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We are carrying out a review of quality at Hillbrook Grange. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary

Overall summary & rating


Updated 6 February 2021

About the service

Hillbrook Grange is a residential care home providing personal and nursing care to 33 people aged 65 and over at the time of the inspection. The service can support up to 41 people.

People’s experience of using this service and what we found

Medicines were not managed safely which placed people at risk of harm. People were not safeguarded from abuse and other risks to them. Infection, prevention and control procedures did not protect people from the contracting of avoidable infections. The environment was well presented but several health and safety risks were identified.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Processes to ensure people were not deprived of their liberty were not always followed.

People did not always receive person-centred care. Care plans had not been reviewed and monitoring records were often incomplete. Complaints were not always responded to in line with the home’s policy. People told us they felt socially isolated and there was a lack of activities. We have made a recommendation about managing social isolation.

The service was not effectively managed and there were limited systems in place to monitor the quality and safety of the service provided. Staff did not always feel supported by the management team. Relatives did not always find the registered manager approachable or proactive. We have made a recommendation about the management of the closed circuit television.

The provider took steps to mitigate risk following the first two days of the inspection. For example, carrying out fire safety checks and risk assessments. There had been some improvement on day three of the inspection but medicines management was still unsafe.

For more details, please see the full report which is on the CQC website at

Rating at last inspection

The last rating for this service was good (published 7 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received about safety, person centred-care, response to concerns and infection control. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has deteriorated to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hillbrook Grange on our website at


We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safety, staffing, person-centred care and governance at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been con

Inspection areas



Updated 6 February 2021

The service was not safe.

Details are in our safe findings below.



Updated 6 February 2021



Updated 6 February 2021


Requires improvement

Updated 6 February 2021

The service was not always responsive.

Details are in our responsive findings below.



Updated 6 February 2021

The service was not well-led.

Details are in our well-Led findings below.