Hill House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm. People were now safe living at the service and staff were trained and knowledgeable about safeguarding. Staff supported people in line with risk assessments in all areas of their support. There were enough staff to support people safely and staff were recruited in line with legislation. Staff kept the service clean, and the environment was safe. People were now supported safely with their medicines.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service now had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. People told us staff were continually learning as they supported them. One person said, ‘‘I don’t have anything to worry me here. Even if something does happen it gets sorted really quickly.’’ A relative told us, ‘‘When things happen, we can trust [staff] to put things right.’’ Staff told us they now discussed incidents and accidents to put measures in place to help prevent them from recurring. The management team reviewed incidents and looked for trends to see if they needed to make changes to improve people’s experiences. For example, they monitored if people were having falls at certain times of the day and took action such as making sure staff were aware of these times so they were on hand to support people. This helped lessons be learned and promoted a learning culture at the service.

The service now worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. People told us they felt safe moving between services. One person said, ‘‘If you need [health professional] then the staff sort this out for you and stay with you to talk things through.’’ A relative told us, ‘‘If staff do need to get [health professional] they will always let me know. I think they keep a good eye on [family member’s] health.’’ Staff spoke confidently about what they would do if they noticed signs people needed support from health professionals. The management team had created care plans specifically for when people used other services so information about how best to support them was available for other professionals. The staff and management team had good working relationships with health professionals. One professional said, ‘‘There has been a significant improvement in the way staff support people. They are quick to get in contact with us if they need support and follow our advice to the letter.’’

The service now worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately. People told us they felt safe. One person said, ‘‘I do feel safe here. [Staff] will always come and check that you are alright, and they will help me if I need it.’’ A relative told us, ‘‘I have never had any concerns and trust all the staff to keep [family member] safe.’’ Staff were trained in safeguarding and knew how to report concerns both at the service and to outside agencies such as the local authority safeguarding team. The management team reported safeguarding concerns and worked with other professionals on any recommendations from them. Safeguarding concerns were now discussed with the staff team so they could change the way they supported people if necessary.

The service now worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. People and relatives felt staff supported them to be safe in line with known risks. One person said, ‘‘[Staff] have a lot of knowledge and really know what they are doing.’’ A relative told us, ‘‘[Staff] really know how to care for [family member]. They have been really good at making sure they have the help they need to eat and drink.’’ Staff were knowledgeable about the risks people faced and knew how to mitigate these as far as possible. They knew how to use equipment to support people with their mobility and did this safely whilst making people feel comfortable. People’s risk assessments and care plans were now detailed and gave good guidance about how to mitigate risks to people. The management and staff team had made significant improvements to these care plans and risk assessments since our last assessment. For example, one person risk assessments made it clear how to best support them to eat and drink enough to stay healthy.

The service now detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People and relatives were positive about the environment at the service. One person said, ‘‘It is lovely here. Feels like a home.’’ A relative told us, ‘‘There has been lots of changes made to the environment recently and for the better. The place looks great.’’ Staff told us there had been a lot of improvements to the environment of the service. The staff member responsible for maintenance had been empowered to focus on this and as a result was making good progress in improving the environment. For example, the necessary repairs had been made to people’s bedrooms to make them safe and work had been completed in communal areas to improve the way they looked. Staff completed health and safety checks of the service and equipment, including fire safety to help make sure the environment was safe. The management team completed audits to monitor the safety of the service.

The service now made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. People and relatives told us there were enough staff to support them safely. They did not have to wait more than a minute or two for staff to support them and staff engaged with people frequently throughout the day. One person said, ‘‘There is always someone to help you out and I have never even had to use my call bell.’’ A relative told us, ‘‘There are definitely enough staff here. Always someone about to help out if needed.’’ Staff told us they had enough time to support people with their support needs but also to spend quality time with them. The management team reviewed staffing levels to make sure they were adequate. Staff were recruited safely in line with legislation. People and relatives also felt staff were well trained and knew how to support them safely. One person said, ‘‘[Staff] are all really good and know how to handle things. Like if someone feels upset, they are really good at helping us feel better.’’ Staff were knowledgeable about their training and spoke about what they had learned and how they used what they learned whilst supporting people. The management team completed competency assessments with staff to make sure training had been effective. They made sure staff completed training in a timely basis and had the training they needed to support people.

The service now assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. People and relatives told us the service was kept clean. One person said, ‘‘You only have to look to see how clean it is. My room is kept beautifully clean, and staff change the bedding too.’’ A relative told us, ‘‘I always check [family members] room and it is always clean. It is much better since they hired the new staff member who focuses solely on cleaning.’’ Staff were trained in infection prevention control (IPC) and told us the service was now kept clean. The provider had recruited a staff member to focus on IPC and keeping the service clean and this had made a huge improvement at the service. We observed the service to look and smell clean during our site visits to the service. The management team completed IPC audits to monitor the cleanliness of the service.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. However, they involved people in planning. Audits were not always effective in identifying where medicines errors may have been made. These were not always recorded effectively making it more difficult to review and learn lessons from potential errors in relation to medicines. There were also no risk assessments in place for people who were prescribed topical medicines. The management team resolved these issues immediately and sent us evidence and assurances this had been dealt with. People and relatives told us they were supported safely with their medicines. One person said, ‘‘I don’t have to worry about medicines. [Staff] take care of all that.’’ Staff were trained to administer medicines safely and had their competency to do this checked regularly. Audits in relation to making sure medicines were administered in line with Medication Administration Records (MAR’S) were effective.