About the service:

Hillingdon House is a care home that provides nursing and personal care for older people, some of whom are living with dementia. At the time of the inspection, 21 people lived at the service. The home is established over three floors, with a range of communal areas included dining spaces, a garden and a large lounge. There is also an annexe next door to the main property with six bedrooms and a small lounge.

People’s experience of using this service:

There had been a number of improvements in the home since the last inspection. People were now safer as they were now being moved safely and staffing levels had increased. The provider was now notifying us of all incidents as required and people’s dignity and privacy was consistently respected.

Some improvements had been made to the management of medicines but records showed that some people had not been given their medications as prescribed. The provider gave us assurances that further improvements would be made.

People told us they felt safe and well looked after in the home and this was supported by the views of relatives. Checks were made to ensure staff were suitable to work in the home and they received regular training and support to ensure they could deliver effective care.

People were supported in line with the Mental Capacity Act 2005 and consent was obtained, where possible before care and support was given. People enjoyed the food on offer and had access to health care services when needed. Improvements had been made to the layout of communal areas and people enjoyed siting in spacious and comfortable rooms.

Staff treated people with kindness and respect and were patient when people became anxious or upset. People were supported to do things for themselves where possible and relatives told us they were made to feel welcome in the home.

People’s needs and preferences were assessed and catered for by staff who knew people well. There was a range of activities on offer which people could choose to take part in. Further improvements had been planned to ensure activities were provided in line with people’s wishes.

People, relatives and staff were happy with the way the service was led and managed. The registered and manager were both visible and demonstrated to the staff team how people should be treated with care and compassion. Audits and checks were effective in identifying areas for improvement and prompt action was taken as a result.

More information is in the detailed findings below.

Rating at last inspection: Requires improvement (report published 13 January 2018). The overall rating has now improved to Good.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement:

No enforcement action was required.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

The inspection took place on 8 November 2017 and was unannounced. When we completed our previous inspection on 21 January 2016 the service was rated as good overall. This is the first time the service has been rated Requires Improvement.

Hillingdon House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Some of the people living in the home were living with dementia. At the time of our inspection 21 people were using the service. Hillingdon House accommodates people in one main building and a separate building which they call the ‘Annexe’ and which we will refer to as the ‘Annexe’ throughout the report. In the main building there is a communal lounge, a dining area, and a garden area that people can access. There is also a communal lounge and a small dining area in the ‘Annexe’ and seven bedrooms.

The service had a registered manager in post. 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.

Risks to people’s health and wellbeing were not always assessed and managed. They were not always assisted to move safely. The night time arrangements to respond to emergencies had not been assessed and to ensure that there were adequate staff. The provider hadn’t always considered the rights and wellbeing of their staff when deploying them at night time. There were not always enough staff available to meet people’s needs during the day. This meant that people were left at risk of harm at times. When accidents were reviewed the provider had not considered the time they happened and whether the staffing levels could have impacted on them.

Staff did not always recognise some incidents as potentially harmful situations. These had not been shared with the responsible external agencies to ensure that people were safeguarded against harm. The risks associated with medicines were not always managed to ensure that people received them as prescribed. The management systems which were in place to monitor the quality of the home were not always effective in highlighting and addressing errors. We were not notified of all of the changes in the home that we require as part of the registration so that we can monitor how it is managed.

People’s dignity and privacy were not always upheld and this had an impact on their independence. They did not always have enough interesting and stimulating activities to engage them.

People’s capacity to make their own decisions was assessed to ensure that they were able to do so. This meant that people were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People had a choice of good quality food; including specialist meals when required. The provider had developed working relationships with other healthcare professional to ensure that people’s health and wellbeing were monitored and managed.

Staff understood people’s preferences for care and their care plans were up to date and reflected their current needs. Staff received training to do their jobs, including induction training. They felt supported through staff meetings and supervisions. They had caring relationships with people and their families who were always welcomed.

Safe recruitment procedures were followed to ensure that staff were safe to work with people. The provider’s previous rating was displayed in the home as required.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

We inspected this service on 21 January 2016. This was an unannounced inspection. Our last inspection took place in December 2014 and we found no concerns with the areas we looked at. The service was registered to provide accommodation for up to 21 people and at the time of our inspection 21 people were using the service.

