Hillsborough House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Improvements had been made to ensure people were supported in a safe environment; for example, regular safety checks took place in the service and staff had undertaken fire drill practice and cleanliness in the service had improved. There were enough suitably trained staff working in the home and staff demonstrated a good understanding of people’s needs. However, we found some documentation relating to people who used the service contained inconsistent information. Risks to a person in relation to their medicines was also not in place and shortfalls were found in relation to medicines audits and processes. These shortfalls were raised with and addressed by the manager at the time of the assessment.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives we spoke with spoke positively about their involvement around incidents and safeguarding and felt there was an ‘openness’ in the home. Two family members said, “I am kept informed whenever there are incidents, I feel the manager is very open.”

Staff confirmed they had opportunities to reflect and have learnt from incidents. Staff told us they discuss incidents in handovers, meetings and supervisions. One staff member said, “We try our best and if incidents happen, we make sure they never happen again, we try and find out what caused an incident, and we complete risk assessments.”

Processes were now in place to ensure learning could take place following incidents, which included discussions with people living and the service and staff. Actions were taken to reduce risk of similar incidents re-occurring, for example checking staff medicines competency following a medicines error or making referrals to health professionals. The service showed transparency and shared information with relevant professionals.

Relatives were made aware of hospital admissions and health appointments. One relative said, “Whenever my loved one needs a medical appointment or a change in medication I am always invited to attend. But I am happy for them to take my loved one and tell me the outcome.”

The Registered Manager said the service made sure people were supported safely during hospital admissions. They explained “people have hospital grab bags which include important information about them, and staff stay with them until they are admitted to hand over information.” Staff told us people had behaviour care plans to help staff understand how to support people to have good days and reduce risk of distress and incidents during appointments with external agencies.

Partners felt the service made appropriate referrals to ensure people received timely health care support. One partner said, “The home has greatly improved and will contact the team for support and advice. They have been working closely with Community Nursing and SLT to support health concerns, liaison with the GP and hospital to prevent admission where possible. The home engages with Annual Health Checks and takes up offers for training on communication and dysphagia.”

The service worked with people and health professionals to establish and maintain safe systems of care, for example, some people had behaviour support plans to help reduce behaviours of distress and incidents. Hospital passports were in place for people; however, we saw some information around eating had not been updated to include information following a recent Speech and Language Therapy (SALT) eating and drinking assessment around changes to food textures. This could put the person at risk of choking in hospital, however staff were aware of the person’s revised eating and drinking information and the manager said staff always supported people with hospital admissions to ensure the correct information in relation to eating and drinking was handed over. The provider addressed this immediately and we were provided with evidence of the updated documents.

People told us they felt safe in their home. Relatives felt their loved one was safe. One relative said, “I am confident my loved one is safe. The manager addresses whatever I bring up.”

Leaders said they spend time in the service and observe for signs of closed culture and poor practice. Staff we spoke with had a good understanding about safeguarding and how to report a safeguarding concern. Leaders said staff completed safeguarding training annually and told us safeguarding was discussed in meetings. Leaders said they also talked about safeguarding in senior meetings twice a week to share learning and knowledge. Leaders told us they promoted any safeguarding events going on, for example safeguarding awareness month and free webinars that people can join.

We saw people were supported safely in the home and observed staff were aware of people’s behaviour support plans and were proactive in their approach to help people feel safe. For example, staff were following a person's behaviour support plan to reduce the risk of the person becoming distressed and a potential incident.

The service worked with people and health professionals to help people understand about safeguarding and keeping safe. For example, the service included discussions about ‘hate crime’ and what abuse meant to everyone in house meetings. Staff and managers received safeguarding training in line with the service’s training expectations, and systems were now in place to report and monitor safeguarding incidents and themes.

Relatives said they were involved in care planning. One relative said, “I attended a recent care review, key workers and the care manager attended. The meeting was very positive, 1:1 funding was agreed so my loved one can access the community more. As a result of the meeting, I have regular contact with my loved one’s key worker”.

Staff were knowledgeable about how risks for people were managed. Leaders said people had accessible and easy read documents to help them understand about identified risks. Leaders said a house meeting took place month for people living in the service where topics such as oral health and safeguarding were discussed, using videos and accessible information to help people understand. This helps people to be involved with their management of risk.

We saw people were supported in line with their care plans, for example, staff followed a person’s behaviour support plan to help the person feel safe and were using the agreed responses to questions to help reduce the risk of distress for the person.

We saw care plans and most risk assessments were in place for people, and people were supported and empowered to take risks in areas they wanted to. For example, one person had a risk assessment in place to support their independence when going out of the service. However, we identified some risk assessments around medicines had not been completed, this was addressed immediately by the manager. Least restrictive approaches had been considered in the service’s kitchen to ensure people’s safety. For example, some foods were kept locked in a fridge to prevent food contamination and people eating unsafe or uncooked meat. People had free access to other safer food. Deprivation of Liberty Safeguards assessments included information on appropriate restrictions which were in place to keep people safe, and these were being followed by staff. Mental Capacity Act (MCA) assessments and best interest decision documents had been completed with the person for appropriate equipment to be available in the kitchen to support their independence, for example hot water dispensers. However, some documents did not always include consultation with other partner agencies outside of the staff team to gain their views in relation to best interest decisions. The provider was aware of this and had an action plan to address this.

