Hill House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We identified 1 breach of the legal regulations. People were not receiving person centred care and staff did not spend meaningful time with people. Staff were not trained or knowledgeable about some of the support needs people were living with. The environment people were living in was not being well-kept. There was little evidence to show how people were engaged with to make sure support was tailored to them. Most people did not engage in 'activities' in place at the service. This led to people spending long periods of time without meaningful engagement. Peoples care and support plans did not contain information about their past histories, preferences, likes or dislikes. This limited the amount of information staff had available to them to help support people as individuals. People were not being supported to achieve their chosen outcomes and their wishes and aspirations were not being discussed with them. There was limited or no use of the accessible information standard at the service. Pictures and signs were not being consistently used and there was no evidence of policies, procedures or care plans being available for people to use in accessible formats. There was no indication of the service being decorated to help people living with dementia to understand where they were in the service or to help them orientate. However, people told us they were mainly happy with their support. People were supported to access health care professionals if this support was needed. People were supported to put plans in place for the end of their life if this was needed.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from people about whether they were supported with person centred care. One person said, ‘'I feel quite lonely here sometimes. Unless my friends come to see me, no one really comes and says hello.’’ A relative told us, ‘‘There used to be some good things happening for [family member] but this does not seem to be the case now. It is always quiet when we visit.’’ However, a person told us, ‘‘[Staff] are kind and friendly and always take the time to say good morning to me.’’ A relative said, ‘‘[Family member] is getting on well here thanks to the staff.’’ Despite people’s comments people were not being supported with person centred care as explained in the rest of this quality statement.

Staff did not understand what person-centred care meant when we asked them to explain how they support people in this way. Staff were unable to explain how to support people in line with their individual support needs such as living with dementia. Staff told us they were not being supported to discuss their practice in supervisions or meetings. The management team did not demonstrate to us that they were supporting staff to help people in a person-centred way. People’s care and support plans did not contain detailed information about their past histories, preferences likes or dislikes which would have helped staff support them in this way.

People were not being supported in a person-centred way. People spent the day sitting in chairs in communal areas or in their bedrooms with little staff engagement. This increased the risk of social isolation and boredom for people. Staff did not respond to people in a timely manner if they were feeling anxious. We had to prompt staff members to attend to people who needed support several times during our assessment as explained in the caring key question.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People told us they were not supported to have information given to them in accessible formats. One person said, ‘‘I think we used to be shown pictures of meal to make a choice but this does not happen anymore.’’ A relative said, ‘‘[Family member] is not able to understand what is happening anymore. However, I do not think there have been efforts made to try anything different to just talking with them.’’ People explained they had not seen their care plans or other information about the service in any formats. One person told us, ‘‘I have not been shown the care plan and would not know what it said anyway.’’ The environment was not decorated or designed to support to support people living with dementia to orientate or understand where they were in the service. People were not being supported in line with the Accessible Information Standard (AIS) as explained in the rest of this quality statement.

Staff did not know what the accessible information standard was and were unable to tell us how they provided information to people in different formats. We observed staff did not use different ways of communicating with people, such as signing or pictures, when supporting them. Staff did not have training in using different communication methods. The management team told us they had pictures of meals which should be used to help people make choices. However, they said these had not been used consistently. They also said, they were used on the second day of our site visit as a result of our visit, rather than as common practice by the staff team. The management team told us policies such as how to make a complaint were not available in an easy read format for people to use.

Processes were not in place to support people to understand information. People’s care and support plans and policies at the service were not available in accessible formats. Other methods of communication such as signs or pictures were not being used to support people to understand information. People’s care plans did not detail how to communicate with them if they did not use verbal communication. There were known areas for decoration and improvement to help people understand information across the service. However, these had not been actioned for an extended period of time.

People and relatives told us they were not supported to discuss their care and support. People’s comments included, ‘‘I have never been asked about my care or seen any of my care plans.’’ and, ‘‘I do not know why [staff] would ask me if I think things need changing or not. They just get on with it.’’ A relative said, ‘‘We never hear from the service unless something happens.’’ People and relatives also confirmed they had not been asked to fill in any surveys or questionnaires to get feedback about the service. One relative said, ‘‘I have never been asked to fill in anything to say how the service is going. Communication is an issue. It takes a long time to hear back from anyone.’’ People and relatives gave mixed feedback about being listened to. One person said, ‘‘I do not bring things up if I am not happy as I do not want to cause trouble.’’ A relative said, ‘‘I feel like I am constantly trying to ask the service to change things but nothing every happens.’’ However one relative said, ‘‘Whenever I bring things up with staff, they seem to take this on board.’’