The service had a registered manager in post. 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 told us that they were supported to keep safe. We saw that medicine was administered and managed safely. Risk was assessed and reduced so that people could be supported to live as independently as possible. There were sufficient staff employed to ensure that people could do this safely. People were supported to make choices and were encouraged to participate in a range of activities. People had their plans reviewed regularly and where relevant families were involved.

The staff team understood the Mental Capacity Act 2005 and were able to explain how people’s capacity had been assessed and how they supported them in line with this. They were aware of the principles of the Deprivation of Liberty Safeguards and this had been applied within the home to protect people’s human rights.

People were supported by staff who had training and line management to provide an effective service. Staff were knowledgeable about protecting people from abuse and knew how to report any concerns. They had their competency checked by senior staff, for example in administering medicines. Safe recruitment procedures were followed when employing new staff.

People had their nutritional needs met and care was taken to ensure that people’s preferences were included in meals. If there were concerns about their health or wellbeing then specialist support and advice was sought from healthcare professionals.

Staff developed caring, respectful relationships with people. Important occasions were celebrated and people were made to feel valued. There were regular meetings so that people and their relatives could feedback any concerns or suggestions to help to improve the service. We saw that quality checks were in place to audit the effectiveness of the service. People and their relatives told us that the registered manager was approachable and supportive.

People told us they were happy with the care they received and staff were responsive to their needs. One person told us, “The staff look after my every need. It’s so lovely and nice to feel safe and have people looking after me so well.”

We observed interactions and saw that people were relaxed with staff. Staff had a good knowledge of people’s support needs and were respectful to people when providing this support.

People using the service had care records which recorded how they wanted to be supported. The information we read in the care records matched the care, support and treatment we saw being delivered to people.

People told us they could make choices about their food and drink. People told us they were provided with a choice of food and refreshments. Snacks and drinks were available throughout the day.

We saw that there was enough skilled staff on duty at all times. This ensured that people received the care and treatment they required.

We inspected this service in May 2012 and found that the service was not compliant with two outcomes and compliance actions were made. This meant the home needed to improve how people had necessary important information about what the service could provide. We also found that more information was needed about people’s care and any identified risk. We carried out this visit to check the improvements in this area. The visit was unannounced which meant the provider and the staff did not know we were coming.

We spoke with seven people using the service, a visiting relative and three staff about how the service was delivered and the quality of service provision.

During our inspection people who used the service told us that they were happy with the care support in the home and staff treated them with respect. People said, “I am happy I chose to live here.” “The staff treat me well, and I’m very happy here with my friends.”

People were dressed in their own style and people were encouraged to continue to take a pride in their appearance on a daily basis. People told us that self image and self respect was important and staff recognised this. One person told us, “The staff help me to look myself, they’re very kind.”

We saw staff were enthusiastic and spoke and engaged positively with people. We saw people involved in one to one activities including knitting and art work, other people were playing cards or dominoes. People told us they liked to play games with their friends or could watch the television and listen to music. One person told us, “It’s lovely here and I get to play games with my friends. It’s lovely to have nice people around me.”

Relatives were able to continue to play an active role and support people and provide care. When important things happened people told us that communication was good.

We carried out this visit as part of our schedule of inspections to check on the care and welfare of people using this service. The visit was unannounced, which meant the registered provider and the staff did not know we were coming. We spoke with seven people using the service and six staff about how the service was delivered and the quality of service provision.

We involve people who use services and family and because of their unique knowledge and experience of using social care services, we have called them experts by experience. An expert by experience took part in this inspection and talked to the people who used the service. They looked at what happened around the home and saw how everyone was getting on together and what the home felt like.

People who used the service told us that they were happy with the care support in the home and staff treated them with respect. People said, “I am very happy here, all my needs are cared for.” And “They do very well for me.”

People were dressed in their own style and people were encouraged to continue to take a pride in their appearance on a daily basis. One person told us, “It’s important to look good. You have to look like someone owns you.” People told us that self image and self respect was important and staff recognised this.

We saw staff were enthusiastic and spoke and engaged positively with people. We saw people involved in one to one activities including jigsaw puzzles, knitting and art work, other people were playing cards or dominoes. People told us they liked to play games with their friends or could watch the television and listen to music.

Relatives were able to continue to play an active role and support people and provide care. When important things happened people told us that communication was good. People told us family or friends could accompany them to any health care appointments and staff treated their family respectfully, and recognised how important they were to people.