Archived: Hilsea Lodge

Updated 3 August 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 19 June 2018 and was unannounced. The inspection was carried out by three inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed the information we held about the home, we reviewed previous inspection reports and action plans from the provider. We looked at notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally required to let us know about.

During the inspection we spent time talking to four people, two relatives, the registered manager, service manager and seven members of staff. We looked at the care records for five people, and staffing records of six members of staff. We saw minutes of staff meetings, policies and procedures, the complaints file, audits and action plans. We were sent copies of the training matrix, rotas and certain policies and procedures after the inspection.

Updated 3 August 2018

We inspected Hilsea Lodge on 19 June 2018. The inspection was unannounced.

Hilsea Lodge provides accommodation for up to 35 older people living with dementia. Single room accommodation is arranged on one level in four separate units, each unit having its own dining and lounge area. There was an enclosed garden. At the time of inspection 17 people were living in the home.

There was a registered manager in place. 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 identified widespread and systemic failings and rated the service ‘Inadequate’ overall. We identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches of Regulation 12 because the management of medicines was not safe and risks to people were not managed effectively; Regulation 13 because people were not safeguarded against abuse; Regulation 11 because the principles of the Mental Capacity Act 2005 had not been followed; Regulation 17 because there was a lack of effective governance processes; Regulation 18 because staff had not received regular supervision, appraisal or training to effectively undertake their role; Regulation 15 because the premises had not been properly maintained; Regulation 9 because people were not provided with person centred care and Regulation 10 because people’s privacy and dignity was not always protected. We also found a breach of Regulation 18 of the Care Quality Commissions (Registration) Regulations 2009 because the registered persons had not always notified CQC of significant events that happened in the home.

Following the inspection, we placed the service in special measures in order to monitor it closely. The provider was required to send us an action plan telling us what they would do to meet the requirements of the law. They sent this to us and we saw at this inspection improvements had been made although more time was needed to determine if these improvements could be sustained. As a result of the improvement seen, this service has now been removed from special measures.

Measures were put in place to mitigate risks to people, however risks to people were not always assessed or monitored effectively. We made a recommendation that the provider seeks advice on how to assess people’s level of risk in relation to skin integrity and falls appropriately. Measures were put in place on the day of inspection to improve the monitoring of people’s food and fluid intake and the risks associated with constipation.

People were not always provided with information they could understand and we made a recommendation that the provider adheres to the Accessible Information Standard to ensure information was available in a format that people understood.

The management of medicines had improved and was safe.

Environmental risks to people were managed effectively. The home was clean and hygienic and staff followed best practice guidance to control the risk and spread of infection.

There were sufficient numbers of staff deployed to meet people's needs and to keep them safe. The provider had effective recruitment procedures in place and carried out checks when they employed staff to help ensure people were safe. Training for staff had improved, however staff needed time to embed the knowledge that they had learnt. Staff were well supported through induction and supervision systems.

Systems had been put in place to protect people from harm and abuse, accidents and incidents had been investigated, analysed and monitored and lessons learned from these had been shared with staff. Staff knew how to report concerns about people’s safety and well-being and felt these would be acted on by the registered manager.

Care plans contained sufficient information to guide staff on how to support people, however some areas of the care plans could be more person centred. People were cared for by people that knew them well and responded to their needs.

Adaptations had been made to some areas of the home to make it supportive of people living with dementia and further work was planned to continue this.

The service complied with the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLs), and people were encouraged to make choices about their day to day life.

Staff treated people with dignity and respect, people’s privacy was protected and people were supported to be as independent as possible. People were cared for with kindness and compassion. We observed positive interactions between people and staff throughout the inspection, with one isolated exception.

There were a wide variety of stimulating activities planned within the home. People looked engaged, relaxed and happy and were supported by staff that knew them well.

People’s dietary needs were met and they received appropriate support to eat and drink. People were supported to access other healthcare services when needed. Staff made information available to other healthcare providers to help ensure continuity of care.

People were aware of how to raise a complaint and we saw that complaints had been investigated and resolved. Feedback was encouraged from people, staff and other health professionals and this was used to improve the service.

Quality assurance systems and processes had improved, however, we identified that quality assurance systems needed further development and time to become fully embedded in practice.

The registered manager and the senior team were visible and approachable and staff told us that the support that was provided to them had improved. Staff were organised and felt engaged in the way the service was run. They demonstrated commitment to the service and the people living within it.

The service had an open and transparent culture. People were consulted about the way the service was run. Visitors were welcomed and the registered manager notified CQC of all significant events.