Hill House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We identified 1 breach of the legal regulations. There was a poor culture at the service. Some members of staff were not being empowered to take on the responsibilities of their roles and it was unclear who was responsible for overseeing the quality of the service. There were not frequent staff meetings or supervisions to discuss a shared vision or culture or to help staff members improve people's lived experiences. Staff did not understand what the values of the service were, and the language used to describe people using the service was disrespectful and outdated. The way people were being treated indicated a poor culture. The service was not being managed well and governance systems in place were not effective. There were no audits happening in key areas of the service such as daily records and care charts. Audits that had been completed did not identify the issues we found at this assessment. Staff supervisions were not taking place. Management staff were not being empowered to be fully aware or responsible for all aspects of the service such as training and competency. This lack of oversight has led to poor or potentially poor experiences for people. There was limited evidence of the service learning or improving. Since the last inspection little action has been successfully taken to improve the service and multiple issues are still present at this assessment. We were not assured from the registered manager or the provider, that our concerns would be acted upon in a timely manner. However, people told us they were mostly happy with how the service was being managed.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they enjoyed working at the service and enjoyed looking after people. However, they were not clear on what the values of the service were. Staff told us they felt comfortable approaching the management team for support. However, they told us they were not being supported to have supervisions, competency assessments or staff meetings to discuss how things were going. The way that staff were treating people as explained in other key questions of this report show a poor culture was present at the service. The management team were disgruntled with other staff members working at the service who were responsible for some aspects of quality monitoring. They felt they should be responsible for this, however did not feel safe to challenge this, and as a result a negative culture in which staff were upset with one another had been able to develop. The management team spoke negatively about staff members when we gave them negative feedback about this assessment, indicating they felt staff were to blame for the issues at the service. The management team explained they were upset staff did not raise issues about the service with them, however were not supporting staff to do this, further leading to a poor culture.

Processes were not in place to help ensure there was a shared direction and a positive culture at the service. The multiple issues discussed in other key questions of this report are indications of a poor culture. Staff were not ensuring people’s home environment was being kept to a good standard or being kept clean. People were not being supported with dignity and respect and were not being supported in a person-centred way to identify and achieve their outcomes. Staff practice was putting people at risk and making people potentially unsafe. The management team were not monitoring staff practice to ensure a poor culture was not developing and staff were not being challenged if they did not support people in a kind and caring way. The management team were not encouraging a shared direction or culture as staff were not being supported to have supervisions and meetings to discuss their practice. The management team were not completing audits based on people’s lived experience or how they were being supported. People and the staff team were not being asked to feedback about the service which would have helped foster a positive culture and a shared direction.

Staff told us they felt supported by the registered manager and management team. However, they were not being supported with supervisions or competency assessments to help them talk about and improve in their job roles. The management team were not capable in all aspects of their job roles. They did not have oversight of the training matrix at the service and were not ensuring staff training had been effective. They were not addressing poor staff practice or making sure staff were competent in areas such as moving and handling or medication administration. The management team were not completing audits in numerous areas of the service to help make sure people were having good quality care. The management team were not inclusive and could not demonstrate how they effectively collaborated and worked with people using the service and the staff team. There was limited or no evidence of staff meetings taking place or people being engaged with for feedback about the service. The management team did not speak about people or staff team using dignified languages showing a lack of compassion. The provider was not supporting the registered manager or the management team to discuss their practice or to ask for support to improve. We were shown no evidence of the management team being supported by the provider or of any audits being completed by the provider.

Processes were not in place to help make sure the management team were capable in their job roles. The provider was not monitoring their performance or having discussions with them to make sure they did not need further support. The registered and home manager were not being supported to review their responsibilities and work and improve if this was necessary. The provider was unaware of the concerns we found during our assessments and did not know the management team were not able to effectively perform in their job roles. They were unaware of the poor culture that had developed at the service and the fact that audits were not happening at the service to monitor many areas of people’s support.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff told us they would report any changes to people’s support and care needs to the management team who would then update care and support plans. However, staff were unable to tell us what audits the management team completed to monitor the quality of the service. They told us they completed daily checks and daily records but did not review these as this was the management teams job. The management team told us they were not completing audits in areas such as reviewing people’s daily records to make sure they were receiving the right support. They told us other staff were supposed to do this and relied on them to inform of any problems. This was not effective and put people at risk of not having their support needs met. They also told us they were not supporting staff with supervisions or competency assessments. The management team did not have oversight of the training staff were completing or whether they were competent in areas such as moving and handling or medication administration. Moving and handling competencies and oversight of the training matrix was being dealt with by another member of staff, however this staff member was also not completing competency assessments for staff moving and handling. This lack of governance led to a risk of people receiving poor care from staff who were not competent to support them.

Processes were not in place to effectively manage and monitor the quality of the service. Audits were not being completed in multiple areas of service provision such as people’s lived experience at the service, daily records, staff training and competency and how feedback was being collected from people and their relatives. Audits that were completed in areas such as IPC were not effective and did not identify the issues we found at this assessment. Where audits did identify actions these were not completed. We were shown no evidence of any audits completed by the provider to monitor the quality of the service.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff told us they were not being supported to learn lessons when things went wrong and these were not discussed with them in staff meetings or supervisions. The management team were not supporting staff to learn lessons. They were not supporting staff to speak about events that happened at the service to see if lessons could be learned.

Processes were not in place to learn lessons. Audits were either not being completed or were not effective in identifying where improvements needed to be made. A service improvement an decoration plan was in place and known actions for improvement had not been completed for a number of years in some cases. During our assessment we fed back our concerns to the registered manager, provider and management team so they could offer us immediate assurances about what they would do to address these concerns. However they did not respond with assurances until we specifically prompted them to do so. This showed a lack of urgency to address issues and improve the service. There had been little to no improvement at the service since our last inspection (report published June 2023) and the service was still not meeting the fundamental standards we expect from care services.