Hilltop Court 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.

This service scored 61 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Care plans were mostly person-centred and included some good guidance for staff on how to support people with distressed behaviours, for example, what redirection techniques work for the individual person. However, we found one person’s care plan was not robust around managing their distress and we discussed our concerns with the registered manager during our site visit. It was clear staff knew people individually and were mainly providing person-centred support; however, we observed some non-person-centred language used by staff during our site visit. Personalised information about people in care plans had improved since the last inspection.

An activities co-ordinator was in place, who was caring and enthusiastic. There was a varied activities programme in place, and during our site visits we observed people enjoying the small outside area and a visit from a sports person to provide exercise activity. We did not see where the activities offer included person-centred 1:1 activities, or good practice in dementia-specific activities particularly in outside spaces, such as, gardening. The registered manager told us they would be employing an additional activity worker and would be improving the provision of activities aimed specifically at people with dementia.

Despite the home being registered with a service specialism of dementia care, we found the environment experienced by people was not always appropriate to promote good experiences for people with dementia. We found the environment was often noisy and busy and this may cause overstimulation and distress in those people with dementia. We were aware from reviewing care documentation that some people preferred a quieter area and could become overwhelmed by noisy and busy environments. However, the home did not benefit from smaller rooms where people could access quieter and more personal areas to relax in. The registered manager told us they had plans to introduce a more dementia-friendly environment including quiet spaces, a sensory room and an improved outside space.

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.

Although agency staff continued to be used at times to maintain staffing levels, there was now a stable staff team who knew people’s care needs which helped promote their continuity of care. We found appropriate and timely action was mostly taken when people's needs changed, including referrals to relevant health and social care professionals to ensure people received the support they required. However, we found one person’s hospital information about their medical condition had not been recorded in their care records to inform staff. We saw staff had mostly received training in the needs of the people living at the home; however, despite some people living at the home with wounds, we found training for clinical staff in wound care was not in place. The registered manager told us this training was being organised.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

We saw that people had communication care plans in place and we received good feedback from families around communication with the registered manager. We saw that relatives’ meetings had been held and feedback gathered from people about their care. Information was displayed in the home’s foyer for people and relatives to be aware of, including how to make a complaint.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

There was a facility to provide feedback in the reception area of the home and there were a complaints policy and a complaints procedure in place. We reviewed recent complaints at the home and saw they had been responded to by the registered manager.

Relatives of people living at the home told us they were happy with the care their relative was receiving and the management were approachable. On relative told us, “[Deputy Manager] has been incredible, communication is superb and [Registered Manager] is open to dialogue. I have sat in on team meetings and at the residents’ meetings they are very receptive to the things we say.” Another relative told us, “I've no complaints about any of the staff. The new manager is trying to improve things. I've no complaints at all.”

The registered manager told us they have a “You said – We did” board for relatives to see that suggestions had been taken on board and actioned. They also told us they hold the relatives’ meeting just prior to the staff meeting so that any comments from family members could be raised early with staff.

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

People had access to a range of healthcare professionals and services, including GP visits and specialist support, which helped meet their needs. Our first site visit was carried out during a heatwave, and the registered manager had ensured they were providing care and support in line with government guidance to keep people safe.

We were not fully assured that people’s environment was conducive to enabling people to easily navigate their way around the home. Some modifications had been made to make the home dementia friendly, for example, some signs denoting specific rooms such as the bathroom. However, improvements were required to make access around the home easier for people with dementia, for example, we found people could not always access some areas of their home due to keypad locks and there was no easy access to outside spaces. On two occasions we found the doors between some bedroom areas and the lounge were locked and this meant people did not always have free access around their home.

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.

Feedback from people and relatives was mainly positive, describing kind and compassionate care. However, our evidence showed variation in people’s experiences. Some people were not meaningfully engaged, and although there was an activity co-ordinator in place and many group activities took place, improvements were need in the provision of 1:1 person-centred activities. This meant people who could not, or did not, wish to join in group activities did not always have the same opportunities or access to activities as other people using the service.

People were 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 inspection, there was no-one at the home receiving end of life care. The registered manager told us staff had received end of life training and nursing staff had undergone enhanced, specialist end of life care training to ensure they were competent to care for a person at the end of their life. The home used the Gold Standards Framework for end of life care; this is a clinical tool to identify if a person is in their final year of life and supports proactive advance care planning.

People had end of life care plans, and we found some were more detailed and person-centred than others. We reviewed one person’s care plan who had a comprehensive advanced care decision in place and details of this decision were included in their end of life care preferences plan. This meant staff could provide end of life care to the person in line with their detailed, pre-decided choices and preferences.