Hilltop

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.

This is the first assessment for this service. This key question has been rated outstanding. This means service leadership was exceptional and distinctive. Leaders and the culture they created brought about and improved high-quality, person-centred care.

This service scored 89 (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 very clear shared vision, strategy and culture. They were committed to quality, care and respect that enabled the principles of Right Support, Right Care, Right Culture to become a reality for people.

There was strong collaboration, team-working and a shared focus throughout the workforce on improving the quality of care and people’s experiences. A genuinely personalised approach to each person’s support was reflected in everyday practice and decision-making. This was evident throughout our inspection and had resulted in positive outcomes for people. People’s named key workers passionately advocated for them and set goals and objectives with their circle of support that reflected the life people wanted to live. Staff celebrated people’s achievements and proudly described how people had been supported to develop skills and enhance their lives.

There was a distinctive improvement culture, shared throughout the staff team. This was reflected in thorough, comprehensive and meaningful auditing of all aspects of people’s care and life at Hilltop, including accidents and incidents. It went beyond what would be expected in a service like Hilltop. Clear communication of the findings meant nearly all audit actions were completed withing 48 hours. All staff we spoke with could describe what audits had found and the improvements the service was making.

The provider continued to review and plan the service to meet people’s needs. They were recruiting more specialist staff, such as a recent appointment of a speech and language therapist and a learning disability nurse consultant. This ensured people had prompt and unlimited access to specialist input to further individualise their support.

The service had developed a working culture that retained and developed staff. Staff were proud of Hilltop as a place to work and spoke highly of its culture and values. Their comments included, “I am so very happy to work here”, “This is the best place I have ever worked”, “I love coming to work” and “We are really like a family, when I don’t feel well, I know coming to work will cheer me up, the people and the team.” Apart from when it first opened in 2023, the service had never needed to use agency staff. Several staff were working on staff development projects which included leading, for example, on health and safety audits. When the service opened, many of the staff were new to working with people who communicated distress and frustration through their behaviour. The manager explained the challenges this had presented to staff confidence and leaders focused on developing staff skills and confidence in positive behaviour support. This report reflects the benefits for people of a stable, capable, confident team of staff who knew them well.

The provider had exceptionally inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

Leaders at every level were visible, accessible and responsive, embodying integrity, honesty and openness. They built strong, respectful relationships with staff and people, and led by example, modelling inclusive behaviours. Staff told us leaders fostered an open culture of trust, being empathic and honest about challenges and mistakes and using these as opportunities for learning. Staff felt leaders actively listened to them and encouraged collective problem solving. They described leaders as visible, accessible and responsive. Comments included, “The owner (provider) is always popping in, knows us and the people living here really well” and “There is always a manager around to support. They work with us and know people very well.’’ Staff consistently told us one of the strengths of the management team was that they would always respond, quickly and comprehensively, always wanting to work with staff and people to find a solution. Staff could not think of any examples when they did not get a response or resolve from a manager.

Leaders were knowledgeable about issues and priorities for the quality of services for people with a learning disability and/or autistic people and were highly skilled in managing such a service. This was evident in, for example, the application of the Right Support, Right Care, Right Culture guidance, the highly personalised care people received, high staff skill and work satisfaction, and compliance with guidance and legislation.

Leaders modelled empathy and compassion. There was a strong acknowledgement from provider that the day-to-day work could be intense. The provider was aware of the risk to people from stressed staff, therefore staff had regular wellbeing debriefs, Staff valued this focus on their wellbeing, which was consistent from all leaders and the provider, making Hilltop a good place to work.

There was an embedded, effective system of leadership development and succession planning. This reflected the diversity of the workforce and supports staff to feel safe, speak up, and grow through learning and development opportunities. Staff told us this supported them to feel safe, speak up, and grow professionally. Leaders provided examples of how they had identified and fostered talent staff had shown for leadership. They told us they were glad to promote staff from within the organisation. However, they understood the risks of and actively guarded against the development of a closed culture where unsafe, poor care went unchallenged, amongst staff who had worked together for a long time.

There was strong collaboration, team-working and support across the service. Staff were engaged, empowered and united by shared values, with a clear sense of belonging and a common focus on improving the quality of care and people’s experiences. Effective care planning, including positive behaviour support guidelines, also meant there were seldom incidents of behaviour that communicated distress. Staff said this made it a good place to work. They stressed how important consistency was for people and care workers were very passionate about the person they lead on and very vocal in ensuring the rest of the staff supported them to the benefit of the person. The culture enabled that kind of challenge and leadership was evident throughout the service.

The leadership team worked collaboratively. The manager told us they felt supported, and able to focus on people, empowered to act and work together to deliver excellent care.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Provider policies guided staff about whistleblowing and how to raise concerns. Staff’s views were also sought through their supervisions. Staff told us leaders worked alongside staff in the home and were accessible to them whether they were on or off site. Staff had the opportunity to speak with them in person and felt they could do so. All staff told us any concerns they had raised had always been acted on promptly.

