Hilltop Court Nursing Home

Updated 27 January 2023

The inspection

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.

Inspection team

This inspection was carried out by two inspectors 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 Court Nursing Home 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 Court Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

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 new manager had been in post for one month and had submitted an application to register. We are currently assessing this application.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. 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. We used all this information to plan our inspection.

During the inspection

We spoke with 11 people who used the service and 4 family members about their experience of the care provided.

We spoke with 11 members of staff including the nominated individual, members of the management team, nurses, activity workers, care staff and a member of the housekeeping team. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 5 people’s care records and multiple medication records. We looked at 4 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 27 January 2023

About the service

Hilltop Court Nursing Home is a residential care home providing personal and nursing care to up to 50 people. The service provides support to older people, some of whom live with dementia. At the time of our inspection there were 42 people using the service.

Hilltop Court Nursing Home accommodates people across two separate floors, each of which has separate adapted facilities.

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

There had been changes of the entire management team since our last inspection. This meant some areas of improvement hadn’t been fully achieved due to a lack of consistency. Existing systems in place failed to always identify the ongoing shortfalls we found throughout this inspection.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The provider had not ensured this in the absence of a manager, although policies and systems were in place to support best practice. The provider had introduced new systems to monitor quality, however these were yet to be embedded to enable sustained improvements to be demonstrated.

Although we found some improvements were still needed, we did observe positive and caring interactions between staff and people living at Hilltop Court Nursing Home. Staff sought consent before providing care and demonstrated an understanding of people’s preferences.

The communication needs of people were clearly documented, and people had access to appropriate healthcare services.

Checks were in place to ensure people lived in a safe environment. Ongoing refurbishment and redecoration of the home was planned.

Appropriate checks on staff were in place to ensure they were suitable for the role before working with people. Staffing levels were safely planned, and were determined by people's needs.

People were protected from the risk of abuse. Systems were in place to monitor and appropriately report accidents and incidents to external agencies.

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 14 April 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 in breach of regulation, however the provider had met the warning notices we had issued.

At our last inspection we recommended that the provider considered current guidance on the safe and appropriate use of tilt-in-space recliner chairs. At this inspection we found the provider had acted on this recommendation and had made improvements.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We carried out an unannounced inspection of this service on 1 February 2022. Breaches of legal requirements were found. We issued two Warning Notices in relation to Regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the provider completed an action plan to show what they would do and by when to improve safe care and treatment.

We undertook this inspection to check whether the Warning Notices we previously served had been met. We also needed to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

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.

For the key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hilltop Court Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified an ongoing breach in relation to effective governance and provider oversight at this inspection. Please see the action we have told the provider to take at the end of this report.

We have also made recommendations in relation to consulting with people around meal options and developing a varied plan of activities for people to enjoy whilst living at Hilltop Court Nursing Home.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety.

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.