Hillsborough House

Hillsborough House is a residential care home providing personal care to 14 people at the time of the inspection. The service supports autistic people and people with learning disabilities, people with mental health needs, physical disabilities, sensory impairment, and older people. The service can support up to 14 people.

Hillsborough House consists of 2 former domestic properties converted into 1 care home. The service is laid out over 3 floors, with private bedroom accommodation on each floor. On the ground floor, people have access to a level garden, communal lounge, and dining area. There is an additional lounge on the second floor and communal toilets and wash facilities accessible on each floor. The registered manager’s office is located on the top floor.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: At this inspection we found medicines safety had improved and checks were in place to monitor medicines management. The provider was working with healthcare professionals, including the GP, dentist, and local pharmacy to ensure people received the support they needed.

Right Care: Since our previous inspection the provider had completed maintenance work to the premises and implemented infection and prevention control measures. The service looked visibly cleaner and was not malodourous. Works were ongoing at the time of our inspection and there were action plans in place to monitor progress.

Right Culture: Oversight and management of care quality and safety had improved since our previous inspection, this included checks in relation to fire safety and infection prevention and control. People told us they were happier. People were being supported to understand fire safety measures in the service and how they should respond in the event of a fire.

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 inadequate (published 16 June 2023).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hillsborough House is a residential care home providing personal care to 13 people at the time of the inspection. The service supports autistic people and people with learning disabilities, people with mental health needs, physical disabilities, sensory impairment and older people. The service can support up to 14 people.

Hillsborough House consists of two former domestic properties converted into 1 care home. The service is laid out over three floors, with private bedroom accommodation on each floor. To the ground floor, people have access to a level garden, communal lounge, and dining area. There is an additional lounge on the second floor and communal toilets and wash facilities accessible on each floor. The registered manager’s office is located on the top floor.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Care: The provider failed to implement fire safety measures consistently and effectively, placing people at risk in the event of a fire. The provider had failed to mitigate infection risks and the environment was visibly unclean. The provider failed to ensure medicines were stored and managed safely. The provider failed to provide consistently safe care in relation to 1 person’s weight management and another person’s oral healthcare.

Right Culture: Checks and audits undertaken at senior leadership and service level had failed to identify the shortfalls we found at this inspection. The provider sought people’s feedback, however there was no evidence to show the feedback was reviewed and used to drive improvement in the service. Staff used people’s communal garden as a smoking area, people had not been asked their views about this.

Right Support: The provider failed to apologise to 1 person who was not being supported in line with their assessed needs, and who subsequently had some teeth extracted after they had decayed. People had mixed experiences of being supported to access the community and their hobbies and interests. We observed kind and caring interactions between staff and people; staff knew people well.

Overall 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 found occasions when people were not supported in this way, including in relation to 1 person not being supported to access the Dentist and staff smoking in people's communal garden.

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 good (published 03/01/2019).

Why we inspected

The inspection was prompted in part due to concerns received about the cleanliness of the service, the efficacy of the registered manager and safeguarding concerns in relation to 2 service users. Additionally, we considered the length of time since our last inspection. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

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

In response to our feedback during the inspection, the provider made some changes, including arranging for a deep-clean, a fire risk assessment to be undertaken with an external contractor and amendments to how medicines were stored.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care, checks and audits and the duty of candour at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Hillsborough House provides accommodation and personal care for up to 14 people with a learning disability. The home is a large converted villa in a residential area of Keynsham. The accommodation is set out over three floors which are accessed via stairs to the front and back of the house. At the time of our inspection there were 12 people living at the home.

The house had a kitchen, dining area, two lounges, an office and a staff sleeping room. Each person had their own bedroom and shared bathrooms.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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 2008 and associated Regulations about how the service is run.

At our last inspection in November 2017 we rated the service requires improvement and identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance. At this inspection we found improvements had been made.

At this inspection the service has been rated good.

Improvements and changes had been made in staffing deployment, medicine guidance and care records. Staff were supported through an effective induction, regular supervision and training. There were opportunities for additional training specific to the needs of the service, including the care of people with epilepsy and autism.

Care records were not used consistently to ensure staff had easy access to important information that supported continuity of care. We have made a recommendation about this.

Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People said the staff made them feel safe because they were kind and reliable. However, some improvements were required. Potential risks to people's health and wellbeing were not uniformly documented to ensure consistency in standard and quality of care plan reviews. Initial assessment care plans were not documented on the provider’s documentation. This meant the quality of the assessment of people's care needs was variable or did not routinely take place before the service began.

People enjoyed participating and achieving individual goals that were inclusive and personal to them. People received care that improved their health, wellbeing, independence and that enabled them to gain new skills and access their local community.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. Where errors had occurred, there was a protocol for staff to follow to minimise risk of harm.

