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Archived: Hilltop Manor Care Home Requires improvement

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Reports


Inspection carried out on 5 June 2019

During a routine inspection

About the service

Hilltop Manor Care Home is a care home providing personal and nursing care to 25 people aged 65 and over at the time of the inspection.

Hilltop Manor Care Home can accommodate up to 80 people in one adapted building.

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

Improvements were needed to the way medicines were managed to ensure they were consistently safe and systems were robust. The provider needed to ensure that improvements made throughout the home were thoroughly embedded and sustained to ensure a consistently well-led service.

People were protected from abuse and avoidable harm by staff who knew people’s risks and how to reduce them. There were enough staff to meet people’s needs and they followed safe practices to ensure people were protected from the spread of infection.

People’s needs and choices were assessed and met by staff who were trained and supported to carry out their roles effectively. 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.

People were happy with the food on offer and had choices. Staff supported people to eat whilst maintaining their dignity. People’s health needs were met and they had access to healthcare professionals when required.

Staff were kind and caring towards people and encouraged them to make their own decisions. People were supported to maintain their independence whilst their privacy and dignity was respected.

Staff knew people well and encouraged them to participate in activities which were meaningful to them. Staff catered for people’s preferences and considered people’s diverse needs.

The registered manager was accessible and approachable and had oversight of the service. They had implemented new systems which needed to be fully embedded and sustained to ensure continuous improvement. Staff were supported and encouraged to learn and felt involved in the service.

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 12 December 2018) and there were three breaches of regulation. We served warning notices and the provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, the service remains rated requires improvement, though significant improvements had been made since the last inspection. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating and to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hilltop Manor Care Home 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.

Inspection carried out on 25 October 2018

During a routine inspection

The inspection was unannounced and took place on the 25 October 2018. At the last inspection carried out on the 18 January 2018, 19 January 2018 and 9 February 2018 we found three breaches in Regulations. The provider breached Regulations because they had not ensured that people were safeguarded from potential harm, people’s risks were not mitigated to keep them safe, medicines were not managed safely and the service lacked monitoring systems to enable poor care to be identified and mitigated.

Following the last inspection, we served a Notice of proposal to request monthly updates from the provider to show the actions in place to make improvements to the care people received and to meet the Regulations. The provider voluntary agreed to restrict any further admissions into the service until they had made the required improvements. At this inspection, we found that some improvements had been made. However, there were two continued breaches in regulations and a new breach in regulation was identified. The provider agreed to continue to voluntarily restrict admissions into the home until the required improvements were made.

Hilltop Manor Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hilltop Manor Care Home accommodates up to 80 people in one adapted building. At the time of the inspection there were 32 people using the service. The provider had made the decision to support people on the ground floor due to the low occupancy at the home.

There was a newly appointed manager at the service who was in the process of applying to become the registered manager. 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.

There was a lack of oversight at the service and the management team had been inconsistent. Systems in place to monitor the service and mitigate risk to people were not consistently effective in identifying and rectifying concerns with the way people’s care was provided. This meant people had continued to receive a poor standard of care.

Medicines were not managed safely. People’s risks were not always mitigated which placed them at potential risk of harm.

People did not always receive a good experience at meal times and improvements were needed to ensure people were supported in a timely and dignified way.

People were not always supported in a caring, dignified and respectful way. Staff did not always promote and encourage people’s choices in the way they wanted their care providing.

We have made a recommendation about the environment for people living with dementia.

Improvements were needed to ensure all incidents were reported to ensure people were safeguarded from potential harm.

Improvements were needed to ensure staff were deployed effectively. Systems in place to learn when things went wrong were not always effective in identifying and improving the care people received.

Training provided had not always been effective which impacted on the care people received.

People’s diverse needs were not consistently assessed and planned to ensure their diverse needs formed part of the support received.

People were protected from the risks of infection and people were supported by safely recruited staff.

