Archived: Hillcrest

Hillcrest is a residential care home registered to provide personal care for two people with a learning disability. At the time of the inspection one person was using the service.

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

Due to the persons needs they were unable to provide us with feedback about their care.

We last inspected the service in March 2021 and the service was rated requires improvement. At that time, we had concerns regarding the safety of the environment, including unlocked cupboards containing potentially dangerous products and the dining area was a possible infection control risk. We also found medicines prescribed ‘as required’ did not have a record to show why they had been administered and some records had not been completed, including records to show checks to monitor the quality of the service. At that inspection the registered manager had been absent and there had been little or no structured management oversight.

At this inspection we found things had improved and they had met the breaches of regulations from the last report.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe, responsive and well-led the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

Staff worked to support the person in line with their preferences providing choice and control.

Right care:

Staff demonstrated a person-centred approach to care and support. People were treated as individuals and staff promoted people’s dignity, privacy and human rights.

Right culture:

Many of the staff working at Hillcrest had done so for some time therefore knew the person well. They were supporting people to have as good a quality of life as possible.

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.

The registered manager was unavailable at the time of this inspection. However, the deputy manager and regional manager supported us during the inspection.

The person living at the service was relaxed and comfortable with staff and observations showed they knew this person well. Staff were caring and spent time chatting with them and though this person spent a lot of time confined to bed, staff interacted with them as much as they wanted.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was requires improvement (published 9 April 2021) and we issued a warning notice for a repeated breach of regulation. There were also further breaches of regulation. The provider completed an action plan after the last inspection to show what action they would take and when they would have improved. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 4 March 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when they would have complied with Regulation 9, Person-centred care, Regulation 12 Safe care and treatment and Regulation 17, Good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires improvement 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 COVID-19 and other infection outbreaks effectively.

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

Follow up

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

About the service

Hillcrest is a residential care home registered to provide personal care for two people with a learning disability. At the time of the inspection one person was using the service.

Hillcrest is a detached two storey property with enclosed gardens. It is situated within walking distance of the nearby town, Redruth.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and setting did not maximise choice, control and independence. The person used the community rarely. Staff had not provided opportunities to leave the property for exercise or a change of scenery. Although the person’s care plans stated they enjoyed drives out, these were rare. There was limited evidence they were being supported to do things that interested them when they were at home.

Right care:

• Systems in place to protect people from the risk of abuse were not robust. Financial records were kept but receipts were sometimes missing, or the expenditure had been handwritten and not counter-signed.

Right culture:

• There was little oversight of the service from the management team. Staff told us they were able to access management support when they needed to, but the approach was reactive rather than pro-active. There had been no staff meetings since December 2020. This meant there had been a lack of opportunities to ensure care was provided in line with organisations ethos and values.

Some aspects of the environment were unsafe. We found cupboards containing potentially dangerous products or equipment were unlocked. The dining area did not offer a pleasant area for eating in and there was a risk of infection.

Records were not consistently completed, and it was not always evident that checks had been carried out to monitor the quality of the service. The registered manager had been absent from the service and there was a lack of structured oversight.

Medicines were stored safely and the person received their medicines as prescribed. When medicines for use as required were administered there was no record to show why they had been given or if they had been effective. We have made a recommendation about this in the report.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement and we identified a breach of regulations (report published 13 March 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staff culture and the availability of food and transport. A decision was made for us to inspect and examine those risks. We undertook a 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 other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the provision of person-centred care, the safety of aspects of the environment, record keeping and oversight of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.