Wall Hill Care Home Limited

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

The provider had failed to have effective systems in place to monitor the quality and safety of care to people. This had led to the development of a culture which was not always person-centred. However, staff felt there was good teamwork, and they liked working in the home. Staff felt positively about the management team and felt able to approach them if they had concerns. The provider knew people and their families. However, as we found multiple concerns with the service, some of which had been concerns we found at the last inspection, we could not be sure concerns would always be addressed in a timely manner. It was not possible to see how feedback from people, relatives and staff had been used to drive improvement in the service. Audits had not always been completely effectively, so omissions had not always been identified. The provider was aware of their duty of candour. The provider, registered manager and deputy manager were open to feedback and willing to work in partnership with external professionals.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were happy working in the home and felt there was good teamwork. One staff member said, “There is a very friendly culture. I love working here. We work well as a team.” Another staff member said, “Teamwork is good.”

While staff were generally caring, they needed to be more mindful of their behaviour and responses to ensure they were always person-centred. As we mention in responsive and caring, people did not always have person-centred care. The provider had not recognised improvements were needed to the culture of the service and had failed to instil a culture of ensuring it was always person-centred. People’s choices and being able to live a fulfilling life with meaningful activity were not at the centre of the service. Staff had not had time for more meaningful interactions with people.

Staff spoke positively about the management team, including the registered manager and other management staff. One staff member said, “The [registered] manager is very knowledgeable, very helpful, approachable, they are a good manager.” Staff told us they felt able to go to the deputy manager if they needed to raise a concern. Some people and staff said the registered manager did not often seem to be at Wall Hill Care Home, so were less visible. However, they still felt the registered manager was approachable.

One person told us they liked the nominated individual and they chatted. A relative told us, “[Deputy manager] has been fantastic, [deputy manager] is good with [my relative].” Another relative said, “I would feel able to speak to [the nominated individual] if I had any concerns.”

The provider clearly knew people and their relatives well. They knew people’s names, their relative’s names and their individual situations. We observed visitors have friendly conversations with the deputy manager and they felt able to approach them.

As there were multiple concerns and regulatory breaches within the service, we could not be sure leaders had the skills and experience to consistently recognise and address things, if they went wrong. The registered manager and provider had failed to fully address the concerns identified at the last inspection. Another member of management staff had put guidance in place for some people for ‘when required’ medicines but these medicines had been stopped for a long period of time, and this had not been recognised. Protocols were also not of a good quality.

Staff felt able to raise concerns. However, people and relatives commented the registered manager and nominated individual did not seem to be at the home often. Staff felt able to go to the deputy manager if they needed to.

The provider was aware of their duty of candour, they said, “It’s being open, frank and honest when things go wrong. Like when someone falls or there’s an incident, relatives are always immediately informed. Being open about discussing when issues have arisen and getting support to address that and learning from errors.”

Notifications were being submitted, as required.

Staff told us on the first day of our inspection there had not been many recent staff meetings, and they had not been asked for their opinions recently through a survey, for example. However, the provider told us there had been regular staff meetings through the year and a member of the management team told us the last survey had been in February 2024, and this was due to be refreshed. Despite this recent survey and meetings the provider told us about, it was not possible to see how feedback from people and staff had been used to drive improvement in the quality and safety of support as we continued to find concerns.

Staff from a variety of backgrounds and needs were supported to work at the service. Staff did not have any feedback to share about Workforce equality, diversity and inclusion.

While staff did not raise any concerns with us about Workforce equality, diversity and inclusion, staff were not provided with the skills and knowledge required to equip them to challenge inequalities and promote better equality, diversity and inclusion or promote the rights of autistic people or people with a learning disability. When speaking with a member of the management team they were unable to provide an explanation why staff were not supported with these essential skills.

The provider and registered manager told us they felt the systems they had in place were sufficient to effectively monitor the service.

However, we found multiple concerns which had not been identified or addressed so systems had not been effective in monitoring the service. The provider and registered manager were responsive to our feedback and described some immediate changes that would be made in response to our feedback.

The provider failed to establish and operate systems or processes to ensure the effective oversight of their service. The provider failed to assess, monitor, improve and mitigate risks to people. The provider failed to always keep a contemporaneous record of decisions taken in respect of people’s care.

Systems in place to monitor people’s medicines were not always effective. Systems had failed to identify unclear or missing guidance about ‘when required’ medicines. The provider did not have a process in place to monitor the temperature of the medicine fridge.

Systems in place to review and improve people’s care records were not effective as they had failed to recognise omissions. A ‘Care plan monthly audit’ was in place which listed people’s names stated ‘up to date’ but did not have any prompts or detail about what was being checked. However, for example, there was missing information about a person’s health conditions, fluid targets and the setting for their mattress to help keep their skin healthy. Two people had conflicting information in their care plans about their mental capacity and this had not been identified.

There was no clear process to effectively monitor and escalate concerns in relation to people’s lack of bowel movements. Following our feedback, the registered manager contacted the software developer about getting an alert set up on the electronic system where people’s care was recorded.

One person’s care plan indicated they had capacity, yet a DoLS had been applied for. DoLS only apply when a person no longer has capacity to make decisions about what restrictions are needed to help keep them safe.

People had not had equal opportunity to access the community and there were missed opportunities as the provider’s minibus was not regularly used to enable all those who wished to go out, to partake in this.

The provider and registered manager felt our findings were one-off concerns rather than repeated issues or evidence of a culture in the service.

Following our first day of visiting the home, we shared our feedback with the provider and the local authority. The local authority then carried out their own visits to the service to check on the safety of people. They continued to find concerns of a similar nature to the CQC, such as medicines, people’s bowel monitoring, food and the lunch time experience and access to drinks.

While the provider had failed to make sufficient improvements in response to previous feedback, they were willing to work with external agencies in a multi-disciplinary approach. The provider also engaged the support from an external consultant in response to concerns identified and was committed to improving the service for people who lived there. We will check improvements have been made and sustained at our next assessment.

The management team were unable to tell us what action they had taken to learn and make improvements in response to a staff survey that had been completed in February 2024. The registered manager and another member of the management team were responsive to our feedback and held an immediate meeting with staff to discuss feedback following our first visit to assess the service.

Effective systems were not in place to ensure improvements were made as a result of people’s feedback. The provider had not effectively acted on people’s feedback about the quality of the food. The provider had developed an action plan in response to the breaches of regulation we identified at the last inspection. We continued to find concerns at this inspection which meant action they had taken had not been fully effective and there had not been enough improvement. The local authority had been sharing feedback about their findings at the other care home the registered manager managed. Learning from this feedback had not been effectively shared at Wall Hill Care Home to improve care to people living there.