Hillsborough Residential Home

Hillsborough residential home is a residential care home providing personal care for up to 22 people. The service provides support to people requiring care and assistance. Some people were living with dementia. At the time of our inspection there were 18 people using the service. The service is also registered to provide care and support to people in their own homes. At the time of the inspection, no-one was receiving support with personal care.

People’s experience of using this service and what we found

There were enough staff to meet people's needs and ensure their safety. Appropriate recruitment procedures ensured prospective staff were suitable to work in the service.

There was equipment available to support staff in providing safe care and assistance. Health and safety checks of the environment and equipment were in place.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Safeguarding processes were in place to help safeguard people from abuse. Risks associated with people's care had been assessed and guidance was in place for staff to follow. Medicines were safely managed.

People living at Hillsborough residential home had care plans which detailed their needs and preferences. Staff knew people's care needs well.

There were processes in place to prevent and control infection at the service. Additional training and systems had been adopted through the COVID-19 pandemic. There were additional cleaning and safe visiting precautions.

Governance systems had been reviewed. Changes made to the management structure ensured effective oversight of the service. The service had clear and effective governance systems in place.

The management team-maintained oversight of complaints, accidents and incidents and safeguarding concerns. The management team engaged well with health and social care professionals.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good published 30 October 2021.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hillsborough Residential Home ("Hillsborough") is a residential care home that provides care and accommodation for up to 22 older people, some of whom are living with dementia. At the time of the inspection there were 14 people living in the service. Hillsborough is also registered to provide personal care to people in their own home. However, at this inspection, no-one was receiving support with personal care.

People’s experience of using this service and what we found

At our last inspection we found the management of people’s medicines and the monitoring of the quality of the service provided were not effective. We also found the environment was not always well maintained or suitable for people’s needs.

At this inspection we found improvements had been made. Medicines were well managed, and people received their medicines safely and as prescribed for them. Robust auditing and quality monitoring systems and been set up and fully implemented. The registered manager had a comprehensive overview of the service and knew where improvements could be made.

The premises were clean and there were no malodours. An extensive re-decoration programme had been in place since our last visit and the service was brighter and more suitable for the needs of people living there. These improvements, while still on-going, included several bedrooms being upgraded and the shared living areas had been de-cluttered, redecorated and re-carpeted. Additional signage had been put in place to help people living with dementia to identify their surroundings more easily.

People were relaxed and comfortable with staff and had no hesitation in asking for help from them. Staff were caring and spent time chatting with people as they moved around the service. There was time for people to have social interaction and activity with staff. Staff knew how to keep people safe from harm. Comments from people included, “Happy with everything” and “I feel safe living here.”

People had access to call bells to alert staff if they required any assistance. We saw people received care and support in a timely manner and calls bells were quickly answered.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Information about people's care needs, and any changes to those needs, were individualised, informative and shared effectively within the staff team. Risks were identified and staff had guidance to help them support people to reduce the risk of avoidable harm.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Staff were informed about people’s changing needs through effective shift handovers and informative records of the daily care provided for people. People were offered a range of healthy meal choices.

Staff were recruited safely and there were enough staff on duty to meet people’s needs. The service had some staff vacancies and recruitment to these posts was on-going. The registered manager assessed staffing levels based on the needs of the people living at the service and only accepted new admissions when there were sufficient staff employed.

Staff had received appropriate training and support to enable them to carry out their role safely and effectively. Staff told us they were well supported by good training, regular one-to-one meetings and approachable management.

We were assured that risks in relation to the COVID pandemic had been managed appropriately. Staff had access to appropriate PPE and hand washing facilities, which they used effectively and safely.

The service sought the views of people, families, staff and other professionals and used feedback received to improve the quality of the service provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (report published on 21 October 2020) and there were three breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We carried out an unannounced inspection of this service on 22 September 2020. Breaches of legal requirements were found. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hillsborough Residential Home on our 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.

We found the following examples of good practice.