People were happy and relaxed with staff and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.

People were being supported to make decisions in their best interests. Consent to care and treatment was sought in line with the Mental Capacity Act 2005. Capacity assessments were untaken where appropriate and decisions taken in people's best interest were decision specific.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people could give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

Care plans described people's preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible.

People's end of life care was not being discussed and planned for and their wishes for end of life care had not been recorded. This was a work in progress.

People chose how to spend their day and were able to take part in activities of their choice. People also attended clubs and events in the community and were also encouraged to stay in touch with their families and receive visitors.

People were encouraged to express their views and had completed surveys. They also said they felt listened to and any concerns or issues they raised were addressed. Technology was used to assist people's care provision. People's individual needs were met by the adaptation of the premises.

Staff felt their opinions were listened to and felt confident they could approach the registered manager and were happy in their work. They felt supported within their roles, describing an 'open door' management approach, where the registered manager was always available to discuss suggestions and address problems or concerns.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

During this inspection we checked that the provider was meeting the legal requirements of the regulations they had breached. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Hillsborough House, on our website at www.cqc.org.uk

Hillsborough House provides personal care and accommodation for up to 14 people with learning disabilities. At the time of our inspection there were 14 people living at the home.

A registered manager was in post at the time of our inspection. 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 home is run.

At this inspection we found that improvements had been made within the service. Four of the five previous breaches had now been met. We found that the service was not always responsive to people needs as further improvements were required in regards to daily information recording and guidance for agency staff. We have made a recommendation in regards to people’s fluid and nutrition.

Systems to monitor and review the quality of care did not always identify potential risks to people. Systems were in place to gain feedback from people, relatives and staff. This was through meetings and surveys. However, the information collected through surveys was not always utilised to make changes or improvements.

Improvements and changes had been made in staffing deployment, medicine guidance and person centred information in care records. Staff were supported through an effective induction, regular training and supervision.

Safe recruitment procedures were in place. People were involved in the interviewing and selection of new staff members. The service was compliant with the requirements of the Deprivation of Liberty Safeguards. Consent to care and treatment was sought in line with the Mental Capacity Act (MCA) 2005. Capacity assessments were untaken where appropriate and decisions taken in people’s best interest were decision specific.

The service was clean and maintenance untaken where required. Further improvements to the environment and garden had been identified. Incidents and accidents were recorded. Actions taken in response had not always been clearly documented.

People were supported by staff who were kind, caring and respectful. Staff knew people well and how people preferred to be supported. People independence was promoted and encouraged. People were supported with their healthcare needs. Recommendations from professionals were followed.

Communication systems with staff and health professionals had improved. People were involved in activities of their choice.

We found one breach 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 this report.

Following the inspection the provider wrote to us to say what they would do to meet the legal requirements. We undertook a focused inspection on 13 August 2015 to check the provider had followed their plan and to confirm they now met the legal requirements. We found that sufficient action had been taken to achieve compliance in the regulations previously breached.

You can read the report for previous inspections, by selecting the 'All reports' link for ' Hillsborough House' on our website at www.cqc.org.uk

This inspection took place on 11 and 12 May 2016 and was unannounced. Hillsborough House is a care home service without nursing for up to 14 people with physical and learning disabilities. On the day of our inspection there were 11 people living at the service.

There was a registered manager in place at the time of our inspection. 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.

At this inspection we found that the provider had failed to sustain improvement following the last inspection of the service. A number of the shortfalls at this inspection related to matters which had been brought to the provider’s attention on previous occasions by the Commission.

The systems in place for monitoring quality and safety were not sufficient to ensure that the risks to people were identified and managed.

The provider’s quality assurance systems to monitor records made by staff or records that related to the management of the service were ineffective.

There were not sufficient numbers of staff to support people safely. We had feedback from staff and people that the current staffing arrangements did not meet the needs of people using the service.

The provider had failed to protect people from the risk of abuse; they had not formulated a plan to prevent safeguarding incidents.

Care was not consistently person centred. Not all care plans were personalised and contained up to date individual information and references to people’s daily lives.

Staff supervisions were not undertaken as planned; there was a failure to monitor and feedback on staff performance. Staff training was not up to date.

The home was not suitably clean.

There were suitable arrangements in place for the safe storage, receipt and administration of people’s medicines. However protocols for PRN (as required) medicines and topical medicines were not in place.

Staff respected people’s privacy and we saw staff working with people in a kind and compassionate way responding to their needs.

Deprivation of Liberty Safeguards (DoLS) applications had been made for those people that required them. These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. The staff did not have a clear knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Meetings had been arranged in order to enable people’s best interest to be assessed when it had been identified that they lacked the capacity to consent to their care and treatment.

People were supported by the staff to use the local community facilities and had been supported to develop skills which promoted their independence.

