Archived: Hilltop Hall Nursing Home

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. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to meeting people’s nutrition and hydration needs.

This service scored 42 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing, and communication needs with them.

The providers own audits had identified shortfalls in how assessments were being completed and during our review of people’s records we found this had not yet been resolved. We found that people had not consistently had their needs assessed prior to admission to the service as there were no records either within the electronic care plan, scanned documents or paper files to evidence a robust assessment of need. Some people had partially completed initial assessments or current assessments within the electronic care plan, whilst for others these records were blank. It was not evident that the provider had oversight of people’s current assessed needs except through the use of risk assessments and care plan reviews. This meant there was a risk that areas of need may be missed due to a lack of holistic assessment.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Care was not always being delivered in line with people’s assessed needs. For example, where people had specific preferences of needs recorded in their care plans there was a lack of evidence that the preferences and needs were being met. For example, people’s preferences for personal care were not being reflected as provided within care records, where people needed repositioning, records did not consistently demonstrate this was completed with any wounds or skin damage being suitably offloaded to promote healing.

People did not always get enough support and encouragement to eat well when they were refusing meals, and it was not evidence that alternative options or snacks were being offered. A stakeholder had raised concerns about people losing weight and whilst the provider had taken appropriate action to improve oversight, and options such as milkshakes were given, these were not noted consistently within the records or in our observations during our visit. It was not clear that people who required their main meals to be fortified were having this as the pre-packaged meals did not reflect that the meals were fortified and hostess told us they had not completed the relevant training to be able to fortify these for people. One person commented, “The food has not improved over the past year, the portions are on the small side. I do not go hungry as you get plenty of snacks.” Where people had food allergies or intolerances, records did not demonstrate that these were being appropriately catered for. The manager assured us that these people’s care needs were being met.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. The provider did not consistently show effective working with other services and stakeholders, and did not always have the oversight to identify shortfalls. We found there was not always sufficient oversight of staff by the nurse or senior leading the team. We spoke to staff who very motivated and committed to providing good quality care and support to people but also observed examples where this care fell short of the provider’s standards.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice, and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People told us they felt well supported and had access to medical support and a doctor if they needed this. Some people’s care records indicated they were actively trying to lose weight. However, it was not evident that staff were actively supporting healthy options as records showed where they had refused a main meal, pudding was given without healthier options being offered.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The was limited evidence to show how the provider ensured they were monitoring people and corroborating the care being given. On the first day of our site visit we found one person who appeared dehydrated and had not had mouth care overnight, although the care records indicated the contrary. We also found a number of instances where people did not have access to drinks, where call bells were out of reach and mattresses had not been set correctly in line with a person’s weight to prevent skin damage.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

Where people had been deemed to lack capacity, it was not always clear that appropriate people including independent advocates or family had been involved in these decisions. Where people were subject to restrictions, an appropriate authorisation had been sought in the form of Deprivation of Liberty Safeguards (DoLS), but where conditions were in place, it was not always evident these had been acted on, or acted on in a timely way. For example, one person had a condition that less restrictive arrangements should be reviewed with the person, but records indicated there had been a delay of 6 months before this had been addressed. Another person had a condition to make their bedroom easy for them to locate, but their bedroom only had a name on the door and they would have struggled to negotiate the home’s different corridors independently to find their bedroom. Some people had conditions in relation to activities but records demonstrated these people had limited engagement with activities. Where conditions included promoting independence, records did not reflect that these activities of daily living were being encouraged on a regular basis with people. Records for people who had fluctuating capacity were confusing and unclear about how the consent, when given, had been given in a meaningful way. We found limited evidence to support where people had lasting power of attorney in place to ensure that people making decisions were doing so lawfully.