There had been an outbreak of Covid-19 at the service. During this time the manager had communicated with people, staff and families regularly to ensure everyone understood the measures put in place to help keep people safe.

All areas of the service were clean and clutter free. Effective cleaning routines had been put in place to ensure infection control risks were minimised and people were kept safe. High contact areas were cleaned regularly throughout each shift and cleaning procedures had been reviewed and updated.

Staff put on and took off their uniforms in a designated room, close to where they entered the building, and uniforms were laundered at the service. This helped to reduce the risk of infection because staff did not enter areas of the home, where people lived, until appropriate infection control measures were in place.

Staff had completed online infection prevention and control and Covid-19 training. In addition, competency checks had been carried out to check if staff understood the online training and were using PPE correctly. Additional PPE had been provided for staff, such as visors, to use during the outbreak. The service had maintained good stocks of PPE and the manager worked with care and domestic staff teams to ensure infection prevention and control measures were followed.

At the start of the outbreak a large proportion of the staff team were unable to work. Agency staff and staff supplied by the local authority were used to cover shifts. The manager ensured there was always at least one permanent member of staff on duty, who was able to handover important information about people’s needs, to help ensure people still received the right care. Once staff returned to work shifts were covered by permanent staff.

During the outbreak, when people were isolating in their rooms, a notice was placed on bedroom doors showing the start and end date of the isolation time. There were also notices giving guidance for staff about what PPE should be worn before entering the room as well as additional checks staff needed to carry out in relation to people’s wellbeing.

At the time of the inspection the service was closed to all visitors in line with government guidance and because of the outbreak. Staff helped people to stay in touch with family and friends through phone and video calls. Some families, with people's permission, had access to the electronic daily notes which enabled them to read about their relative’s care and how they were spending their time.

The manager had reviewed the infection control policy in response to the pandemic. Specific Covid-19 policies had also been developed to provide guidance for staff about how to respond to the pandemic and the outbreak. These policies were kept under continuous review as changes to government guidance was published.

Further information is in the detailed findings below.

Hillsborough Residential Home ("Hillsborough") is a residential care home providing accommodation and personal care to 19 people aged 65 and over at the time of the inspection. Hillsborough also provided personal care to people in their own home. However, at this inspection, no-one was receiving support with personal care.

People’s experience of using this service and what we found

When we inspected Hillsborough to assess the safety and quality of people’s care, we took into consideration the significant pressures the COVID-19 pandemic had put on the service. However, we found that some aspects of safe care, particularly medication were not always robust. The underpinning of governance and recording systems to prevent or address issues had not always been effective. We therefore assessed that the provider was in breach of regulations regarding safe care and treatment and good governance.

The service was not always safe. We could not be sure people received their ‘as required’ medicines when they needed them. Some action had been taken to strengthen quality monitoring processes to improve outcomes for people, but the provider's quality assurance systems required further improvement. Quality improvement measures and oversight of medicines had been ineffective at driving enough improvement in this area. 'As required' medicine audits required further development to ensure people received their medicines as prescribed.

Some improvements had been made since the last inspection and regular checks of the environment and of records were completed. However, some areas of the environment still required improvement for people living with dementia, and identifying people's needs in relation to the environment. The provider informed us of future planned improvements.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act 2005 (MCA) had now been followed as required at the last inspection.

People had care plans, which described their needs and preferences. The care records were all held electronically. Improvements had been made to the information held about individuals and staff had a better understanding of the electronic system. This included a scanning system to ensure staff had checked a person’s wellbeing. This was particularly important if the person was being nursed in bed.

The registered manager continued to increase the amount of checks to monitor the people who used the service and the environment. Records showed changes and improvements had been made. However, as it had only been a short time since the last inspection, we could not be sure these had been embedded effectively into the service.

People told us they were happy living in the home and a visiting professional said the service was very homely. The provider's passion for caring for people was clear.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 January 2020), for the third time, and there were multiple breaches of regulation; three of which were repeat breaches from the previous inspection.

