Archived: Hilltop Residential Services

Updated 14 March 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. We also checked to make sure the provider had made the improvements required from our previous inspection.

This inspection took place on 15 & 17 February 2017, was unannounced and was carried out by one inspector.

Before the inspection we reviewed the information we held about the service such as previous inspection reports and notifications we had received. A notification is information about important events which the provider is required to tell us about by law.

During our visit we spoke with one person who lived at Hilltop, four care staff and the registered provider. Most people were not able to tell us about their experiences of living at Hilltop so we also carried out a number of observations to assess how staff interacted with, and cared for the people they were supporting. During the inspection we received feedback from three health professionals and an external consultant employed to support the provider with making improvements to the home. Following the inspection we spoke with two relatives for their views on how the staff delivered care to their family members.

We pathway tracked two people’s care. This is when we follow a person’s experience through the service. This enables us to capture information about a sample of people receiving care. We looked at five staff training and recruitment records and other records relating to the management of the home such as staff duty rosters, policies and procedures and internal quality assurance audits.

We last inspected the home in January 2016 when we found two breaches of regulation.

Updated 14 March 2017

This inspection was carried out by an inspector on 15 and 17 February 2017.

Hilltop Residential Services provides accommodation and support for up to six people who may have a learning disability, complex physical needs, sensory impairment and epilepsy. Six people were living at Hilltop at the time of our inspection. The home is an ordinary house within a small residential area in a semi-rural location. The service offers a variety of activities in the local community and can also support holidays and trips away.

The home was not required to have a registered manager as the provider is registered as an individual with the commission. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered provider was present in the home each day to oversee the day to day running of the home with their assistant manager. The registered provider told us they were in the process of restructuring the management within the service. They were actively recruiting a registered manager to take overall responsibility for the day to day management of the home.

At our previous inspection we found a breach of two regulations in relation to the safe care and treatment of people and good governance. This included concerns in relation to the management of medicines, the Mental Capacity Act 2005, record keeping and quality assurance systems. At this inspection we found that significant improvements had been made and all regulations were now being met. There was still work to do to improve record keeping and embed new systems to ensure effective monitoring of the quality of the service.

Systems had been put in place to monitor the quality and safety of the service provided. The registered provider had recently commissioned a detailed external audit of the service and was working through the action plan to make improvements. Although no formal analysis of incidents and accidents was undertaken, the communication within the small, consistent staff team enabled them to ensure learning and take remedial actions to prevent a reocurrence of incidents. .

There were sufficient numbers of staff on duty to support people safely and meet their assessed needs. We saw that staff communicated effectively and worked flexibly to cover each other when health emergencies arose.

The registered provider had appropriate systems in place to recruit staff and appropriate checks were carried out before they commenced employment.

Staff understood how to keep people safe and knew about their responsibilities to report any concerns of possible abuse. Risks to people had been identified and measures put in place to mitigate the risks.

Systems to manage the ordering, storage and administration of medicines were in place. Staff received training and new staff were assessed to make sure they were competent before being allowed to give people their medicines.

Staff had received training in the requirements of the Mental Capacity Act 2005 (MCA) and understood their responsibilities in how to apply the Act. MCA assessments had been completed to establish when people lacked capacity to make specific decisions, although these were under review to improve the quality of information. Deprivation of Liberty Safeguard authorisations had been submitted to the local authority as required.

Staff received an induction before they started work and were supported to undertake on-going training to maintain their skills and knowledge.

People were supported to maintain their health and well-being. Staff were knowledgeable about people’s health conditions and quickly identified if they were becoming unwell. Health professionals confirmed advice and assistance was sought quickly by staff if they had concerns.

People were offered home cooked food and drinks which were sufficient for their needs and that met their dietary requirements. Although no formal meal planning took place with each person, staff had a good knowledge of people’s food likes and dislikes and offered alternatives to the main meal each day if required.

Staff showed a very good understanding of the needs of the people they supported. People’s hobbies and interests were documented and staff accurately described people’s preferred routines. Some people’s abilities had changed and declined over the years which had made it more difficult for them to engage in their routines. Staff supported people to take part in activities both within the home and in the community as much as they were able to.

There was a strong, visible person centred culture within the home. People were encouraged to maintain their independence as much as possible. Staff treated people with kindness and compassion and offered re-assurance when they were poorly or anxious. Staff respected people’s privacy and dignity.

People’s care plans were personalised and support was tailored to their individual needs. People, their families and their advocates were involved in the planning and review of their care.

Complaints procedures were in place. The home had not received any complaints. Relatives told us they were happy with the care people received.

Staff understood the vision and values of the service and what the registered provider was trying to achieve. Staff were actively involved in the development and improvement of the service.