Hilltop

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 84 (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 had a strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

A positive safety culture was firmly embedded in the service, with safety concerns recognised as essential to ongoing learning and improvement. This was based on openness, transparency and applying learning from events that could have caused harm. People using the service, their families and staff were encouraged and supported to raise safety concerns and suggest improvements, without fear of negative repercussions. Staff knew how to report safety incidents and did so when necessary. Managers and staff were candid about safety concerns, promptly addressing issues as they arose to help reduce the risk of similar incidents in future. A relative described how staff had been open and honest, immediately informing them of an incident involving their family member and a member of staff.

Leaders demonstrated visible commitment to safety, being open, responsive and able to show clear, sustained improvements in safety outcomes. The service continually and actively sought opportunities to learn from risk and safety incidents and good practice. Lessons learned from safety incidents resulted in changes that improved outcomes, especially fewer incidents of distress and reduced restrictions, for the person concerned and for others, including people using the provider’s other services. This involved detailed reviews of each incident, as well as analysis of incident trends, to establish contributory factors and how these might best be managed in future. For example, a review revealed how watching the same DVD for a long time could cause the person to become frustrated, which they communicated through behaviour that could hurt themselves. These reviews involved members of the management team, and the provider’s clinical psychologist and speech and language therapist, as well as staff who worked closely with people. The learning was clearly communicated to all staff, through written information, handovers, staff meetings and supervision. It was also shared across the provider’s services, where relevant. A member of staff described how they had changed the way they supported someone because of such learning, which had reduced the frequency of safety incidents involving the person and improved their quality of life.

The provider worked with people and healthcare partners to establish and maintain safe systems of care. They made sure there was continuity of care when people moved into the service or received care from other services.

There was a thorough assessment and transition process when people were moving into Hilltop. This enabled people to meet people and staff, get used to the environment and see whether they liked being there. It also enabled the provider to be sure the service could support people safely and effectively. Managers gathered detailed information about people’s needs from the referral, building on this as the assessment progressed through discussion with people themselves, their families and professionals who worked with them.

Staff were proactive in discussing risks with people’s health and social care professionals. This enabled joint working to manage those risks in the least restrictive way possible.

The provider worked well with people and healthcare partners to understand fully what being safe meant to them and the best way to achieve that. Staff had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider always shared concerns quickly and appropriately.

The provider’s approach to safeguarding proactively promoted people’s safety, wellbeing and rights. Managers and staff supported people and their families to understand safeguarding, what being safe meant to them, and how to raise concerns. The provider had developed easy-read and pictorial information displayed around the service, to help people understand safeguarding matters. With support from the provider’s speech and language therapist, staff had developed communication tools such as social stories, to support people who did not communicate through speech to discuss safeguarding. We saw an example of how these tools had been used over multiple sessions to support a person to participate actively and effectively in a safeguarding investigation. People had ‘Keeping Safeguarding Personal’ sessions with their keyworkers, using communication tools appropriate to the person’s preferred communication method to discuss safeguarding matters, such as abuse, finances, personal property, raising concerns and staying safe. The safeguarding leads were developing further safeguarding information resources for relatives.

The provider had established a culture in which staff actively sought and valued opportunities to promote people’s human rights. The provider and staff shared a commitment to safeguarding people and upholding their right to live in dignity, free from neglect and abuse; this was evident in the way they talked about their work. This culture was reflected in the strong emphasis amongst staff at all levels on least restrictive practice, positive behavioural support, and preventing the development of a closed culture where abuse and neglect were ignored.

There was a comprehensive safeguarding system, through which safeguarding risks were proactively identified, managed and reduced. Managers and staff had a strong understanding of safeguarding and their role in it. They received initial and regular update training about this, which was reinforced in supervision and during staff meetings. The safeguarding system was enhanced by the provider’s reviews of safeguarding incidents.

Safeguarding was a shared, strategic priority embedded across the whole service. Safeguarding systems were continually improved through evidence-based learning and innovation, and changes were sustained. All staff and people who used the service were actively involved in reviewing and improving safeguarding practice at the service. A senior manager held the role of safeguarding lead across the provider’s services, with the manager of Hilltop as their deputy. Together, they regularly reviewed safeguarding incidents and practice across all the provider’s services, identifying learning and sharing this in a meaningful way with staff, people and their families. For example, by reviewing incidents and safeguarding reports, they had identified a trend in relation to errors with medicines and the underlying causes of these. They had already informed people’s families, in line with the provider’s legal duty of candour. They addressed the individual incidents with the staff involved, encouraging them to reflect on what had happened and identify how they might reduce the likelihood of repetition. Afterwards they shared the general themes and improvements in newsletters for staff and families, identifying how outcomes for people had improved as a result.

