Wall Hill Care Home Limited

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

Risks to people were not always effectively assessed and planned for. There was not always effective learning after things had gone wrong. Some monitoring of people’s health conditions had worked well, such as weight checks, but other checks had not been effective, such as bowel monitoring. People’s care plans did not aways adequately detail their needs or ways to mitigate risks to people. People did not have any specific feedback to share about the environment. We observed improvements were needed in some areas due to the condition or cleanliness. We asked the provider to make some swift improvements in relation to uncovered pipes and window restrictors and they acted on our feedback. Improvements were needed in the management of medicines to ensure it was safe. Professionals had also found improvements were needed to the quality and safety of care. There was mixed feedback about staffing. People told us they felt safe and well supported by staff. Staff told us they knew people’s needs. Staff suitability to work in the home was checked. People had access to other health professionals. Staff understood their safeguarding responsibilities. We observed safe moving and handling. However, staff did not feel there were enough staff and records showed there was not always appropriate training in place.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not have any specific feedback about learning culture and learning following incidents. One person told us they had not fallen since moving into the home, whereas they had fallen prior to moving in.

The nominated individual and registered manager also carried out these roles in another care home. The nominated individual said, “If there are good things to learn – we can share it across services.”

However, we found learning was not always effectively shared between the provider’s 2 services, as concerns persisted. Audits of accidents and incident records were poorly completed. No one had come to harm as a result of this; however, the audits were not effective when identifying trends or areas for improvement.

People were supported to access other health professionals.

Staff did not have any specific feedback to share about Safe systems, pathways and transitions.

One professional that had visited the service said, “There isn’t much in the care records; the care notes don’t have much detail, so there isn’t that much actual content. The recording could be better.” The local authority was carrying out visits to the service to check people were safe and identified improvements were needed in ensuring staff had the most up to date information and referrals to other professionals were being made.

People had their weight monitored and action was taken if someone was unintentionally losing weight, to try to keep them healthy. However, systems were not always in place to effectively monitor bowel movements. As described below, care plans were not always up to date, and action was not always taken in response to people’s needs.

Care plans were not always reflective of people’s needs. Staff were monitoring a person’s health condition, as they told us about this, and we saw it documented. However, this was not detailed in the person’s care plan. Therefore, if staff were absent or changed, there was a risk this monitoring may have not continued. The same person’s care plan also had conflicting information about the person’s fluid consumption and the setting for a mattress which was in place to help keep their skin healthy.

Another person had experienced multiple falls. A referral had been made to an appropriate health professional following the falls and an item was prescribed to support the person. A member of the management team had already noted an action for themselves to update the person’s care plan to reflect this professional guidance. However, in addition to this, the person’s risk assessment had also not been reviewed following each previous fall to check it remained suitable This meant the provider had not checked all of the most appropriate measures were in place to reduce the risk of the person falling.

We observed 1 person displaying a possible symptom or behaviour which could be associated with their health condition and could cause the person discomfort. This behaviour was not referenced in the person’s care plans and they had not been referred to an appropriate health professional in order to seek support to reduce this behaviour. A referral was made following our feedback, but this was prompted by us. Therefore, the person had been left at risk of discomfort.

People and relatives felt the service was safe. One relative said, “I feel happy that my relative is safe and looked after.” Another relative told us, “I leave feeling my relative is safe.”

Staff were aware of their safeguarding responsibilities and knew how to recognise different types of abuse and to report it.

Staff did not always use a dignified and person-centred approach towards people. This approach did not protect people from avoidable harm and potential abuse and this approach fell below the standard of care we would expect to see. We go into more detail about staff approach in the caring key question.

We had to make a safeguarding referral for multiple people following our visit to the service as we were not assured people were always being supported appropriately. The local safeguarding authority checked on individuals and the concerns were either closed as they did not need further investigation or were found to be unsubstantiated. However, the local authority deemed it necessary to continue to visit the service as they did not always feel people were consistently safe. The provider and deputy manager were open to feedback and making improvements.

People told us they felt safe while being supported by staff. One person said, “I get help to have a bath from staff, always feel safe when they help me in and out.” Another person said, “I feel safe because the staff help me.” A relative told us, “My relative had falls before they came here, and they put a sensor mat in my relative’s room to let staff know if they have got out of bed or chair.”

Staff generally knew people’s needs. For example, 1 staff member told us of people’s repositioning needs. Another staff member told us of the monitoring they carried out for the health condition some people had.

We observed safe moving and handling when people needed equipment to help them move. People who had a modified diet were supported with this.

However, people were left at risk as some risks had not been fully recognised, assessed and mitigated. The provider failed to ensure care was always provided in a safe way for people. The provider failed to always assess and do all that was reasonably practicable to mitigate risks to people.

Some people did not always have guidance in place about their health condition in their care plans. Two people had missing information about a specific health condition. New staff or agency staff would not know people as well until they had the opportunity to get to know people, so would need access to correct information. The registered manager told us this was available in the medicines room however not all staff accessed this room as it was for senior staff, so some staff may not have had access to the information.