The provider regularly encouraged people, relatives and staff to speak up if they had concerns about any aspect of life at Hilltop. The relatives and staff we spoke with all said they felt able to raise concerns, with confidence these would be heard, addressed and used to improve the service. This positive speaking up culture was reflected in records, such as meeting minutes and management reports.

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.

All staff spoken with told us the provider promoted inclusion, equality and fairness. Staff’s personal circumstances were known to the manager and were respected when shifts were planned. Staff were particularly appreciative of how long in advance shifts were planned to enable them to plan their personal lives accordingly. They were also complimentary of the provider’s regular presence in the home and their interest in staff.

Staff were positive about the provider’s focus on developing and promoting staff from within the organisation and felt these opportunities were equally available to all staff.

The provider had clear responsibilities, roles and systems of accountability, and good governance. They used these to manage and deliver high-quality, sustainable care. They always acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

There was a demonstrated commitment across the service to good practice, service performance and risk management systems and processes. Staff were engaged, respected and supported to use these systems effectively, addressing problems openly and swiftly through collaborative and responsive leadership. The provider had fostered an exceptional quality monitoring culture, with all staff highly passionate about improving the service for people who used it. Very comprehensive governance arrangements covered all aspects of the service; this reflected good practice and the provider regularly reviewed them. Monitoring systems were rigorous, and empowered staff at all levels to identify and bring about positive outcomes for people. All staff demonstrated a passion and commitment to good practice and service performance. Audits were completed according to a schedule; actions identified were shared quickly with all staff and completed swiftly.

Monitoring systems were distinct in their effectiveness. For example, staff undertook quality audits, same day actions or learning was emailed to staff and completed immediately. Staff could describe the learning they had taken from items such as the last fire drill and the last medicines audit, and how this had impacted on people’s lives. For example, 1 person needed to be woken up at night to receive their prescribed medicines. Staff monitored this and found it adversely affected their quality of sleep; they therefore asked the GP to change this. They described how they now monitored all new prescriptions to ensure any issues with unsociable or other medicines timings that might disrupt sleep or spoil activities were addressed promptly.

Audits not only focused on safety and quality; they considered people’s experience also. For example, following a fire drill staff found it took too long to get people’s grab bags, so they put together a second grab bag to ensure these could be taken quickly, irrespective of where in the home the fire started. Staff explained how important these bags were and how they had been personalised to include 2 sets of clothing, people’s preferred snacks/drinks and some small activity or objects that soothed people. This was to ensure people could remain occupied and have familiar objects whils waiting for the fire brigade to arrive. These grab bags were regularly checked and updated as needed, including adding a printed social story for people who found these useful. All staff were trained fire marshals.

All staff we spoke with could describe their role and contribution towards ongoing performance monitoring, including acting on feedback, and how this had facilitated improvements in the service. This included better outcomes for people in relation to, for example, medicines management, learning from incidents and safeguarding investigations. For example, a member of staff told us as they got to know an individual they had an improved understanding of what might worry them, leading to an escalation of distressed behaviour. The team had implemented simple changes to the way they supported the person at mealtimes, so the person felt comfortable to eat in the presence of others without experiencing distress. Relatives confirmed the service was highly responsive in addressing any queries or issues they raised.

Monitoring also took place across all the provider’s services and staff could explain how the service had benefitted from understanding themes and trends across services.

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.

Staff and leaders worked in partnership with key organisations to support care provision, service development and joined-up care. The service had strong relationships with other organisations, with staff and leaders engaging early with those organisations to share learning. This resulted in positive outcomes for people and improvements to the service. Professionals from other organisations confirmed staff worked openly and collaboratively with them.

The provider had a strong focus on continuous learning, innovation and improvement across the organisation. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe and effective practice.

The service approached learning as a continuous process, embedded through reflection, collective problem solving, and sharing mistakes as well as good practice. Learning was taken from all aspects of the service; for example, safeguarding investigations had been strengthened to support people to be involved through use of social stories and communication aids. We saw an example of how a person was supported to be an active participant in a safeguarding process through regular meetings and a developing social story which included using the symbols they understood.

Leaders used challenges to bring about improvement. This was particularly evident in the provider’s decisions to include a psychologist, speech and language therapist and a learning disability nurse consultant in the team. This had come from reviewing access times and realising people were waiting too long to access community services and the impact it had on their care and quality of life. The provider had also developed a supported living service to support people where appropriate to move to more independent living.

The provider had also set up their own day care service to enable people to meet others across their 4 services. The provider also ensured they bought residential homes close together so managers, staff and people could build a community. We heard many examples of how this had supported managers and how people had developed friendships which extended to regular visits to each other’s homes.