Archived: Hillview Care Home

Updated 22 August 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Before the inspection we reviewed all of the information we held about the service. The information included notifications that we had received from the service. Notifications are changes, events or incidents the provider is legally required to let us know about. We also contacted Redcar and Cleveland local authority commissioning team and South Tees Clinical Commissioning Group. We used the information they gave us to help plan the inspection.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

One adult social care inspector and two experts by experience carried out this inspection on 22 May 2017. One adult social care inspector returned for a second day of inspection on 30 May 2017. The experts by experience involved in this inspection had experience of working with adults and older people. In June 2017, we received a number of whistleblowing concerns about the service. Two inspectors carried out a third day of inspection on 3 July 2017 in response to growing concerns about the service.

During the inspection we spoke with 22 people and six relatives. We also spoke with the regional manager, registered manager, clinical lead, five nurses, 12 care staff, an activities coordinator, a dining room hostess, a maintenance person and a member of domestic staff.

We reviewed 11 people's care records in detail and the supplementary records (medicine administration records, topical cream records, food and fluid balance records, positional change records and hydration thickening protocol records) of a further five people. We reviewed five staff recruitment and induction records, the training summary records for all staff and six staff supervision and appraisal records as well as records relating to the management of the service.

We looked around the service and went into some people’s bedrooms (with their permission) and visited the communal areas. We carried out observations of practice and conducted a short observational framework for inspection (SOFI) to capture the experiences of people who may not be able to express themselves or communicate with us.

Updated 22 August 2017

This unannounced inspection took place on 22 May 2017. This meant the provider, staff and people using the service did not know that we would be carrying out an inspection of the service. We returned on 30 May 2017 to carry out a second day of inspection which was announced.

Throughout June 2017, we received a number of whistleblowing concerns. In response to these, two inspectors carried out a third day of inspection on 3 July 2017 which was unannounced.

Hillview Care Home provides personal and nursing care for up to 53 people who live with a physical impairment, have a mental health condition, a dementia type illness or are living with a learning disability. Hillview Care Home is a large building within its own grounds in a residential area close to local amenities. There are gardens to the front and rear of the service with views of Eston Hills.

At the time of the inspection, there were 49 people using the service who were supported by the registered manager and 73 care staff.

The registered manager has been registered with the Care Quality Commission since May 2017; however they had been in post since 1 August 2016. 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.

People did not receive person-centred care because the care people were given did not always reflect their needs, wishes and preferences. Staff told us they did not have time to read people’s care plans and daily records did not match the needs identified in people’s care plans.

People were left in bed throughout each day of inspection. One person asked us if they were allowed to get out of bed. Outside of planned activities there was a lack of stimulation for people. Staff did not spend time sitting with people and talking to them. Staff told us they did not have time.

People’s privacy and dignity was not maintained or respected. We observed a nurse walk into a person’s room whilst they were receiving personal care without knocking. A used incontinence pad was left next to one person whilst they were laid in bed. Personal items such as urine bags, incontinence pads and nutritional supplements were on display. One person had been left on the toilet for three hours.

One person did not speak English. There was no information in the care records about how to communicate with this person such as key phrases and very little action was taken to seek alternative means of communication.

Prior to inspection, the Clinical Commissioning Group shared concerns with the management of medicines at the service. The registered manager had taken some action to address these concerns. We identified that the management of medicines needed to be improved. Medicines were signed for before people had been given them. Medicines were crushed without protocols in place. People did not receive their topical creams as prescribed. Nutritional supplements were not stored appropriately.

People at risk of malnutrition were not appropriately supported. Weekly weights were not consistently carried out. Risk assessments and care plans relating to these had not been regularly updated. We identified two people had not been given there breakfast by 11:30 on one of the days of inspection. One of these people was living wit a diagnosis of diabetes.

Staff were not responsive when people’s needs changed. We identified delays in responding to people, seeking treatment and obtaining prescribed creams. People at risk of developing pressure sores did not receive appropriate care and treatment. Staff failed to communicate clearly and care records relating to these were inaccurate, incomplete or had not been regularly reviewed.

