Hilton House

Updated 8 January 2022

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 Care Act 2014.

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

This inspection was carried out by two inspectors.

Service and service type

Hilton House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This 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. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with six relatives about their experience of the care provided. We spoke with 12 members of staff including the regional support manager, the registered manager, the governance and quality manager, unit managers, senior care worker, care workers, kitchen and domestic staff.

We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 8 January 2022

About the service

Hilton House is a residential care home providing personal care to 36 people at the time of inspection. The service can support up to 55 people. Hilton House accommodates people over two floors, each floor has been environmentally adapted to meet the needs of people.

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

Risks were not always managed safely, sensor alarms which alert staff when a person requires assistance were not always set correctly. The deployment of staff was insufficient to meet people's needs and care plans did not contain enough detail to monitor risks safely.

There were systems to monitor safety of the service people received, however many of these were newly implemented; therefore, the success of these new systems could not be measured.

Infection prevention control was adequate, visitors received COVID-19 checks before being permitted into the service and the home was clean. There was room for improvement regarding following current government guidance in relation to monitoring and recording people’s temperature twice daily.

There were processes in place to protect people from the risk of the spread of infection and measures were in place to mitigate the risks associated with COVID-19.

The service worked in partnership with other health and social care professionals to achieve good outcomes for people.

Medicines were managed, stored and administered in a safe way. Robust quality audits ensured medicines were routinely stock checked.

Safeguarding and whistle-blowing policies were available to staff and they told us where they were located. Staff received training, they knew how to safeguard people and felt confident to report their concerns.

The provider's procedures for staff recruitment helped protect people from the risk of abuse. Staff were recruited safely, and the registered manager ensured all relevant staffing checks were conducted prior to employment.

Relatives felt people were safe living at the home and with the staff who supported them. Regular health and safety checks were carried out on the environment and contingency plans were in place to keep people safe.

The registered manager was new in the post. All staff and people felt the registered manager was approachable and had confidence in their abilities.

Quality audits were in place to monitor risk, many of these were newly implemented. These will be reviewed at the next inspection. There was a culture of improving care, the registered manager had clear plans in place to drive improvements within the home.

Relatives and staff members felt involved in the care provided within the home and there was a culture of transparency and learning from mistakes.

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.

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

Rating at last inspection

The last rating for this service was requires improvement (published 19 August 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to infection control, staffing and people's care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed, the service remains requires improvement. 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 assure the service can respond to COVID-19 and other infection outbreaks effectively.

The provider needs to make improvements to ensure safe care is provided at all times. The registered manager has begun to take actions to remedy the shortfalls we identified and put measures in place to further mitigate risk. Please see the Safe and Well-Led relevant key question sections of this full 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 Hilton House 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 to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.