12 July 2023
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
The inspection was undertaken by two inspectors, a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Hilltop Hall is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Hilltop Hall is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was not a registered manager in post. A manager was in post but was leaving post and the provider had taken steps to advertise for the position of registered manager of Hilltop Hall.
Notice of inspection
This inspection was unannounced on both days of site visit.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. This included information of concern and notifications the service is required to submit regarding any significant events happening at the service. We sought feedback from the local authority, and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. All this information was used to plan the inspection.
During the inspection
We reviewed staffing levels and walked around the building to ensure it was clean and a safe place for people to live. We observed how staff supported people and provided care.
We spoke with 15 people who use the service, 1 relative and 6 members of staff including members of the senior management team, manager and deputy manager, unit manager, nurses care workers, and auxiliary staff including domestic and kitchen staff and activity workers.
We reviewed a range of records including 7 people's care records. We looked at 4 staff files in relation to recruitment, training and support. We observed how staff supported people to take their medicines, reviewed records of medicines and systems of oversight regarding the safe management of medicines. A variety of records relating to the management of the service, including policies and procedures were examined during and following the site visits.
12 July 2023
About the service
Hilltop Hall Nursing Home is a care home providing personal and nursing care to up to 54 people. The service provides support to older people. At the time of our inspection there were 43 people using the service. The care home accommodates people in one adapted building across 3 floors.
People’s experience of using this service and what we found
There had been a lack of stability of management since our last inspection which had impacted on how effectively change and improvements had been progressed. Audits and checks were being completed although these were not always robust and had not identified and resolved some of the issues we found during the inspection. Where shortfalls had been identified and action taken, these were not always followed up to ensure they became embedded into practice. A service improvement plan was in place, and this was being progressed prior to, and during the inspection.
Medicines were not always safely managed and suitably robust assessments of staff competency in this area was not always in place. There were generally enough staff to meet people’s needs, but they were not always suitably deployed within the service. Records did not always demonstrate a robust recruitment process had been followed. Shortfalls in the environment had been identified and work was ongoing as part of a service improvement plan. The home was generally clean, and people felt safe. We found some improvements were needed to the recording and management of risk.
Staff completed a variety of training but further work to ensure staff on shift had the relevant knowledge, skills and competency was needed. Assessments were in place, but these were not always accurate, and records did not always demonstrate that the appropriate levels of care were being given. Work to improve the mealtime experience was being undertaken at the time of inspection and these improvements needed to be completed and embedded.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice although records needed to be more robust in demonstrating how the service was working within the principles of the Mental Capacity Act.
The provider was making progress in providing personalised care and although care plans had improved, further work was needed and currently being completed to ensure these were personalised to include people’s wishes and preferences. Activities were available for people, but the records did not always demonstrate how people were supported fully to engage in their hobbies and interests. People and families felt able to raise concerns, but feedback from staff about this was mixed. Care plans were in place to support people who may require care at the end of life, but these needed to be personalised.
Staff were kind and caring and were seen to promote people’s independence and dignity as much as possible. People felt involved in making decisions about their care although records did not always reflect this.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 29 June 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained requires improvement and in breach of regulations. The service has been rated requires improvement for the past three inspections.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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 COVID-19 and other infection outbreaks effectively.
Enforcement and Recommendations
We have identified breaches in relation to how people’s medicines were managed; the need for further improvements to ensure people received care and support that was individualised, appropriate and met people’s needs; and the oversight of the service to drive improvements and ensure robust record keeping at this inspection.
At our last inspection we recommended that the provider refers to current guidance to prioritise meaningful individual activities for people cared for in bed. At this inspection we found some changes had been made but further improvements were needed.
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 concluded.
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.