People were supported in line with the Mental Capacity Act 2005, which ensured people were supported in their best interests and in the least restrictive way possible.

People had access to healthcare professionals and staff received a handover to ensure they were aware of a change in people’s needs.

Staff felt the manager was suppo

Inspection carried out on 18 January 2018

During a routine inspection

This inspection took place on 18, 19 January and 9 February 2018 and was unannounced.

At the last inspection the service was rated Requires Improvement. At this inspection we found that the service had deteriorated and more improvements were needed. We identified some Regulatory breaches and we told the provider that improvements were needed to ensure people consistently received care that was safe, effective, caring, responsive and well-led. The service has a rating of ‘requires improvement’ overall but was rated 'inadequate' in well led.

Hilltop Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hilltop Manor Care Home accommodates up to 80 people in one adapted building and care is provided over two floors. Each floor has its own unit manager and separate adapted facilities. At the start of this inspection there were 62 people using the service.

There was a registered manager but they were not working during this inspection and they have since left the provider’s employment. 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. There was an acting home manager in place with additional support from the provider.

People's risks were not always safely managed. The systems in place to monitor safety and quality of services provided were not always effective in identifying issues and implementing timely changes.

People were not always protected from avoidable harm as potential safeguarding incidents had not always been investigated, reported or action taken to reduce the likelihood of them reoccurring.

Systems were not effective in identifying concerns and resolving them in timely manner which left people at risk to their health and wellbeing.

People told us they received their medicines when they needed them but we found that improvements were needed to the way medicines were managed to ensure they were safe.

We found that staff sometimes spoke about people in an undignified way, which sometimes compromised their privacy and dignity.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. However, staff needed more support to understand the relevant law in relation to this.

People had access to healthcare professionals when they needed them; however improvements were needed to the handover systems to ensure that important information was passed over within staff teams and to professionals.

Some people’s care plans did not contain up to date and relevant information that staff needed in order to provide personalised care, including information about their wishes for end of life care. The provider had a plan in place to address this.

There were enough safely recruited staff to meet people’s needs and people were protected from the spread of infection. Staff were provided with training and support in order to provide effective care, however staff felt they would benefit from more face to face training and guidance to improve their understanding in some areas.

People mostly, but not always, had choices about their care and treatment and enjoyed the food on offer. People were happy with the care they received and felt that staff treated them in a kind and caring way. They told us they had access to activities they enjoyed.

People felt comfortable to complain if they needed to and the provider had a suitable complaints policy in place. People were provided with the opportunity to give feedback about

Inspection carried out on 18 May 2017

During a routine inspection

The inspection took place on 18 May 2017 and was unannounced. At our last inspection on 10 February 2015 the service was good overall.

Hill Top Manor Care Home provides accommodation for up to 80 people who require nursing or personal care.

There was a registered manager in post. 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.

We found some improvements were required to ensure people’s medicines were managed safely. Although risk assessments had been completed, staff did not always follow the guidance in place. We saw some people were not supported to move in a safe manner. The arrangements to support people who needed help with decision making were not consistent. Some people were being deprived of their liberty to keep them safe however the necessary permissions were not in place.

There were a sufficient number of suitably recruited staff to meet people’s needs in a timely manner. Staff had access to training and support to improve their knowledge of care and enhance their skills. People were provided with a choice of nutritious food and plentiful drinks. Staff supported people to retain their independence and when support was required it was provided in a kind and reassuring manner.

People enjoyed the company of staff who respected their privacy and promoted their dignity. People were able to maintain their important relationships, as relatives and friends could visit at any time.

People received the care they preferred because staff asked them and their relatives about their likes and dislikes. Care was reviewed regularly to ensure it was still relevant for people. People enjoyed a varied programme of entertainment and support with activities to prevent them from becoming socially isolated. People told us they were happy with their care and would speak with the registered manager or staff if they wanted to discuss a concern or complaint.

People, their relatives and staff were given opportunities to discuss the care and offer their opinions which were listened to and acted upon. People and staff felt well supported by the registered manager and the deputy.

