Hilltop Court 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 changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (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.

Improvements had been made to information in care plans, and these had been made more concise since the last inspection. Records showed care plans were reviewed regularly and monitoring tools, such as food and fluid charts and weight records were being completed. However, further work was needed to ensure these improvements were fully embedded and consistently reflected a person-centred approach to assessing and planning care. Relatives told us they felt involved; however, we did not see evidence in assessments and care plans that people and relatives had been meaningfully involved in writing plans and reviewing health and wellbeing needs. The registered manager recognised the need to evidence involvement of people and relatives in care planning and had started to take action to improve the quality of care plans. However, these changes were not yet fully embedded, and their impact could not yet be consistently evidenced across records.

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

We noted people in their bedrooms did not always have access to drinks as they were not available or they had been placed out of the person’s reach. We observed people were given a choice of only orange or blackcurrant cordial at mealtimes and hot drinks were served to people in the lounge areas.

We found some people were underweight and at risk of further weight loss and had been assessed as requiring a fortified diet. There was information in the kitchen about people’s needs around diet and drink modification; however, we were not assured meals and drinks were robustly fortified and we had concerns about people receiving enough calories to ensure good health. Despite some people having specific dietician advice in place, kitchen staff told us the snack option for people on a modified diet was a yoghurt and we did not see where high-calorie, fortified snacks were offered regularly throughout each day. We passed on our concerns in relation to the management of weight loss and people’s fortified diets to the registered manager. We were advised after the inspection that actions were being implemented to improve people’s fortified diets.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

There was evidence of partnership working with external professionals such as GPs, pharmacists and specialist nurses to support people’s health needs. Staff told us they had information they need to provide effective care, and care plans were up to date and reflective of people’s current care and support needs. Staff felt communication and teamwork had improved since the new registered manager came to post. One staff member told us, “We have more freedom to work as a team.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People received medical attention when required and staff made appropriate referrals to healthcare professionals when needed. People’s relatives told us they were confident medical attention would be sought when needed. One relative told us, “If I think [relative] needs to see a doctor, I mention it and they [staff] get it sorted.” Another relative told us, “[Name] sees the doctor and the chiropodist.”

There was clear, person-centred guidance for staff on how to monitor and respond to changes in people’s conditions, including when to escalate concerns to healthcare professionals. For example,people’s care plans and assessments directed staff to monitor a person for specific behaviour changes and report any concerns to the clinical lead or GP.

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

Not all care plans we reviewed included details of people’s goals or aspirations, or information about individual positive outcomes to achieve. Although we received mostly positive feedback from people about the care they received at the home, we were not assured people were always experiencing positive outcomes in their daily lives. For example, we were not assured people were receiving 1:1 person-centred activities that were meaningful to them or that they were always receiving enough support to eat and drink to maintain good health.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People’s mental capacity had been assessed, and where appropriate, best interest decisions had been recorded. The registered manager demonstrated their understanding of consent to care and told us they had proof families had Lasting Power of Attorney in place for health and welfare where decisions about care and support were being made for people. People’s electronic care records indicated consent had not always been given; however, the registered manager told us consent had been gained and was recorded elsewhere. The registered manager needs to satisfy themselves that all consents are recorded appropriately, for example, for people to have their photograph taken, as we are aware the service posts photographs and videos of people on social media.

During our site visits, we observed staff mostly asking people for consent before providing care and support.