Hill House Nursing Home is registered to provide accommodation, personal and nursing care for up to 44 older people who may be living with a dementia. At the time of our inspection there were 38 people living at the home. The home offers both long stay and short stay respite care. This inspection took place on 5, 12 & 13 January 2017, the first and second days of our inspection were unannounced. Two adult social care inspectors carried out this inspection. Hill House was previously inspected in November 2013, when it was found to be compliant with the regulations at that time.
Although Hill House did not have a registered manager at time of our inspection, a new manager had been appointed, and was being supported by the nominated individual. The previous manager had left in October 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run.
People's medicines were not always managed safely. Medicine Administration Records (MARs) were not always completed accurately. This meant staff were unable to tell if people had received their medicines as prescribed. Where people were prescribed medicines to be given “when required” there was no guidance provided for staff as to when this should be used. Where people were prescribed topical medicines or creams, detailed guidance had not been provided and staff were not recording consistently within people’s records these had been applied. People received their prescribed medicines when they needed them and in a safe way. People were given time and encouragement to take their medicines at their own pace and staff always sought people’s consent. Staff had received training in the safe administration of medicines and records confirmed this.
People were not fully protected from the risks posed to them by environmental factors. Whilst some premises checks had been completed in a timely manner there were no recordings of water temperatures being carried out. Although the manager assured us taps were thermostatically controlled, these checks are important as they allow staff to monitor the temperature of the water to protect people from scalding when having a bath or shower. Whilst we did not find any taps where very hot water was being delivered, staff were not carrying out checks to ensure this was always the case.
There was insufficient oversight by the management team and nursing staff to ensure people's needs were being monitored on a day-to-day basis, as some records were either not maintained or were incomplete. Although people’s care plans had been regularly reviewed, we found nursing staff did not consistently review people’s daily notes as part of this process. This meant nursing staff were not reviewing all the information available to them and as such could not be sure that people were being adequately supported or receiving care appropriate to their needs.
We looked at the home’s quality assurance and governance systems and found the provider did not have effective systems to assess and monitor the quality and safety of the services provided at the home. Although some systems were working well others had not identified the concerns we found during this inspection.
We raised our concerns with the manager; who told us they were in the process of undertaking a complete review of the home. The manager had already identified many of the concerns we identified as part of this inspection and they were in the process of developing an action plan with time scales to address these concerns.
People said they felt safe and well cared for at Hill House, their comments included "I do feel safe” and "I love it here.” Relatives told us they did not have any concerns about people's safety. One relative said, "People are safe and well looked after here”. A visiting healthcare professional said people always appeared to be happy and well cared for.
People were protected from abuse and harm. Staff received training in safeguarding vulnerable adults and demonstrated a good understanding of how to keep people safe. There was a comprehensive staff-training programme in place. This included safeguarding, first aid, pressure area care, infection control, moving and handling, and food hygiene. Some staff had received additional training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).
People were encouraged to make choices and were involved in the care and support they received. Staff had an awareness of the MCA and DoLS and how to support people within their best interests.
People told us staff treated them with respect and maintained their dignity. Throughout the inspection, there was a relaxed and friendly atmosphere within the home. Staff spoke about people with kindness and compassion. People and relatives told us they were involved in identifying their needs and developing the care provided. People's care plans were informative, detailed, and designed to help ensure people received personalised care.
People spoke positively about activities at the home and told us they had the opportunity to join in if they wanted. The home had a programme of organised activities that included arts and crafts, music sessions, exercise classes, card games, and quizzes.
People, relatives, and staff spoke highly of the management team and told us the home was well managed. Staffs described a culture of openness and transparency where people, relatives and staff, were able to provide feedback, raise concerns, and were confident they would be taken seriously.
The home had notified the Care Quality Commission of all significant events that had occurred in line with their legal responsibilities.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.