Relatives were positive about improvements made to the environment. One relative said, “I recently visited the home and was pleasantly surprised, the home has been decorated and was clean and tidy and my loved one’s room had also been decorated. The furniture has been arranged to make it easier for my loved one to be more independent”.

Staff were clear about their responsibilities in maintaining a safe environment and were aware of the process in place for reporting any health and safety concerns.

We saw the service had made improvements and now provided a safe environment for people to live in. The service was now visibly clean and had been redecorated since our last visit. There were no trip hazards seen throughout our onsite visit. We saw the environment was equipped with appropriate fire safety equipment and these were serviced regularly.

Processes were now in place to maintain a safe environment, for example, the service checked for risks in the environment and systems were in place to ensure equipment, facilities and technology supported the delivery of safe care. For example, the home completed health and safety audits of the environment and rectified any issues. Staff made daily checks on assistive technology in place for a person as part of their personal emergency evacuation plan (PEEP). Fire checks and fire drills now took place in line with the policy.

People said they were happy with the support from the staff in their home. Relatives said there were enough staff to meet their relative's needs. And, although there were still a lot of agency staff, they were regular staff and knew people’s needs. One relative said, “the staff are brilliant, there is a positive, caring atmosphere now.”

Staff told us there were usually enough staff, however, some staff said there were not enough staff at busy times during the day during the weekend. One staff said they had spoken to the manager about this, and as a result more staff had been allocated to work weekends.

We saw staff were available to support people according to the service’s rota. Staff appeared to be trained to meet people’s needs, for example staff had recently attended a SALT eating and drinking training session and demonstrated an awareness of how to prepare a person’s drink in line with their SALT eating and drinking recommendations.

The service made sure there were enough qualified, skilled and experienced staff who received effective support, supervision and development. For example, processes were in place to check newly recruited staff were safe to work in the service and new staff were given an induction to the home and support to get to know about people living in the home and their needs. Processes were also in place to check staff competency for example, mealtime observations were undertaken around people’s eating and drinking support to ensure people were being appropriately supported.

One relative said, ‘I recently visited the home and was pleasantly surprised, the home has been decorated and was clean and tidy.’

Leaders said they shared the infection control policy with staff and with the people they supported. The manager told us, “All the staff have completed infection control training, and we have done an effective hand washing learning session with staff and people.”

We saw the home was clean and free from odours. However, on our first visit to the service, we observed one staff member not following the service policy around using protective personal equipment (PPE) for personal care. PPE was not easily available for staff to use when needed. The manager said this was because PPE in the bathrooms had previously posed a risk to a person who has not lived in the service for a number of months. This was rectified immediately by the manager.

Processes were in place to reduce the risk of infection in the home. For example, staff training, checklists to clean the home and water safety checks to reduce the risk of legionella were being completed. The manager had oversight of infection control through biannual infection control audits. However, the audit was not completely effective as it had not identified the issue regarding access to PPE within the service.

The service took a person-centred approach to medicines administration. For example, one person said they wanted to become more independent with their medicines, so staff were working closely with the person and their GP to support this. One relative said “whenever my loved one needs a medical appointment or a change in medication, I am always invited to attend. But I am happy for them to take my loved one and tell me the outcome”

Staff were proud of the work that had been done to improve medicines optimisation in the home, but they accepted that further work was still required. Staff were able to demonstrate they understood and implemented the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) and ensured people’s medicines were reviewed by prescribers in line with those principles. Staff told us they received annual medicines training and competency checks.

There were processes in place to ensure people received medicines safely and in line with best practice and manufacturers’ recommendations. However, these were not being consistently implemented and followed by staff. There was a system in place for reporting medicines errors. Lessons learnt through these processes were being used to drive improvements in the service. Care plans contained information to support staff with the safe administration of medicines. Since our last inspection, staff had worked to improve care plans. Risk assessments for all service users prescribed creams with a flammable risk were now in place. However, for some medicines, risk assessments were outstanding. For example, the risk assessment for an anticoagulant medicine for one person, was not in place. (Anti-coagulant medicines have an associated risk of increased bleeding and bruising). The manager confirmed their awareness of the risks associated with this medicine and took steps to begin the risk assessment during the onsite visit. There were arrangements in place for storage of medicines. Where medicines were stored in a resident's room, these were in locked cupboards and the appropriate risk assessments were in place. However, staff were not maintaining records of medicines returned to the pharmacy in line with the provider’s medicines policy. The manager addressed this immediately by putting a system in place to account for medicines returns. Since our last inspection a system of weekly managers checks had been implemented to help reduce medicines errors. However, records indicated that this was not happening consistently. The manager told us they were aware of these shortcomings from their own audits and had changed their system to address this.