The provider was required to send us monthly reports detailing the improvements they had identified and what action they had taken as a result. We have reviewed these reports.

At this inspection enough improvement had not been made and the provider was still in breach of some of the regulations. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same as the last inspection, requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hillsborough House Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to monitor the service and continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified four continued breaches in relation to the safety of people's care, premises and equipment, fit and proper persons employed and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hillsborough Residential Home ("Hillsborough") is a residential care home providing accommodation and personal care to 22 people aged 65 and over at the time of the inspection. Hillsborough Residential Home Limited also provided personal care to people in their own home. However, at this inspection, no-one was receiving support with personal care. The registered manager and provider told us they planned to review whether they would accept more people to that part of the service in January 2020.

People’s experience of using this service and what we found

The service was not always safe. Some improvements had been made since the last inspection and regular checks of the environment and of records were completed. However, not all risks relating to the environment had been identified or assessed, and records did not show people’s care had been delivered as required, to reduce risks to them. Infection control practices were now being monitored but had not identified times when staff were not following best practice.

Staff recruitment processes had improved but there were still gaps in the checks being completed. Staffing levels had improved but we have made a recommendation about staff deployment. Records of incidents and accidents were now in place.

Medicines management and practices had improved and were safer. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, the principles of the Mental Capacity Act 2005 (MCA) had not been followed for two people who lacked capacity.

Improvements to the environment were still required; this included identifying people’s needs in relation to the environment.

The registered manager had increased the amount of checks to monitor the service. Records showed changes and improvements had been made as a result of audits, events or staff ideas. However, these had still not effectively highlighted all the gaps identified at this inspection. Concerns raised during the last inspection, such as environmental risks, ensuring risks to people were reduced, infection control practices, recruitment practices and not meeting the Mental Capacity Act 2005 (MCA), had not been fully resolved.

People told us they were happy living in the home and staff told us they particularly enjoyed working in the homely atmosphere. The provider’s passion for caring for people was clear.

People told us they were happy with the food and the choices available to them. People were supported to remain healthy and staff were knowledgeable about people’s needs. People saw healthcare professionals regularly but records of these visits were not always easy to find. We have made a recommendation about this.

People received support from staff who cared about them. People were supported to express their views in the way they wanted to. When people raised concerns, records did not always show what action had been taken. We have made a recommendation about this. People’s privacy and dignity were mostly respected but we have made a recommendation about the storage of people’s medicines records and continence aids.

People had care plans in place to describe their needs and preferences. The registered manager had identified that some more detail was required and had a plan to ensure this happened. Staff were responsive to people’s requests and gave people choice and control over their care. Improvements were being made to the options available for how people spent their time. Complaints had been recorded and appropriate action taken.

There was a plan in place to ensure all staff training was up to date. Staff’s understanding of people’s needs and of best practice was being developed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 03 July 2019), for the second time, and there were multiple breaches of regulation; two of which were repeat breaches from the previous inspection. The provider was required to send us monthly reports detailing the improvements they had identified and what action they had taken as a result. We have reviewed these reports.

At this inspection enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating, to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider continues to need to make improvements. Please see the safe, effective and well led sections of this full report.

Enforcement

We have identified breaches in relation to how the service keeps people safe, the environment, infection control, staff recruitment, the Mental Capacity Act 2005 (MCA) and the governance of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

People’s experience of using this service:

•People did not always receive their medicines safely and were not always protected by infection control practices.

•People did not always have the required risk assessments in place relating to their health and social care needs, to help keep them safe.

•Staff were not always recruited safely to ensure they were suitable to work with vulnerable people.

•Systems of leadership and governance did not ensure that there were effective checks of the quality of the service taking place.

•Staff had not always received the appropriate training, professional development, and supervision to carry out their duties.

•People and relatives were positive about the service and the care given in the residential home and in their own homes. People told us the food was delicious.

Rating at last inspection: The rating at the last inspection was Requires Improvement (Report published 05 April 2018).

