Archived: Hillside Nursing Home

Hillside Nursing Home is a purpose built 55 bed care home providing accommodation and nursing and personal care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those that need it. For example, hoists and adapted baths are available. 52 people were using the service when we visited.

The service had a registered manager. 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 and associated Regulations about how the service is run.

We found medicines were not safely managed and people did not always receive their medicines in line with the prescriber’s directions. People who received their medicines without their knowledge (covertly) were not managed safely.

There were not enough staff deployed to safely provide people with the care and support they needed.

Although services and equipment were checked they were not always properly maintained.

People had access to healthcare professionals when needed but recommendations from them were not always followed. For example, with regards to pressure area care.

People were placed at risk of receiving care and support that did not fully met their current needs. This was because care plans did not always contain sufficient detail or consistent information.

The provider had systems in place to monitor the service provided but these were not robust and had not ensured that people received a good quality of service.

Staff received appropriate training to provide a safe service that met people’s needs. Further training was scheduled to ensure that staff training was up to date

Staff supported people to make choices about their care and systems were in place to ensure they were not unlawfully deprived of their liberty.

People were happy to talk to the registered manager and to raise any concerns they had. Staff told us they received good support.

Systems were in place to safeguard people from abuse and staff were aware of how to identify and report any concerns about people’s safety and welfare.

People told us they felt safe at Hillside and were supported by kind and caring staff.

We saw that staff supported people patiently, with care and encouraged them to do things for themselves. Staff provided care in a respectful way that promoted people’s dignity.

The provider’s recruitment process ensured staff were suitable to work with people who need support.

People’s nutritional needs were met but we have recommended that lunchtime arrangements and support be reviewed to ensure that people receive the support they need in a timely manner.

Activities were provided but people told us that there was not enough to do. Activity worker hours were being increased to help to address this concern.

We found five 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.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found.

Is the service safe?

We spent time in all three units and observed how people were supported by the staff. We saw that staff treated people respectfully. Relatives told us that they felt people were safe. One relative said, 'It is safe, caring and meets [my relative's] needs.

Staff had received training in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). When there were concerns about a person's ability to make a decision affecting their safety and welfare, a mental capacity assessment had been carried out and a DoLS put in place. This kept people safe and protected their rights.

We found that staff were properly recruited and checked to ensure that they were suitable to work with vulnerable adults.

Although most care plans we looked at had been reviewed regularly to ensure they were up to date this was not the case for a person with very complex needs. In addition for some people we found that their care and treatment did not reflect relevant research and guidance. Therefore their care was not planned and delivered in a way that ensured their safety and welfare.

Is the service effective?

People were supported to receive the healthcare that they needed. One healthcare professional told us, 'Things are definitely getting better here. We are working together to improve 'end of life' care.'

People's care needs were assessed and plans of care developed from these. Staff had a good understanding of how to meet people's individual and assessed needs and of individual preferences.

Is the service caring?

Relatives we spoke with were positive about the care provided by the staff team. One relative told us, 'It's relaxed and friendly here. They are very good with [our relative]." We saw that staff supported people in a gentle, respectful and kind way. They offered people choices and talked to them about what was happening or what they needed to do. For example, we heard a member of staff ask one person if they wanted to have their dinner before they had their hair done. A person who used the service smiled and said, 'The staff are lovely and kind.'

Is the service responsive?

Care staff were able to tell us about people's needs and how they supported and cared for them. The service was responsive to people's changing needs. For example, we saw that timely referrals were made to the dietician when there were concerns about people's weight loss. A member of staff told us that they received a handover and updates about any changes or specific support that people needed.

Is the service well led?

The service had a registered manager in post and a clear management structure. Staff we spoke with said they felt the home was well managed and that they received the support and guidance they needed to carry out their duties and to meet people's needs. The manager had developed a service improvement and action plan to address issues that arose and to develop and improve the service provided.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately. People we spoke with said they had not had cause to complain but were confident any complaint they made would be taken seriously and resolved. One relative responded "yeah, definitely, they would take it on board" when asked about this.

People were provided with a choice of suitable and nutritious food and drink. There were various meal choices available as well as hot and cold drinks. A relative we spoke with during lunch said "the food is good, (my relative) finishes it all." People told us they felt safe at the home. Apart from one new member of staff who had worked at the home for under a month, all staff we spoke with had recently received safeguarding training. They all understood what constituted abuse and the different types and signs of abuse.

Prior to our inspection we had been made aware of concerns about low staffing levels at the home, specifically during the day. We had also been told that there was a high level of staff absence and that a number of staff had recently left. During our inspection we found that on occasion the number of staff on duty was below that assessed as necessary by the home itself. This meant that on those occasions there were not enough staff working at the service to ensure that people's health, safety and welfare needs were being met.