There was a clear understanding of the Deprivation of Liberty Safeguards (DoLS), which were applied appropriately. DoLS ensure people who cannot consent to their care arrangements in a care home are protected if those arrangements deprive them of their liberty.

The provider always worked well with people and their families to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

A rights-respecting culture was embedded in the service. Reducing restrictive practices was a shared priority for the provider and staff at all levels, and the service was able to demonstrate how restrictions had reduced for people since they had lived at Hilltop. Staff recognised the importance of working consistently with people’s positive behaviour support plans; positive behaviour support involves understanding the reasons behind behaviour, which enables support that better anticipates and meets those needs.

The service exemplified consistent person-centred care within a positive culture that engendered trust between people and staff and protected people’s safety and wellbeing.  When people communicated their needs, emotions or distress, staff managed this positively, protecting people’s rights and dignity and maximising learning for the future about the causes of their distress. A range of staff reviewed each incident of distress in detail, including managers, staff who worked with the person, the safeguarding lead and deputy, and the provider’s clinical psychologist, to identify contributing factors and ways of managing these. Improvements identified were implemented promptly. Positive outcomes for people included fewer incidents of distress and reduced restriction, such as less physical holding for their safety. This demonstrated how managers and staff learnt from any escalation, upheld peoples’ rights, and adopted least restrictive practice.

People, those close to them and staff collaborated to review and improve the management of risks. There was a strong focus on equity and inclusion as part of this. People’s risks were assessed, with people and their relatives involved in this process as much as possible. There was serious consideration about the least restrictive way to manage these, and the provider sought additional resources where needed to uphold people’s human rights. For example, without additional staffing, an individual would have been unable to leave the premises safely due to the complexity of their needs. The provider obtained additional funding for the person to have the support they needed when they were out, enabling the person to visit their family and use community facilities. Risk assessments were clear, detailed, proportionate and kept under review. People’s care plans reflected these risk assessments, including any foreseeable risks that could need restrictions. Staff understood people’s risks and the care they needed to maintain their safety and wellbeing.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Fire safety procedures were effective. Regular fire drills took place to monitor staff compliance with the provider’s evacuation procedures. These drills were well documented; learning was shared with staff and followed up to ensure any risks were mitigated.

There were regular checks were to ensure the home environment remained safe. These included checks and preventative measures to mitigate risk of water-related bacteria.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff were positive about their training and development opportunities and felt these provided them with the skills and knowledge required to support people appropriately. Training was refreshed at regular intervals and staff’s competency was assessed as required to maintain their knowledge and skills, for example, when administering medicines. Induction, supervision and appraisal processes supported staff to develop their skills, and systems were in place to manage poor performance appropriately.

The provider was aware of the staff training requirements when supporting people with a learning disability and/or autism. They were developing their training further to include contributions from people with a learning disability.

There were appropriate staffing levels and skill mix to meet people’s needs. Relatives praised the competence of staff and told us there were always enough staff on duty. Staff told us people’s individual needs were taken into consideration so that when people received one-to-one support, the skills and experience of staff were matched to the person’s needs.

Thorough and safe recruitment practices ensured staff were safe to carry out their roles.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff understood their infection prevention and control responsibilities. They kept the premises and equipment clean and followed food safety principles to minimise the risk of infection.

Where appropriate people were involved in keeping their rooms clean and tidy.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Records showed people had received their medicines as prescribed. People’s administration of PRN medicines (medicines taken when required) was guided by clear protocols, which were regularly reviewed to ensure they remained effective.

People’s medicines were ordered, administered, recorded, stored and disposed of safely in line with legislation and guidance.

Staff worked closely with health care professionals to review people’s medicines to ensure people only received the medicines they required. We heard examples of how staff involvement had ensured people’s epilepsy and anxiety related medicines were adjusted to improve their quality of life.

People’s behaviour was not controlled by the excessive or inappropriate use of medicines.