We found seven breaches of the Health and Social Care Act (2008), and made recommendations in respect of the environment, and the Accessible Information Standard (AIS).

Why we inspected: We inspected the service in line with our inspection methodology. We followed up on the breaches of Regulations and the recommendations from the previous inspection.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: The overall rating for this registered provider is requires improvement. Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated requires improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Hillsborough Residential Home is registered to provide residential care for up to 22 people. At the time of our inspection there were 22 people living at the service. The provider was also registered to support people with personal care within their own homes; known as a community care service. At the time of our inspection, there were nine people receiving support.

Prior to our inspection we had received concerns about the safety of the building and people’s access to the kitchen. We looked at these concerns as part of our inspection and found that improvements were required.

Hillsborough Residential Home had a registered manager who was also the registered provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 service is run. The provider was supported by a deputy manager. The deputy manager was in the process of undertaking a qualification in leadership and management to enable them to become the registered manager of the service.

At our last inspection in June 2015 the service was rated Good. However, at this inspection we found the service to require improving.

Overall, people living at the care home were supported by sufficient numbers of staff to be able to meet their needs. However, staff told us that sometimes they were understaffed because the provider did not find additional cover when staff were on annual leave or unwell. Staffing rotas also showed this. People were looked after by staff who were trained to meet their needs. New members of staff completed an induction to introduce them to the day to day aspects of the service, and to relevant policies and procedures.

People’s care plans and personal risk assessments contained good detail about how important it was that their physical care needs were safely monitored. However, when people had a specific risk relating to their healthcare, risk assessments were not always in place to help guide staff to provide safe and consistent care. The provider had not considered whether the format of people’s care plans met with their individual communication needs.

Accidents, incidents and falls were monitored to establish if there were common trends, so as to help minimise repetition. People had personal emergency evacuation plans (PEEPs) in place. This meant the emergency services would know what to do, for each person living in the home in the event of an emergency such as a fire.

Policies relating to the environment were not always being adhered to by staff. For example, the kitchen door which should have been closed to ensure people’s safety was found to be open. We also noted the environment was cluttered, with many items of furniture which impeded people’s movement. People were not always supported in the environment because signage was not always clear and may not have always been in a suitable format for people to understand.

People’s medicines were managed safely, with good recording processes in place. People’s health needs were met. Staff worked closely with external health and social care services to help ensure a co-ordinated approach to people’s care.

People were protected by the providers safeguarding processes, staff knew what action to take if they suspected someone was being abused mistreated or neglected. Overall, people were supported by staff who had been recruited safely to ensure they were suitable to work with vulnerable people. However, we did note for one employee the provider had not followed their own recruitment policy, by ensuring their employment history had been obtained.

People living in the care home told us the food was nice. However, some people who received meals in the community as part of their care package, told us that often these were not hot, nor did they get much choice. People were not always being provided with the means to remain socially stimulated or to continue their hobbies.

People’s human rights were protected. Staff had received training in the Mental Capacity Act 2005 (MCA) and had a good understanding of the legislative frameworks. People were asked their consent, prior to staff supporting them.

People’s personal information was not always treated confidentially. People’s care records were kept in an unlocked cupboard in the dining room and staff talked about people in shared areas, such as the dining room, while other people were in hearing.

People told us, staff were “very caring” and we observed examples of this caring ethos during our inspection. People’s visitors were greeted warmly and made to feel comfortable. People’s dignity and privacy was promoted, by staff knocking on people’s doors before entering their room. People’s religious and cultural needs were respected.

People were cared for at the end of their life by staff who had received palliative care training. However people’s end of life care plans were not individualised, this meant people may not experience personalised and individualised care in their final days.

People’s complaints were handled in a respectful manner. The provider had a complaints procedure. However, the complaints policy may not have been in a suitable format for everyone to understand.

Overall, staff thought the service was well managed, but told us they did not always feel valued. The provider did not have effective systems in place to monitor the ongoing quality of the service and when systems were in place, these had not always been effective in identifying when improvements were required.