People had access to healthcare professionals when required, and records demonstrated the service had made referrals when there were concerns.

There was a complaints procedure for people, families and friends to use and compliments could also be recorded.

There was a robust staff recruitment process in operation designed to employ staff that would have or be able to develop the skills to keep people safe and support individuals to meet their needs.

The provider had made appropriate notifications to the Commission; notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled.

We found five breaches of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

We were given a tour of the home and the grounds. We spoke with three people who lived in the home. They told us they liked living at the home and staff were nice. We spoke with a senior member of staff and four members of staff. We read the care records of three people who lived in the home. We inspected the policies and procedures, the record of complaints and the safeguarding folder which included details of safeguarding referrals and the audit for 2013. We read the reports from quality monitoring visits. We observed staffs interactions with people they were supporting.

A single adult social care inspector carried out the inspection. The focus of the inspection was to answer five questions: Is the service safe, effective, caring, responsive and well-led?

We found the service was safe.

Staff told us they had received training about safeguarding vulnerable people. They told us they would report concerns immediately to a senior staff member. Policies, procedures and local guidelines were available for staff to follow.

We saw that staff had a good rapport and interacted well with the people living in the home. This included our observation of people confidently and freely approaching members of staff when they wanted support.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act (MCA). Applications had been submitted for DoLS authorisations where applicable but none had yet been authorised. This was in line with the provider's policies and procedures, and the CQC would be notified as required by law. This meant that people would be safeguarded as required. We saw systems in place to ensure that managers and staff learnt from accidents and incidents as well as comments received from people who used the service and their relatives.

We found the service was effective.

People's health and care needs were assessed and we found they had been supported to be involved with their health action plans and care plans. We saw involvement from external health professionals such as the community learning disability team (CLDT).

We spoke with staff who told us that the induction training for their role had been thorough. They also told us they received regular supervision. The records we reviewed did not identify annual appraisals which was confirmed by a senior member of staff.

We found the service was caring.

We spoke with staff, and observed the interactions they had with people. People told us they liked staff and we found, without exception, that staff spoke kindly and demonstrated a good understanding of people's needs. Staff said they "loved working with the people" and that the home had a "very friendly, family atmosphere." During our visit we observed there was a relaxed atmosphere with people choosing where they wished to spend their time. We observed staff treating people with kindness and patience. Staff demonstrated they knew people's needs and ensured people were treated with privacy and dignity.

We saw people freely expressing what they wanted to do during the day, and they were supported by kind and reassuring staff.

We found the service was responsive.

People had their needs assessed on a regular basis. They met with their key workers regularly to review their plans and to discuss what was important to them. However, we found care plans had not always been updated to show people's actual care and treatment needs.

Staff told us that people understood what they said and were able to respond through various means which included the use of symbols, signs and gestures.

We found the service was well-led.

We saw that people were asked for their feedback. We saw the responses from people and found there were many positive responses and some suggestions for improvements. People said they liked their home and did not want to change anything. Suggestions for improvements included more day trips and access to the home's vehicle. We saw evidence of an activities board which incorporated days out and the use of the home's vehicle. Feedback was recorded in people's meetings and we saw a letter sent to families in response to their feedback. The audit of people's feedback provided a summary of responses but did not include an action for each item.

The service had a good quality monitoring system which ensured that the manager was aware of any changes in the service and was able to respond proactively. We observed good relationship between staff and people on the day of our visit. Staff were clear about their roles and responsibilities and told us that they were supported by their manager.

We also looked at the arrangements being made for supporting people with their medicines and with their health and personal care. Suitable arrangements were being made for meeting people's needs in these areas.

We found that people's needs were being kept under review through meetings and the involvement of key workers. One person who used the service said that they had a 'lovely key worker' who talked to them about their needs and how they were getting on. We saw that staff were observant of changes in people's health and personal care needs, which helped to ensure that people received the right level of support.

At the time of our inspection there were 13 people living in the home. We spoke with seven people who used the service and three members of staff.

The people we spoke with were able to tell us about their experience of living in the home and overall the comments were positive.

Some people's comments included; 'it's brilliant here', 'the staff are nice to us, I make things'. One person told us that they were supported to go horse riding and was very positive about the experience. Another person told us 'the staff now are fantastic, but the house is falling down'. We spoke with this person in depth about their comments. They told us the decorating needed attention around the home, but the care from the staff was 'the best ever'.

People were observed engaging with staff in a relaxed manner and some people were negotiating what to do for the rest of the day. For example, one person was heard deciding with staff to go out shopping and what to buy.

People living in the home were encouraged to be as independent as possible and were observed making their own hot drinks, as and when required in a small area of the dining room.

Throughout our visit we observed people being enabled to make choices of what to do and what to eat. People we spoke with confirmed all the choices and involvement they had in their daily lives.