Notts Hill House

Updated 23 March 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The first day of the inspection was carried out by two inspectors and an assistant inspector. The second day of the inspection was carried out by one inspector and an Expert by Experience made phone calls to people’s relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The third day of the inspection was carried out by an inspector from the medicines team.

Service and service type

Notts Hill House is a 'care home'. People in care homes receive accommodation and personal care as a single package under one contractual agreement dependent on their registration with us. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

The first day of the inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the inspection we spoke with 5 people and 6 relatives about their experience of the care provided. We looked around the building and observed care and support in communal areas. We spoke with 12 staff including the operations director, registered manager, deputy manager, care staff, maintenance person, housekeeper and the chef. We reviewed a range of records. This included 5 people's care records and multiple medication records. We looked at 3 staff files in relation to recruitment, training and supervision. We also looked at a variety of records relating to the management of the home including polices and audits.

Updated 23 March 2023

About the service

Notts Hill House is a residential care home providing personal care to up to 16 people. The service provides support to people with a physical disability, and/or acquired brain injury. At the time of our inspection there were 11 people using the service.

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

During our inspection in 2019, quality assurance processes were identified as requiring improvement. This inspection has found improvements are still required to ensure risks are effectively mitigated and monitored and care records are kept current and up to date.

Whilst medicines were generally managed safely, one person’s medicine was not always given as prescribed and audit checks of medicines administration records had not identified this.

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, we have made a recommendation about ensuring staff revisit The Mental Capacity Act training.

Risks to people were assessed and actions were taken to minimise risk. People’s support plans were personalised to each individual and contained sufficient detail to assist staff to provide safe care.

People were provided with rehabilitation support to regain daily living skills and help them enjoy as much independence as they could. People had support to access healthcare services when they needed.

Systems and processes were in place in place to protect people from abuse. Staff had received safeguarding training and understood how to recognise and report signs of abuse.

People were supported by enough staff to meet their needs and there were safe recruitment processes in place.

People were supported by staff that had received induction and training appropriate for their roles and the people they supported.

People were protected from the risk of infection because staff followed safe infection control practices and personal protective equipment was being used.

People told us they enjoyed the food. People's dietary and nutritional needs were assessed, recorded and managed and advice was sought from nutrition specialists when needed.

People were encouraged to follow their interests and were supported to take part in a range of activities both in-house and away from the service.

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People told us they knew how to make a complaint and would speak to a member of staff if they needed to.

People lived in a service that was well maintained and adapted and designed to meet their needs.

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 4 February 2021). This was a focused inspection looking at the safe and well led key questions only. This inspection did not look at the previous breaches of regulation from the inspection in July 2019.

At the previous inspection in July 2019 (Published 28 August 2019) we found breaches of regulations. The provider completed an action plan after this inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

This focused inspection was carried out to follow up on action we told the provider to take at the inspection in July 2019.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe, and well led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to risk management, medicines management and the providers governance systems in place at this inspection.

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

We have made a recommendation in relation to The Mental Capacity Act 2005.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.