Records showed people had been bathed at unsafe water temperatures between 20 and 36 degrees Celsius. Bins causing malodours had not been emptied. Incontinence pads and disposable gloves were not readily available for staff.

People’s personal information was not protected because we found care records on display on each day of inspection. Some staff shared personal information about people and the service with the public. The provider was taking action to address this.

There were gaps in all care records looked at. Care records were not regularly updated and some contained inaccuracies. Care plans were not always put in place when people moved into the service. This meant staff did not have the information they needed to provide safe care and support to people.

We raised concerns on the first day of inspection and asked for immediate action to be taken, especially in relation to the quality of record keeping. All concerns remained in place on the third day of inspection.

Quality assurance procedures were in place but had not highlighted the same level of concerns during this inspection. There were gaps in audits and information was not always clear. Action plans were put in place, however were not effective because staff did not carry out the tasks identified within them.

A strong and stable team who were supportive of each other was not in place. Staff were not accountable for their actions and did not follow the values of the service. This meant there was a lack of communication and team work.

There were insufficient staff on duty on the first floor of the service. Staff were not appropriately deployed on the ground floor. Call bells went unanswered.

Not all staff had received up to date training in fire safety, pressure area care and moving and handling. Competency checks had not been carried out for staff who lack confidence in using a new hoist. No training in learning disabilities, mental health and Parkinson’s disease had been made available for staff despite people with these health conditions using the service.

There were not enough hoists available for people on the first day of inspection. Although an order had been placed, no action had been taken to address the temporary shortfall. We asked the registered manager to address this during inspection. They took action and a further hoist was made available for staff.

The health and safety of the service was regularly monitored. Up to date safety certificates were in place and staff participated in regular planned fire drills.

Personal emergency evacuation plans were in place for each person and detailed important health conditions, medicines and any difficulties with mobility.

Staff training in safeguarding adults was up to date, however staff had not always raised concerns when needed. Where safeguarding alerts had been made, investigations had been carried out and actions put in place to minimise the risk of a reoccurrence.

Care staff had received regular supervision and appraisals, however not all nurses had received their appraisal. The provider already had an action plan in place.

People spoke very positively about the food provided at the service. Regular drinks and snacks were offered to people and each person had a jug of water or diluted juice in their rooms.

Health and social care professionals were involved in people’s care. Staff had not always shared information with health professionals in relation to pressure area care. Guidance from these professionals was documented in people’s care records. We found some care plans had been updated with this guidance, however others had not.

Staff had followed the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) had been applied for and granted for 10 people. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Dementia friendly signage was on display in some areas of the service. The registered manager told us that this was an area for further development at the service. There were quiet areas available for people and there were flat outside spaces for people.

People spoke positively about the staff who provided care and support to them. We observed positive relationships between people and staff. Staff appeared to know people well. We observed laughing and joking and friendly banter between people and staff.

Care records showed that some people and their relatives had been involved in planning and making decisions about their care. The registered manager told us they regularly met with people and their relatives to discuss the care and support people received. Staff had organised for advocates to be involved in some people’s care to ensure their voice was heard.

People spoke positively about planned activities. Details about planned activities were on display and we observed people enjoying the performance by external singers and a visit from an ex-guide dog.

People knew how to make a complaint it they needed to. Each person spoken to told us they had confidence that the registered manager would take their concerns seriously. At the time of inspection no-one had wanted to raise a complaint. Concerns were raised outside of the days which we visited the service. We shared relevant information with the local authority and registered provider. We also considered these concerns during this inspection process.

Staff were generally supportive of the registered manager, had confidence in them and thought that improvements had been made since they came into post. Most staff told us they enjoyed working at the service and could approach the registered manager.

People told us they had confidence in the registered manager. People and staff told us they were kept up to date with changes at the service and upcoming events at meetings and via newsletters.

The service had links with the local community which included schools and religious organisations. The service held fundraising events