Hilltop

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service. This key question has been rated outstanding. This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 88 (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 always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

A consistent, holistic approach to assessing, planning and delivering care enhanced people’s outcomes, independence and quality of life. Relatives told us how their family member’s improved outcomes exceeded their expectations. For example, a relative recounted how they had noticed a big positive change in their family member since moving to Hilltop, and that the person’s communication had improved considerably.

Comprehensive assessments were completed before people moved into Hilltop, involving people, their relatives and professionals who worked with them. A particular strength was the consideration of the person’s compatibility with people already living there, in terms of their temperament, needs and interests. This underpinned the ‘family feel’ of the service, which we noticed and which staff and relatives remarked upon. Leaders continually sought new ways to assess people’s needs and plan care, to ensure the service understood their needs and preferences in detail and worked with the person and their family to plan care tailored to these. To this end, the provider had employed a clinical psychologist, who was central to positive behaviour support planning, and a speech and language therapist, who supported the assessment of communication needs and positive behavioural support planning when this was related to eating and drinking.

There was a creative and person-centred approach in ensuring people’s communication needs were assessed and met. People at the service communicated using specialist communication methods instead of, or alongside, speech, such as methods based on pictures and signs. A relative explained how staff had supported their family member to learn a communication method commonly used by people with a learning disability; it uses pictures, signs (hand gestures) and speech to assist communication. The relative told us how the provider had their own speech and language therapist to do more of this sort of work. Another person liked to use their own unique signs as part of the same communication method. With staff, they had developed their own dictionary containing pictures of their signs and the words they meant. We observed staff encouraging people who communicated using signs to do so.

All staff were expected and supported to develop a deep understanding of people’s needs and preferences. Staff had a detailed understanding of individuals and the care they needed. They engaged with people, relatives, leaders, the provider’s clinical professionals, and outside professionals to explore new ideas and approaches to further enhance the person’s outcomes. They kept people at the heart of this process.

People’s care needs were reviewed routinely and in response to incidents. Assessments and care plans were up to date.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff and leaders understood and followed the current legislation, standards and good practice relevant to Hilltop. Leaders kept up to date with this and shared it with staff, ensuring it became embedded in the service.

People’s nutritional and hydration needs were met in line with current standards and good practice guidance. Staff were aware of people’s individual needs and preferences in relation to eating and drinking, such as swallowing difficulties and nutritional requirements. They supported people to manage these accordingly.

The provider worked well across teams and services to support people. They shared their assessment of needs when people used different services.

People experienced well-coordinated support because staff worked proactively and collaboratively with commissioners and other services involved in their care. When needed, staff shared information with those services in people’s best interests. Professionals gave us positive feedback about this, as did relatives.

The provider fully supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

There was an emphasis on people having the best possible health and well-being outcomes to boost their quality of life, building strong, collaborative relationships with health and social care professionals to this end. Leaders supported staff to understand people’s health and wellbeing by embedding learning and ensuring they understood care plans that set out in detail the support the health and wellbeing support people needed and signs of possible deterioration. Staff knew people well and were able to identify signs that might indicate a health concern. They contacted health professionals promptly and appropriately when they had concerns about someone’s health. A health professional commented, “[Staff] are proactive in helping their patients have a good active, life and have really supported them.”

In striving towards positive health outcomes, emergencies such as epileptic seizures were reviewed and analysed as other incidents were. Leaders shared with staff a monthly epilepsy overview for each person with epilepsy, highlighting changes in the type, frequency and circumstances of the person’s seizures. These identified possible improvements to practice and where medicines might not be fully effective or be causing difficult side effects, prompting liaison with the prescriber and other professionals involved.

Where people had complex health and care needs, staff sought innovative and evidence-based ways to help them reduce the impact of long-term term health conditions and lead healthier lives. Excellent links with health professionals enabled this. For example, staff had successfully worked with a health professional to provide a medical intervention desensitisation programme for someone who feared medical interventions, enabling the person to receive treatment that could significantly reduce the impact of their long-term condition. Their relative described it as “outstanding” that their family member would accept the interventions without difficulty. Another person had been diagnosed with a long-term health condition since moving to the service. Staff had worked closely with a range of health professionals to develop a comprehensive risk assessment, care plan and emergency protocol, to ensure the person received safe and effective support when they showed symptoms. A relative commented that staff had been very supportive about this: “They were there for me if I had any questions.”

People had up to date health passports that set out their health and wellbeing needs clearly and concisely, including what they could do for themselves and the support they would need from others if they were in hospital.

The provider monitored people’s care and treatment thoroughly to improve it continuously. They ensured outcomes were positive and consistent, meeting the expectations of people and, where appropriate, their families and professionals.

Managers and staff shared the expectation that thorough monitoring of people’s care, treatment and outcomes could lead to further improvements for people. Staff actively and effectively engaged in monitoring the quality of care. This happened through key workers regularly reviewing care with people, care plan review meetings involving families and outside professionals as well as people and staff, managers’ audits, and the incident review process. This involved a range of managers and staff, including the provider’s clinical psychologist and speech and language therapist, identifying contributing factors and making recommendations for care. Monitoring also happened through reflection and discussion during staff meetings and in individual staff supervision meetings. This all resulted in updated care plans and improvements to care. For example, staff identified side effects from a person’s medicines were affecting their enjoyment of daily life, and changes were made to their prescription to overcome this.

Outcomes for people were consistently positive and improving, regularly exceeding people’s and their relatives’ expectations. These included starting to go out and to enjoy this, visiting relatives at home, choosing to spend more time in communal areas, improving communication, reducing the impact of long-term health conditions and of medication side effects, fewer incidents of distress, and fewer physical holds to keep people safe. Relatives told us these outcomes were significant for people, in the sense that they exceeded what they previously thought possible.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff followed the principles of the Mental Capacity Act 2005. Where people did not have the capacity to make decisions about specific aspects of their care and had no-one with the legal authority to consent on their behalf, staff provided the least restrictive care needed in people’s best interests. Staff consulted the appropriate people in reaching these best interests decisions, including advocates where appropriate to ensure people’s perspectives were represented.