Hill House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care. The management team wanted what was best for people and shared this vision with the staff team. They understood their roles and had processes and audits in place to monitor the quality of the service. The staff team enjoyed working at the service and felt well supported. There had been significant improvements at the service since our last assessment. The management team were open and honest about how there were still improvements to be made, and existing improvements would need time to embed.

This service scored 71 (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 shared vision, strategy, and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. People and relatives were complimentary about the changes made at the service since the last assessment. One person said, ‘‘It is really lovely here. The people, the staff, the food, the house. It is all great.’’ A relative told us, ‘‘Things have changed drastically the last few months. Things are really starting to get done and we have never felt more listened to. Such a fantastic change!’’ The staff team were now passionate about supporting people to have the best lives possible. They shared the management team and providers vision to give people the best experiences possible. The management team had started to foster and build a positive culture at the service and regularly shared and discussed this with the staff team. The provider and management team were open and honest about the areas where the service had failed to meet regulations at our last assessment. They had made a real effort to change the culture at the service and this had resulted in a more positive atmosphere at the service and better experiences for people as described throughout this report.

The service now had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience, and credibility to lead effectively. They did so with integrity, openness and honesty. People and relatives told us the management team were kind and compassionate and listened to their feedback and concerns. One person said, ‘‘There has been a lot of [management staff] here recently and they are all great. They have been helping staff to have a good time.’’ A relative told us, ‘‘The service is being so much better managed now. There are still lots of improvements to be made but they are working hard on this.’’ Staff told us they now had confident in the management team and how they were being supported. They felt able to speak to the management team and knew their feedback and concerns would be dealt with effectively. The manager was compassionate when it came to speaking with people and the staff team. They had a good understanding of their job role and had started and continued to drive improvements at the service. The provider and senior management team had a very large presence at the service. They had used their skills and knowledge to implement significant improvements at the service. We discussed how they needed to support and upskill the manager and other staff at the service to help ensure these improvements continued.

The service now fostered a positive culture where people felt they could speak up and their voice would be heard. People and relatives felt able to speak up and share their ideas. One person said, ‘‘[Staff] are always asking me how things are going, and they make little changes if I ask for them. I am not afraid to say what I mean.’’ A relative said, ‘‘There has been a real increase in communication from the service. They keep me updated and always ask for our opinions.’’ Staff spoke about the change in atmosphere and culture at the service and how they were not only supported but encouraged to speak up on a regular basis. Staff now had regular supervisions, competency assessments and meetings where their feedback was considered and listened to. They told us this had a positive impact on their experience of working at the service. The management team understood the importance of people feeling able to speak up and feedback. They promoted this and had processes in place to collate and review feedback to help drive improvements at the service.

The service now valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them. Staff enjoyed working at the service and were positive about the support they had from the management team and provider. They spoke about the difference in the atmosphere at the service since our last assessment. They now felt empowered to speak up and prioritise people’s care and support. The management team understood the importance of staff wellbeing. They spoke with staff regularly and made sure they had the support they needed to perform their roles as best as possible. The providers recruitment policy was fair and equitable. Staff members flexible working requests were considered to promote a good working environment for the staff team.

The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. The staff team had been supported to understand their job roles and the management team completed competencies with them to check training had been effective. The management team completed supervisions with the staff team and also completed audits across multiple areas of the service to monitor the quality of people’s support. However, these audits were not always completely effective in identifying areas for improvement in areas such as medicines management or food and fluid recording. A lot of audits were new and needed time to fully embed before they could be effective. A lot of the management of the service was also being completed by the provider and senior management team which was not sustainable in the long term. We discussed this with the provider and management team who agreed that audits needed to be continually worked on, and they also needed to work with the manager and senior staff to make sure they had the support to monitor the quality of the service more independently. People and relatives felt the staff and management team were well trained and had the skills they needed to manage the service well. One person said, ‘‘The staff team really know their stuff and I think the manager is doing a great job.’’ A relative told us, ‘‘There is no question things are getting better and better at the moment. I think [manager] really wants what’s best and you can see the difference in the service over the last few months.’’

The service now understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement. People and relatives told us staff supported them in line with advice from other professionals. One relative told us, ‘‘[Family member] saw [health professional] recently and the manager rang me to tell me what had happened. They also told me how they were going to make sure the staff team followed what they said.’’ Professionals who worked with the service were positive about how staff worked with them and listened to their advice. They told us people had been supported to have good outcomes as a result of the support from the staff team. Staff understood the importance of working in partnership with health professionals. They spoke about working with people to identify opportunities in the community where people may wish to follow their interests, such as attending a place if religious significance. The manager and management team had linked and worked well with partners such as the local authority to help identify and improve some areas of the service. The provider, management team and staff team shared the same values and worked well together to help support people as best as possible.

The service now focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research. People and relatives all told us how the service had improved a lot since our last assessment. One person said, ‘‘I can’t think of anywhere better to live than here. I like everything about it.’’ A relative said, ‘‘Things are definitely getting done now. It is a shame it has taken some hard times to get thing going. The management team have really got things moving now and things are so much better.’’ Staff told us about how the service had improved since out last assessment. They now felt supported and able to give people person centred care and support. The manager and management team used findings from internal and external audits to put service improvement plans in place at the service. They monitored these and made sure actions were completed in a timely fashion. We had discussions with the provider and management team about the importance of maintaining these improvements and continuing to improve the service.