North Hill House

Updated 19 February 2022

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.

As part of CQC’s response to the COVID-19 pandemic we are looking at how services manage infection control and visiting arrangements. This was a targeted inspection looking at the infection prevention and control measures the provider had in place. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service.

This inspection took place 27 January 2022 and was announced. We gave the service one days’ notice of the inspection.

After the inspection we spoke with two people’s relatives to gain their feedback on the service performance and visiting arrangements.

Updated 19 February 2022

About the service

North Hill House is a 'care home' that provides personal and nursing care plus accommodation for a maximum of 35 adults, of all ages, with a range of health care needs and physical disabilities. At the time of the inspection 34 people were living at the service.

People’s experience of using this service and what we found

Since the last inspection improvements had been made to the way medicines were being managed. Improvements had been made to the recording of when people’s medicines were given, stock control, medicines audits and medicines care plans. There was a system to record and act on any errors. We were assured records and systems were being maintained for the safe management of medicines.

Improvements had been made to the way people’s care and support were being reported. A review of all care planning systems had taken place. Improvements had been made in all areas of care planning, delivery and review. Staff had a clear understanding of individual needs and responses. We were assured risks were identified and staff had guidance to help them support people to reduce the risk of avoidable harm.

Since the last inspection improvements had been made to governance systems. The management structure had been reviewed and changes made. There were individual responsibilities to ensure a more cohesive overview of the service. The managers had reflected on previous failings and responded by using the collective skill set of the management team to improve all areas. At this inspection we found the assessing and monitoring of the safety and quality of the service had significantly improved. There was now a robust auditing system for the provider and manager to have oversight of the service. We were assured governance systems were effective in the management of the service.

Staff were recruited safely. Staffing levels had been reviewed and significantly increased. This meant people were receiving care and support in a timely manner. Staff were visible in all areas of the service throughout the inspection. Call bells were responded to promptly. The increase in staffing levels meant there was no reliance on the use of agency staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Cleaning and infection control procedures had been updated in line with Covid-19 guidance to help protect people, visitors and staff from the risk of infection. Arrangements were in place to support visitors and residents to see each other in a safe area of the home. Staff changed into uniform in the service and changed prior to leaving to help with infection control.

The service had suitable safeguarding systems in place, and staff knew how to recognise and what to do if they suspected abuse was occurring.

Rating at last inspection and update

The service was previously rated Requires Improvement for the key questions of Effective, and Well Led (report published 13 March 2019). Two breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. They were repeated breaches from the previous inspection, although we found the seriousness and risks associated with the breaches had been reduced.

Following the March 2019 inspection, we met with the provider to discuss the shortcomings of the service and how they would be addressed. The provider completed an action plan to show what they would do and by when to improve. We returned and inspected the service on 02 March 2020. At that inspection we found improvements had been made and the provider had complied with some of the breaches in regulation. The service was rated Requires Improvement for the key questions of Safe, Responsive and Well Led (report published 01 April 2020). Two breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We asked the provider to complete an action plan to show what they would do and by when to improve.

At this inspection enough improvement had been made and the breaches of regulation had been met.

Why we inspected

The inspection was carried out to follow up on the action we told the provider to take at the last inspections. As a result, we carried out this focused inspection to review the key questions of Safe, Responsive and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the caring and effective key questions and therefore we did not inspect those key questions. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has improved to Good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for North Hill on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.