Archived: Hilltop Residential Services

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.

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 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. The registered provider was present in the home each day to oversee the day to day running of the home which they had delegated to their home manager. 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.

People’s medicines were ordered routinely and in a timely way. However, systems to manage the storage and administration of medicines were not sufficiently robust and were not always safe and in line with good practice guidance.

The home was not working within the principles of the MCA. The manager and some staff did not fully understand the requirements of the Mental Capacity Act 2005 (MCA). MCA assessments had not been completed to establish that people lacked capacity to make specific decisions, although the manager had applied for DoLS authorisations for everyone who lived at the home.

There were insufficient systems in place to monitor the quality and safety of the service provided. Current systems were not effective and had not identified issues such as gaps in medicines recording or out of date policies. The provider and manager were not aware that new regulations had come in to force in April 2015 and policies still related to the previous regulations.

Incidents and accidents were recorded, although records were disorganised and no analysis of incidents was undertaken. Complaints procedures were in place. The home had not received any complaints.

Staff showed a good understanding of the needs of the people they supported. People were offered a choice of home cooked food and drinks which were sufficient for their needs and that met their dietary requirements. People’s hobbies and interests were documented and staff accurately described people’s preferred routines. Staff supported people to take part in activities both within the home and in the community.

There was a strong, visible person centred culture within the home. Staff delivered care that supported people to maintain their independence and provided re-assurance when needed. Staff treated people with kindness and compassion and respected people’s privacy and dignity.

Relatives told us they were happy with the care people received. People, their families and their advocates were involved in the planning and review of their care. People’s care plans were personalised and support was tailored to their individual needs. Staff were knowledgeable about people’s health conditions and made referrals to health care professionals quickly when people became unwell or if they had concerns.

There were sufficient numbers of staff on duty to support people safely and meet their assessed needs. The provider had appropriate systems in place to recruit staff and appropriate checks were carried out before they commenced employment to ensure they were suitable for the role. Staff received an induction before they started work and were appropriately trained and skilled to deliver safe care.

Safeguarding people was understood by staff who knew about their responsibilities to report any concerns of possible abuse. Individual and environmental risk assessments had been carried out and measures put in place to mitigate risks to people.

There was an open and transparent culture within the home and staff and relatives said the provider and manager were helpful and approachable. Staff understood the vision and values of the service and were actively involved in the development and improvement of the service.

We found two breaches of the Health and Social Care Act 2008. You can see what action we have asked the provider to take in the main report.

One person told us: "The food is alright and the staff are really good." Another person told us: "I really like living here and I was glad to come back after being in hospital. I missed the staff and other people." They both told us they liked doing activities they had identified within their care plans. This showed us they had been involved in their care planning and their wishes had been listened to.

People who used the service were aware of safeguarding and said they would tell the provider if they thought they were being abused. Staff had received training in safeguarding vulnerable adults and were able to explain the process they would follow if they discovered abuse.

A member of staff told us "The support I get from the provider is outstanding and the communication within the team is great." We saw in staff records they were suitably qualified, skilled and experienced.

On our last inspection we found the service to be non-compliant in the areas of record keeping and risk assessment. We found significant work had occurred and appropriate records were being maintained in those areas.

We found that people who used the service were treated with dignity and respect and were involved in aspects of their care planning and its delivery. Assessments and care plans identified people's individual care needs and ensured people received appropriate care. People were protected from the risks of inadequate nutrition and dehydration and were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them. People were cared for by suitably qualified, skilled and experienced staff. People were being cared for by staff that were formally supervised and appraised.

Regular quality assurance monitoring did not take place which covered services people received or their environment. People were not fully protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained or regularly reviewed.