Archived: Hilltop Hall Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to how the provider ensured people received person centred care.

This service scored 46 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

There was limited evidence to support how the provider involved people and families in decisions about their care. Several people told us that family members were involved in care planning but this was not supported by feedback from relatives or from the records. People’s care records generally had limited evidence to show how people and families were involved and personalised information had not consistently been incorporated into people’s care records. Where personalised detail was in place, it was not clear that these were being consistently followed. For example, some people had detailed sleeping care plans but when we arrived early in the morning it was not evident that these care plans were being followed.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity. The provider was supporting people with a range of needs including sensory needs and learning disabilities. However, it was not clear that the provider had considered best practice guidance and the quality of life assessment tool when supporting people with these specific needs. There was limited evidence of how people living with dementia were supported to remain independent or how tools such as communication tools and pictorial menus were used to support choice. People felt confident the staff would seek support to meet their needs and staff told us communication about people’s needs were generally shared. The provider had introduced flash meetings in addition to clinical meetings to discuss people’s needs and risk and enable better oversight. We observed one flash meeting covered a variety of issues but were not provided with evidence from clinical meetings as part of our review of records although these were requested.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

One family member told us, “I know the manager’s face, but not their name. They are always changing managers. Communication is good. They hold relative meetings and I receive emails and letters. I am confident staff would ring me if they had any concerns.” However, we found the provider had not always provided information that was tailored to people’s needs to ensure people had clear and accurate information about the running of the home.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment, and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

The provider held residents’ meetings and there was some evidence of how families were involved in decision making. People and families generally felt that concerns would be addressed. However, we noted that where action had been taken following concerns it was not always evident that changes and improvements were maintained.

The provider did not always make sure that people could access the care, support, and treatment they needed when they needed it.

We found limited evidence of improvement for people where English was not their first language since we last visited the home. Whilst communication cards were in one person’s room these were not near to hand for the person to use. We continued to find shortfalls in how people were supported with the care they needed and that care records did not reflect people’s involvement in decision making. It was not evident that the service had appropriately escalated the requirement for medicines one person needed as they became unwell.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this. At our last inspection we noted the service is registered for a wide variety of service user types, but adaptations had not been made to ensure the service was able to deliver positive experiences and outcomes for all the service user groups they supported including those with complex health needs and people with support needs in relation to learning disabilities. Action taken to address this point and follow best practice guidance in relation to supporting people with learning disabilities or living with dementia was limited, for example in relation to adaptations in the home or access to the community.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

At the time of our visit, staff were providing support to people who were approaching the end of their life. However, it was not evident that staff had increased oversight of these people and their needs to ensure they remained comfortable or that access to the right medicines had been implemented. Staff told us there were sometimes difficulties in obtained authorisation to use anticipatory medicines from the doctor. Families were encouraged to visit people approaching the end of their life. People did have care plans in relation to managing the end of their life but these generally lacked detail and were very task based and generic. For example, one person who was actively involved in practicing their faith had an end of life care plan that reflected little about how their spiritual needs would be met when they approached the end of their life.