About the serviceHill House is a residential care home, providing personal care and accommodation for up to 13 people with learning disabilities and/or autistic spectrum disorder. There were 12 people living at the home at the time of our inspection. The home was divided into three separate floors for people who used the service, with lounges, sensory rooms, activities rooms, gardens and dining room areas.
The service had been registered since October 2010, however, the provider was not taking into consideration the principles and values that underpin Registering the Right Support and other best practice guidance for the accommodation of people with learning disabilities. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not receive planned and co-ordinated person-centred support that was appropriate and inclusive for them.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
People’s experience of using this service and what we found
Since our last inspection visit, we had received concerning information that indicated people did not always receive personalised care, specifically around the lack of skilled staffing levels and risk management.
People and staff did not always feel safe at Hill House. Staff did not always understand how to keep people safe and reduce potential risks to people. Risks associated with some people’s care were not managed safely. People’s individual needs, health conditions and complex behaviours, had not always prompted risk management plans to be in place.
People did not receive person-centred care from staff, as staff lacked the skills and training they needed, and the guidance they needed to ensure people were supported according to their personal needs.
People were not always involved in choosing their care and support, from pre-admission to living in the home. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.
The staff team did not always prevent people from becoming socially isolated within the home. People did not always have their privacy and dignity respected. People were not always encouraged to be independent and make everyday decisions about how they wanted to live their lives.
People and their relatives knew how to raise concerns and provide feedback about the service, and there was evidence that concerns had been raised with the manager of the home. However, concerns were not documented in a complaints log, which did not promote an understanding of how concerns were being addressed and learned from.
The previous registered manager had left the provider’s organisation several weeks before our inspection visit. The service was led by a manager who had been in post for five weeks, and a deputy manager. The provider was not offering the support and guidance needed at the home, to the staffing team and the new manager. There was a lack of effective auditing procedures in place to identify issues and areas for improvement at the service.
Although some risks to people, and the need to update care records, had been identified by the new manager and the provider before our inspection visit, action to mitigate risks to people’s safety had not been resolved in a timely way, and whilst problems continued, additional measures to reduce risks had not been taken by the provider. Following our inspection, measures were put in place and a review of the service commenced.
Rating at last inspection
The last comprehensive inspection report for Hill House (published April 2019) we gave a rating of good in all areas. At this inspection we found the service had deteriorated and have rated the service as inadequate.
During this inspection visit, we found the safety and quality of the service had deteriorated and some people’s care outcomes were not of a good standard. The service is now rated Inadequate. We identified breaches of the Health and Social Care Act 2014 (Regulated Activities):
Regulation 10 Privacy and Dignity
Regulation 11 Need for Consent
Regulation 12 Safe care and treatment
Regulation 13 Safeguarding
Regulation 17 Good governance
Regulation 18 Staffing
Why we inspected
This inspection was a responsive inspection prompted in part due to concerns received about safeguarding alerts and investigations that were notified to CQC. This included incidents of challenging and violent behaviours. We were also notified of the findings of a recent compliance inspection by the local authority where the service was rated as Inadequate. A decision was made for us to inspect and examine those risks.
We found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.
Follow up
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.