Hillcrest Residential Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question as good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

During our initial site visit to the home, we were told the provider had no specific written vision or values in place. The registered manager stated they aimed to be caring, compassionate and treat people how they want to be treated, but these were not formal values committed to paper. Following our site visits, the provider sent us additional evidence for review, which included a document titled, ‘Hillcrest Quality Statement’. Within this document, it stated the provider’s values were respect, dignity, choice and control, independence, kindness and compassion, safety and inclusion. It was unclear how new these visions were or how widely shared they had been, as none of the staff we spoke with knew about them, nor were they displayed in the home or with the ‘service user’ guide, so people and relatives were also aware.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

People, relatives and staff spoke positively about the registered manager, who they described as approachable, willing to listen and visible within the home. However, it was apparent limited provider support, guidance and oversight had been provided to assist the registered manager in consistently meeting health and social care legislation.

The previous owner was no longer involved in the home, having recently sold the business. The new owner had chosen to keep the same provider name and therefore maintain the home’s regulatory history. The new nominated individual confirmed during our site visits, better support structures would be in place moving forwards, with systems and processes used at their other services adopted to assist the registered manager and help drive improvements.

Although people felt they could speak up and their voice would be heard, guidance in place for staff on how to whistle blow or raise concerns about poor practice was limited and lacked detail. The provider’s current whistleblowing policy was lengthy with multiple references to CQC’s assessment criteria but lacked practical guidance for staff. The policy advised staff to raise concerns internally and listed a number of people they could speak to. This included the safeguarding lead and whistleblowing lead. It did not say who these people were, nor did we see any reference to who they were within the home, such as posters or in meeting minutes. The policy also stated staff could raise concerns externally and provided a list of organisations they could speak with, such as CQC, the police or safeguarding. However, there were no contact details for any of the people or organisations listed in the policy.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Audit and governance processes were not robust. There was no clear schedule in place to specify what audits were completed and how often. The amount of audits and monitoring currently being completed was limited and did not cover all aspects of care, or the care home environment. As a result, the provider had not identified the issues we found during the assessment. A monthly report audit was due to be completed, which the registered manager told us covered all areas and was sent to the provider for review. We looked at the last 2 months and noted multiple sections had been left blank and the information which had been recorded was limited in detail.

The new owner told us they would be introducing their own audit schedule, which would include improved provider level oversight, to ensure governance processes had been completed consistently and any issues addressed timely.

The provider’s business continuity plan required more details on what they would do should the premises be temporarily inhabitable. Currently it stated the home would be evacuated if needs be, extra staff would be called in and people moved to appropriate premises, specifically local hotels. There was no information on which hotels, how people would get there, how this would be paid for, how care would be provided in such circumstances. It was not clear if other, more practical options had been considered, such as neighbouring care homes or community centres.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

During site visits it was unclear where any actions from audits and governance processes were recorded, as we did not see an action / improvement plan, nor was one shared with us. Two action plans were included within the evidence bundle sent to us after our site visits. However, it was apparent these had only been created recently, as they contained actions for shortfalls we had identified and discussed verbally with the registered manager and provider during both site visits.

As covered in the safe key question, there was a lack of learning from incidents, to help with identifying causes and reduce the likelihood of recurrence.