Staff did not take time throughout the day to sit and talk or listen with people. Staff told us they did not ask people how they felt about their support or if there were any changes that needed to happen. They were also unable to tell us about how people were involved in their care. The management team were unable to tell us or demonstrate that people or their relatives were supported to be involved in discussions about their care and support.

Processes were not in place or were not effective, to listen to people or ask them for feedback about the service. Staff completed ‘resident of the day’ paperwork with people however it was not meaningful, and staff did not support people to complete this, but rather completed this for them. The home manager shared some questionnaires filled in by family members however when we spoke with relatives, they told us they had not been sent these to complete. There was no evidence people or relatives were invited to meetings to discuss how their support was. There was no evidence people, or their family members were involved in discussing care and support plans.

People told us they were supported to see health professionals if they needed this support. One person said, ‘‘The doctor comes once a week but the staff would call for someone if we needed it.’’ Another person was supported to go to hospital as staff were unable to support them with their needs any further. Staff worked well with this person to support them to go to hospital as they did not want to do this originally. A relative told us, ‘‘I was glad [staff] noticed [family member] had an injury and contacted [health professionals] to sort this out.’’

Staff told us the management team organised hospital appointments or health professional appointments for people. We observed senior members of staff contacting the GP for people if they were unwell during our site visits.

Professionals working with staff gave us some good feedback about how people were supported. One professional said, ‘‘It took a long time and a lot of hard work from staff to support [person] to come to hospital but it was the right thing for them.’’ Professionals also told us that because they visited the service on a weekly basis they were able to keep informed about any health related support people might need.

Processes were not always effective in making sure people were able to access health services if they needed this support. People’s care records were not being reviewed by the management team to see if any support form health professionals was needed. Staff were not being supported with supervisions or competency assessments to help make sure they could identify signs that people may need support from other service. Changes or advice from health professionals was not always clearly recorded or added to people’s support plans in a timely manner.

People told us they were not supported to follow their preferred past times or leave the service to access the local community. One person said, ‘‘It can be quite slow here. Each day feels the same. There is never much going on.’’ Another person told us, ‘‘It would be nice if I could go out a bit more but this hasn’t happened for a long time. I guess it would take staff away from the house to help people.’’ People’s comments about the activities on offer at the service included, ‘‘Every now and then the staff will get a game out or something, but I am never interested.’’ and, ‘‘I do think there used to be more going on here.’’ Relatives told us they felt there was little opportunity for people to take part in social engagement at the service. One relative said, ‘‘When [family member] first went in to the service there was loads going on but not so much anymore. They wouldn’t be able to take part in things like quizzes now.’’ Another relative told us, ‘‘I do not think there is enough social engagement at the service. They used to have someone who did this but they left and [provider] didn’t replace them.’’ We observed there was little activities to occupy people throughout the day. On one day we observed a hat making activity taking place with 4 people for 20 minutes. There was no other engagement for people who could not or chose not to participate in this activity. On another day people were supported to play bingo and a board game. However, people were not engaged with to understand or fully participate in these activities. One person said ‘‘We never usually play board games’’ indicating this was not usual practice.

Staff told us they made sure people were comfortable and had what they needed such as something to eat and drink. However, they were unable to tell us how they supported people to identify their interests and preferences or how they then helped them to follow these. Staff told us they did not have an ‘activity schedule’ to follow and also there was no staff member dedicated to social engagement for people as there used to be in the past. They told us they would try and play games with people if they had the time to do so but this did not always happen. Staff told us they had not supported people to leave the service or access the community for an extended period of time. Staff told us people used to have access to a hair salon and a room that was designed to look like a sweet shop. However, these had not been used for some years and were now used as store rooms. The registered manager explained they did not have a dedicated staff member employed to support people with social engagement and activities and relied on care staff to do this. However, they said they were not completing audits or checks to make sure this was happening.

Processes were not in place to make sure people had equity in experiences and outcomes. The management team were not completing audits focusing on how people spent their time and were not discussing this with people. People’s wishes and ambitions were not being recorded or monitored to ensure people were being supported to achieve these. Staff were not being supported with supervisions or meetings to discuss this, nor were they being empowered to discuss this with people.

People and their relatives told us they were supported to put plans in place for the end of their life if this was needed. One relative said, ‘‘It is reassuring there are plans in place to support [family member] and I am happy our wishes have been listened to.’’

Staff did not have training in supporting people living at the end of their life. However, they explained they would treat people with dignity and compassion and would refer to people’s care plans or ask the management team if they needed any support.

Processes were not full in place to support people at the end of their life. Staff were not being supported to discuss this in supervisions or meetings. People’s care plans could have been more detailed in relation to their specific preferences at this time of their lives.