One person had a care plan in place for their skin integrity which stated the mattress needed to be on the right setting for them, but the plan did not detail what this setting was so it was not clear how staff would know how to support this person to mitigate the risks to their skin. Following our feedback, the provider explained the information about mattress settings was available in the management office and a member of management staff would complete a daily walkaround which included checking the mattress settings. No one had come to harm as a result of this not being included in care plans. However, staff not having this information in an easily accessible location put people at risk of harm.

People did not have any specific feedback about the environment.

We discussed damage to the décor with the provider and registered manager. They explained they had attempted to engage external contractors to carry out environmental improvements, but it had proved difficult, as they had been let down.

The provider had window restrictors in place to reduce the risk. We raised a query about the fixings for these being tamper-proof. The registered manager confirmed and provided evidence that action had been taken to address any unsuitable fixings. We saw 2 people’s rooms which had exposed hot pipes in the en suites. We asked the provider to undertake a swift review of the home to ensure all pipes were made safe to reduce the burns risk for people. There was damaged furniture in people’s bedrooms, such as 1 damaged toilet frame which meant it could not be kept hygienically clean and was not dignified.

Checks were made on the safety of the building, such as electrical, gas, water hygiene and fire checks. An audit did identify some wardrobes were not attached to the wall as required and we saw this issue had been resolved in the rooms identified. However, systems in place to audit the physical environment of the home had failed to identify and address the exposed pipes and the concerns about the cleanliness and wear and tear in some areas.

People generally told us they did not have to wait long for support and felt well supported. One person said, “I feel safe, because staff know their job well.” A relative said, “Staff come quickly when we have needed them and pressed the buzzer.”

Staff did not feel there were always enough staff. One staff member said, “There is not enough staff in the morning.” Another staff member also said, “We need more staff in the morning and at night.” Another staff member also commented, “There’s not enough staff. We could do with 1 more. I think we give a good quality of care, but it would be better for staff if there was another staff member.” The provider acted on the feedback we shared and told us they had increased the staffing by 1 to improve this. Staff told us they had received training.

The lunch time experience for people was not always a communal experience as people were left waiting and watching whilst those they were sitting next to were able to eat their lunch. One person commented, “I’m always the last to be served and I’d really like to know why.” This meant staff were not deployed effectively to support people in a timely manner. On the first day of our assessment, an extra staff member arrived who would not have normally been there. This was due to a mix up, but the provider was open and honest about this.

Staff had not received all the training they needed. For example, staff had not undertaken any training about supporting people with a learning disability or autism. The nominated individual and another member of the management team told us this training was not in place. This was a requirement and had not been completed as the provider had failed to recognise this was needed. Following the inspection, the provider told us staff had now either received this training or had been enrolled on a course to complete this training.

The provider had a dependency tool in place to calculate staffing levels. This had not been effective at ensuring there were enough staff, as the provider had increased staffing levels following our feedback about what staff told us. It is positive the provider acted on feedback.

Permanent staff were recruited safely. Checks were made on their suitability to work with people who used the service. Their employment history, references and checks with the Disclosure and Baring Service (DBS) were completed. The DBS helps employers make informed decisions about staff and checks if they have criminal records. The provider also used agency staff. These had appropriate profiles in place, however there was no documented induction when they first started working in the home, to assist them to get to know the home and people living there.

People told us staff wore gloves and aprons when needed. People felt the home was kept clean and tidy.

Staff confirmed they had access to Personal Protective Equipment (PPE). Staff did not share any feedback about the cleanliness of the home with us.

The home was generally tidy. However, some areas could not be kept hygienically clean due to their condition, such as chipped paint or damage. Wallpaper in the dining room was stained. Some of the chairs in the communal lounges were unclean. There were malodours in multiple people’s bedrooms and in an upstairs communal area. We fed back about these, and the provider took action to try and clean the areas to remove the smell. A light pull cord in 1 person’s bedroom en suite needed replacing as it was unclean.

While no one had come to harm, processes in place and action being taken by the provider had not yet been effective at remedying all areas which needed addressing. The provider was in the process of making improvements.

One person said, “Staff bring me my medicine, and put cream on me.”

Staff told us they had received training, and competency checks in order to administer medicine. We observed staff wearing a red tabard while administering medicines to reduce interruptions so they could concentrate on supporting people with their medicines.

The medicines fridge was not having the temperature checked. Fridge temperatures need to be within a certain range to ensure the efficacy or safety of the medicines stored. Staff were not checking the fridge temperatures, this put people at risk. While the provider acted on our feedback and started checking the temperature, they had not recognised this needed to be done themselves. There was not always clear guidance in place for medicines with a variable dose so there was a risk people may not receive their medicines as needed. One person had a protocol in place for a ‘when required’ medicine. The quality of this protocol was poor, it did not detail when the medicine was needed and was only put in place after the medicine had been discontinued weeks before. Topical medicines, such as creams and gels, had clear instructions in place about where they needed applying. There were body maps in place highlighting where this was needed.