We carried out an inspection at Hilton Residential Home on 10 and 11 May 2017. The first day was unannounced.Hilton Residential Home provides residential care to older people in nine single and five double rooms. Five rooms have en-suite toilet facilities. The home is located half a mile from Padiham town centre in Lancashire and is close to local shops and transport routes. Car parking is available at the front of the home. There are comfortable lounges, dining rooms and a conservatory. Various aids and adaptations are provided to support people maintain their independence in addition to assisted bathing facilities. There is a passenger lift to the lower ground floor bedrooms. At the time of our visit there were 15 people who lived in the home.
At the time of our inspection the service had a registered manager who had been in post since 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.
We last inspected Hilton Residential Home on 14 and19 January 2015 and found the service was meeting regulations and was rated overall as good.
During this inspection we found the service to be in breach of five regulations under the Health and Social Care Act, 2008 (Regulated Activities) Regulations 2014. The breaches were in respect of Regulation 11, seeking consent, Regulation 12, safe care and treatment, Regulation 17 good governance, Regulation 18, staffing, Regulation 19 employment of fit and proper persons. This included shortfalls in the effective management of risks of harm and abuse within the service and a failure to implement systems and processes for seeking consent and mental capacity assessments, shortfalls in staff training, supervision and appraisals and lack of evidence to demonstrate the oversight provided to the registered manager to ensure compliance. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
Before this inspection, we had received some concerning information in relation to the quality of the service, management of people’s money and good governance. We looked into these areas during the inspection.
Feedback from people and their relatives regarding the care quality was overwhelmingly positive. Views from professionals were also positive.
People who lived at Hilton Residential Home told us that they felt safe and there was sufficient staff available to meet their needs. Visitors and people who lived at the home spoke highly of the registered manager and the owner who is also the provider. They told us they were happy with the care and treatment.
There was deterioration in the quality of the service since the last inspection in January 2015.There had been a change in management and a high turnover of care staff. However, there was evidence of improvements that the registered manager had started to implement.
There were policies and procedures in use by staff. We noted that some of the policies were due for update and the registered manager had started to update them to ensure they reflected current practice, legislation and best practice.
We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found there were policies and procedures on safeguarding people. Although some staff had not received up to date training in safeguarding adults; they showed awareness of signs of abuse and what actions to take if they witnessed someone being ill-treated. Improvements were required in this area. The registered manager showed us evidence of the training and support that they had planned to implement to resolve this.
Safeguarding incidents had been reported to the relevant safeguarding authority. Staff had documented the support people received after incidents. Staff had sought advice from other health and social care professionals where necessary. There were risk assessments which had been undertaken for various areas of people’s needs. Plans to minimise or remove risks had been drawn however; these had not always been reviewed following significant incidents or accidents. The risk of having pets in the service had not been adequately addressed.
The level of staffing on the day of the inspection was sufficient to ensure that the current number of people who lived at the home had their needs met in a timely manner. Systems for the recruitment of staff and to make sure the relevant checks were carried out before employment were not robust. We found records required to demonstrate that staff had been recruited safely such as proof of identity applications forms were not in the staff files. The registered manager took action to address the concerns and updated their practice and policy.
Staff had received training in the safe management of medicines and regular medicine audits had been undertaken. On the day of the inspection we observed that oral medicines were administered safely and in a person centred manner. We found records relating to medicine administration had been adequately completed to show whether people had received their medicines. Some improvements were required for monitoring records for topical medicines such as creams.
People were protected against the risk of fire. Building fire risk assessments were in place including personal emergency evacuation plans (PEEP’S).
We found care planning was not always done in line with the Mental Capacity Act 2005 (MCA).
People, staff and their relatives had not been consulted in relation to the use of a surveillance system in the service. Surveillance may be used as a tool to help protect people from the risk of abuse, or to investigate allegations or serious concerns about possible abuse or crime. However safeguards are required to protect people’s privacy and ensure the operation is lawful.
People who lived at the home had access to healthcare professionals as required to meet their needs.
Staff had received induction; however we found shortfalls in training required for the role. There was a policy on staff supervision and appraisals however staff had not received regular supervision and appraisals.
Some care records were written in a person centred manner however, some further improvement were required as five out of six files had missing information which included missing care plans, missing reviews of care and information which did not reflect changes in people’s needs. People who lived at the home and their relatives told us they were consulted about their care.
The provider had not consistently sought people’s opinions on the quality of care and treatment being provided. Relatives and residents meetings were not regular and surveys had not been undertaken to seek people’s opinions.
People’s nutritional needs were met. Risks of malnutrition and dehydration had been assessed and monitored. Where people's health and well-being were at risk, relevant health care advice had been sought so that people could receive the treatment and support they needed. Health and safety concerns were identified and rectified. People were supported with meaningful daytime activities.
Governance and management systems in the home required some improvement. Internal audit and quality assurance systems were in place. However; they had not always been effectively implemented to assess and improve the quality of the service and to proactively identify areas of improvement. Care files, staff files, and some medicine administration records for topical medicines such as creams had not been audited. There was a lack of evidence on how the provider monitored compliance of the registered manager. Various organisational polices were in place however they required updating in line with current practices and legislation. The organisation’s own polices had not always been followed.
Staff told us there was a positive culture within the service. Staff we spoke with told us they enjoyed their work and wanted to do their best to enhance the experience of people who lived at the home. We received positive feedback from visiting professionals and relatives of people who lived at the home.
There was a business contingency plan which demonstrated how the provider had planned for unexpected eventualities which may have an impact on the delivery of regulated activities.
The majority of people felt they received a good service and spoke highly of the staff. They told us staff were kind, caring and respectful.
We found the service had a policy on how people could raise complaints about care and treatment.