected people's preferences and rehabilitation needs, and people were supported with communication, family contact and activities. Most people inspectors spoke with nevertheless said they felt bored and that there was little stimulation.
- Well-led?
- Requires improvement
- The management team promoted person-centred care and was viewed positively by people, relatives and staff. However, governance checks had not identified risks, incomplete records or the medicines problem.
What inspectors found, March 2023
Rated Requires Improvement; inspectors found caring and rehabilitation support, but gaps in risk management, medicines records and quality checks remained.
Inspectors visited on three days in February 2023. They spoke with people, relatives and staff, observed care, and checked care records, medicines records, staff files and management audits. The first day was unannounced.
The home provided personalised care and rehabilitation support. People were supported to make choices, access healthcare, keep in touch with relatives and take part in activities. Staff were described as trained and supportive, and infection control arrangements were satisfactory.
However, some risks were not properly managed. Food and fluid records were incomplete, care records were not always up to date, and one person's eye drops had not been given as prescribed. The provider's checks had not found these problems.
The overall rating was Requires Improvement. Safe, effective and well-led were rated Requires Improvement, while responsive was rated Good. The report says the provider remained in breach of regulations and would be monitored through an action plan.
Rehabilitation support
People received support to regain daily living skills and increase their independence. The provider had employed occupational therapy and physiotherapy staff for assessed rehabilitation needs.
“People were provided with rehabilitation support to regain daily living skills and help them enjoy as much independence as they could.” from the report
Staff training
Inspectors found that staff had induction and training suited to their roles and to the needs of people living in the home.
“Staff received comprehensive mandatory training and had been provided with specific training to meet the needs of people living at Notts Hill House, such as positive behaviour support and acquired brain injury awareness training.” from the report
Person-centred support
Support plans included people's preferences, hobbies and communication needs. Inspectors saw staff asking for consent and allowing people time to respond.
“People's likes, dislikes and how they wanted to be supported had been captured as part of this process.” from the report
Infection control
Inspectors were assured that the home used protective equipment safely and had arrangements to prevent and manage infection outbreaks.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Risk controls
seriousA cupboard containing snacks was left unlocked despite a person's high choking risk, and food and fluid monitoring was incomplete. This was part of a breach of Regulation 12.
“This potentially placed the person at an increased risk of avoidable harm.” from the report
Medicine not given
seriousOne person's glaucoma eye drops had not been given since 28 January 2023. Medicine audits had not identified this failure, and Regulation 12 was breached.
“Although most people received their medicines safely and as prescribed, we saw that one person's eye drop medicine to treat glaucoma had not been administered since 28 January 2023.” from the report
Out-of-date records
seriousSome support plans and risk assessments had not been reviewed for several months. Staff therefore did not always have the latest guidance for safe care.
“People were at risk from harm as staff did not always have the most up to date information and guidance to ensure they provide safe care.” from the report
Weak quality checks
seriousThe provider's audits had not found the problems with risks, records and medicines. This was a breach of Regulation 17.
“The provider's governance systems had not identified the issues we found during this inspection.” from the report
Limited activities
needs fixingAlthough some activities took place, most people inspectors spoke with felt bored and said there was little stimulation. The manager linked this partly to high agency staffing levels.
“However, most people we spoke with told us they felt bored and there was little going on in terms of stimulation at the service.” from the report
Mental capacity records
needs fixingInspectors found that some mental capacity assessments were not decision-specific and did not have the right best-interest records. The manager corrected the records during the inspection, but CQC recommended that staff revisit training.
“We recommend the provider ensures all staff revisit MCA training to ensure they understand and employ the principles of the MCA Act in their practice.” from the report
- 01What action has been taken to make sure choking risks are controlled after the unlocked snack cupboard was found?
- 02How do you now check that every person's food and fluid records are completed each day?
- 03What changes have been made to medicines audits so that a missed prescribed medicine is identified quickly?
- 04Have all support plans and risk assessments been reviewed and brought up to date?
- 05What regular activities and opportunities to go out are now available for people who previously felt bored?
This was a focused follow-up inspection of action required after the 2019 inspection, with infection prevention and control also checked; the report says ratings for key questions not inspected were carried over from the last inspection. This explanation was written from the published report of 23 March 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 2021
Rated Requires Improvement; inspectors found safe care, but leadership was not yet consistent.
This was an unannounced focused inspection on 8 December 2020. Inspectors looked mainly at whether people were safe and whether the home was well-led. They spoke with people, staff, relatives and professionals, and checked care records, medicines, staff files, incidents and quality audits.
The home was rated Good for Safe. Inspectors found enough suitably recruited staff, safe medicines arrangements, safeguarding training and risk assessments. They found no evidence that people were at risk of harm from the safeguarding concerns that led to the inspection. Infection prevention arrangements were also judged satisfactory.
The overall rating remained Requires Improvement because Well-led remained Requires Improvement. The home did not have a registered manager, and there had been frequent management changes. The provider said improvements had been made since the previous inspection, including around mental capacity, person-centred care and quality audits, but this focused inspection did not check those areas in enough detail to confirm they were fully established.
Enough staff
Inspectors found enough staff to meet people's needs. Staff were available around the home and responded promptly when people needed help or reassurance.
“There were sufficient numbers of staff to meet people's need.” from the report
Safe medicines
Medicines were stored and given safely. Records, storage checks, as-required medicine instructions and medicine reviews were in place.
“Medicines were stored and administered safely.” from the report
Protection from harm
Staff had safeguarding training and said they would report concerns. Inspectors saw positive interactions and found no evidence that people were at risk of harm from the concerns that prompted the inspection.
“People continued to be safeguarded from abuse and avoidable harm.” from the report
Family contact and advocacy
Relatives said staff kept them informed during the COVID-19 pandemic. People could use advocacy services and were supported to stay in contact with important people.
“All the relatives we spoke with said that during the COVID19 pandemic staff had worked really hard to keep them updated and connected.” from the report
No consistent registered manager
needs fixingThere was no registered manager when inspectors visited. Staff and relatives described frequent changes in management, which had affected consistency and had sometimes been unsettling.
“Staff did say the frequent change of management had at times been very unsettling” from the report
Behaviour risk plan needed more detail
needs fixingOne person's care plan did not give enough detail about what staff should do if behaviour escalated and staff had to withdraw from the person's accommodation. Inspectors recommended updating care planning using current guidance.
“the person's care plan did not include this information in sufficient detail to ensure consistency.” from the report
Some improvements were not checked
minorThe provider said improvements had been made in assessing mental capacity, person-centred care and quality auditing. Because this was a focused inspection, inspectors could not confirm whether those improvements had become established in practice.
“It was therefore not possible to see if these improvements had been embedded in practice.” from the report
- 01Has a registered manager now started, and how will the home provide consistent leadership?
- 02How are care plans being updated when someone's behaviour may escalate or staff may need to withdraw?
- 03What evidence can you show that improvements in mental capacity assessments and person-centred care are now embedded?
- 04How are family members kept informed and supported to maintain contact with residents?
- 05How often are medicines, incidents and care plans audited, and how are any problems followed up?
This was a focused inspection of Safe and Well-led only; the other key questions were not assessed in detail and the overall rating remained from the previous inspection. This explanation was written from the published report of 4 February 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 Notts Hill House
5 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- March 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2021Requires improvementstayed Requires improvementSafe: GoodWell-led: Requires improvement
- August 2019Requires improvementstayed Requires improvementSafe: GoodEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- July 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- December 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- June 2012
Registered with the Care Quality Commission on 6 June 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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Most charge £980 to £1,400 a week. 17 can care for a couple. 12 years' experience on average.
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