People’s feedback was obtained to help develop and improve the service. However, whilst surveys were carried out, some actions had been carried forward from 2015 to 2016 and were still uncompleted by December 2017. This demonstrated the provider was not always responsive in using people’s feedback to help improve the quality of the service.

People lived in a service whereby the provider and deputy manager did not keep up to date with changes in legislation and with health and social care best practice. For example, they were not aware of the changes which had been made to the Key Lines of Enquiry (KLOEs) which came into being from 01 November 2017. They were also unaware of the Accessible information Standard (AIS). The AIS is a nationally recognised and required standard within the health and social care sector, which must be implemented to help ensure there is a consistent and inclusive approach to meeting people’s individual communication and support needs of people.

The provider informed the Commission of notifiable incidents in line with legal requirements, such as deaths or serious injuries. The provider was open when uncommon incidents had occurred, demonstrating the principles of the Duty of Candour. Duty of Candour means that a service must act in an open and transparent way in relation to care and treatment provided when things go wrong.

We recommend the provider reviews the environment, by taking account of best practice and dementia research, and that the provider reviews the quality of meals with people within the community, and makes changes accordingly. In addition, we recommend the provider ensures the Accessible Information Standard (AIS) is fully implemented within the service as well as using a staffing tool to help demonstrate they have sufficient numbers of staff on duty, to meet people’s needs safely.

You can see what action we told the provider to take at the back of the full version of the report.

We observed that staff spoke with people in a friendly and respectful manner. People told us that they were able to make choices about their day to day lives. One person told us 'It's brilliant here.'

The care plans we looked at were personal to the individual and gave staff clear information to follow. This made sure that people received care and support which met their individual needs.

The environment was clean and there were systems in place to minimise the risk of infection.

There were robust systems in place to ensure that before staff began working in the home that they were safe and trained to look after the people.

The home kept a log of all complaints and concerns raised. One person told us 'I have no complaints, but I could talk to staff if I did.' We read the log and saw that all concerns were responded to promptly.

We also inspected the Hillsborough Domiciliary Care Service which is managed from the care home. We found that care plans provided information for people using the service and staff to ensure people's needs were met.

People were positive about the care they received at Hillsborough House and the domiciliary care provided. They told us 'they treat you like a human being here' and 'this is best place I have been so far '

We saw that people were treated with dignity and respect. We saw that they had choices and they were included in their plan of care. We observed that people's information was maintained to ensure their confidentiality was protected.

Staff told us that they felt supported in their role and they had received updated training in medication management and the safeguarding of vulnerable adults.

Records relating to people's care were detailed and personal to each person and reflected their choices and preferences.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Auditing of the views of people living at the home, their relatives and staff had been undertaken. This was to monitor people's view of the service provided and make changes when needed.

We also inspected the Hillsborough Domiciliary Care Service which is managed from the care home. We found that care pans had been developed and further information provided for people using the service and staff to ensure people's needs were met.

People told us 'we are well looked after here, the owner is a lovely person' and 'we have no grumbles'.

People said there was not a lot of activity provided and so there was not a lot to entertain them.

We saw that sometimes people were not treated with dignity and their privacy was not protected or respected.

Staff told us that they felt supported in their role and that they had sufficient induction and training to help them do their jobs. However, training in all areas of care was not provided, this included the protection of vulnerable adults and medication training which may place people at risk.

We looked at the care provided and records relating to five people. Records relating to people's care were detailed and personal to each person. However, the plans of care were not all an accurate reflection of the person's current care needs.

Medication systems were not well managed and may place people at risk.

Auditing systems undertaken by the management of the home had recently been put in place to monitor the environment of the home. A plan of maintenance and action was being developed to improve the fabric of the home.

We also inspected the Hillsborough Domiciliary Care Service which is managed from the care home. We found that some areas of the service needed further development to ensure people received a good standard of care.