Inspection carried out on 10 February 2015

During a routine inspection

This inspection took place on 10 February 2015 and was unannounced.

Hilltop Manor Care Home is registered to provide accommodation for up to 80 people who require nursing or personal care. At the time of this inspection 68 people lived at the home.

The home had a registered manager. 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.

We found that the service was not consistently effective when people who lived at the home were unable to make certain decisions about their care. The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate; decisions are made in people’s best interests when they are unable to do this for themselves. The registered manager and provider could not show us that under these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. This meant people could not be fully assured that decisions were being made in their best interests when they were unable to make decisions for themselves. We made a recommendation that the provider refers to current guidance in relation to the Mental Capacity Act 2005.

People told us they felt safe and comfortable living at the home. Assessments were completed when people were identified as being at risk of harm. Staffing levels were adequate; people’s individual care preferences and needs were met.

Records relating to people’s care were accurate, up to date and readily accessible in the event of an emergency situation. Staff were aware of people’s individual care and support needs.

People’s medicines were managed, stored and administered safely; staff were knowledgeable and supported people with their medication as required.

People told us they enjoyed the food that was provided and they had sufficient to eat and drink each day. People were provided with additional support with eating and drinking when it was required.

People’s health care needs were met. They were supported to see a health care professional or specialist when they became unwell or their needs changed. People told us the staff were caring and considerate. We saw staff were patient and thoughtful when interacting with people.

There was a range of leisure and recreational activities available for people to enjoy. These were either group based or on a one to one basis. People told us their preferences to participate or not were respected.

Meetings with people were arranged at regular intervals which gave them opportunity to discuss their experiences and make suggestions for improvements. Staff told us they felt well supported by the management and they all worked well as a team. The safety and quality of the home was regularly checked and improvements made when necessary.

Inspection carried out on 9 October 2013

During a routine inspection

During the inspection we spoke with fifteen people who used the service and six staff members. We also held discussions with the registered manager and deputy manager and spoke with the two social workers who were employed by the provider. Staff felt supported by the provider and thought that this was a good place to work.

People who used the service felt that they had their needs met effectively by staff who were caring and attentive. People who used the service thought that staff worked well together in order to support them. A person told us, "The staff are all very good and I am getting the help I thought I would get."

The provider carried out detailed assessments of people's needs and only offered places where they felt they could meet the person's needs. This meant that people entering the home could be assured that their needs would be met.

There was evidence that the provider worked collaboratively with other professionals and employed a good skill mix of professionals including physiotherapists, occupational therapists and social workers. This meant that the provider was responsive to the needs of people.

The provider monitored the quality all of the services provided. This included listening to the views of people who used the service and talking with them about concerns. This meant that people felt listened to and received safe quality care and support in a safe environment. People felt that the service was well-led.

Inspection carried out on 17 January 2013

During a routine inspection

During the inspection we spoke with fifteen people who lived at the home, two families who visited the home and twelve members of staff. The families told us that the home was 'good' and that they were, happy with the care that their family member received.

People in the home told us they were given choices and were respected by the care staff. Staff told us that there were enough staff on duty to care for people in the home properly. People who lived in the home told us that they liked it here, one person said, "I love it here".

We saw seven plans of care which reflected that people who lived in the home had an assessment of care needs completed, reviewed and implemented. We observed staff who carried out care in a way which respected the dignity and privacy for the people in their care. They used screens to give added privacy when in the communal areas and took time to listen to preferences that had been expressed.

People who lived in the service told us that they liked the home and the staff. One person told us �I know what I want and I tell the staff and they do it for me�; they were referring to when they wanted to get up and go to bed each day.

Staff told us that they knew how to raise a concern about potential or actual abuse. We saw that the home had a policy and procedure for this to happen effectively. People who lived at the told told us they felt safe and happy in the home.

Reports under our old system of regulation (including those from before CQC was created)