Hilltop Court Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

Theproviderwas previously in breach of the legal regulations in relation to staffing and safe care and treatment. Improvements were found at this assessment, and theproviderwas no longer in breach of these regulations.

This service scored 56 (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 have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Improvements in the recording and reporting of accidents, incidents and safeguardings were evident since the registered manager has been in post and was demonstrating lessons learnt documentation. These improvements need to be embedded and sustained; these can be further improved with the use of regular, detailed analysis of trends and actions taken to mitigate further risks. Some concerns found at the last inspection had not been addressed and were still evident at this inspection, such as, people’s personal care in relation to hygiene and presentation.

The registered manager had worked hard to improve how concerns were raised and responded to within the service since our last assessment. The management had changed, and we could see the improvements being introduced in the staff engagement and approach. Staff told us they now felt confident raising concerns with the manager and felt they would take appropriate action.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

The new registered manager was working with partner agencies to improve continuity of care and was aware of the need to manage safety between services. We found one person was being treated by medical teams for a skin condition; however, information about this condition was not available to staff or fully recorded in care plans. This meant there was a risk their condition was not being safely managed.

We found the effectiveness of staff handovers had improved at this inspection and more information was shared between staff in relation to people’s immediate care needs. However, handovers were verbal and not fully recorded to enable a review of what was discussed and tomaintain oversight. One staff member told us there were plans to introduce handover records.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Where people were subject to restrictions within the home, Deprivation of Liberty Safeguards (DoLS) were in place and were being tracked to ensure authorisations were renewed. Where the DoLS incorporated conditions, these had been included in care plans to ensure staff were aware and could provide care in line with the conditions.

Staff had received safeguarding training and the registered manager engaged with local partners to ensure actions were taken to safeguard people from harm. People and relatives did not raise any concerns with us about their safety living at the home. One relative told us, “I feel [Name] is very safe there. All the staff are nice.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s individual care plans and risk assessments were improved and mostly appropriate. However, records did not demonstrate that people or families had been involved in developing plans of care and decisions about how risk could be managed.

We found some concerns relating to the completion of wound care plans, correct mattress settings, access to drinks in bedrooms and staff practice around using items, such as pillows under sheets to keep people in position in bed. We passed on our concerns in relation to the management of risk from distressed behaviours for one person to the registered manager. Further consideration is needed to support the oversight of people who need ongoing supervision or additional encouragement when eating and drinking.

We discussed concerns with the registered manager around the approach to the significant use of sensor beams to alert staff of people’s movements in their bed. We found the assessments for sensor beams were not robust and did not evidence this was the least restrictive practice. All other avenues had not been explored and exhausted, and the impact of the loud alarms had not been considered. On the second site visit, the registered manager told us she had reviewed everyone’s use of sensor beams.

We found evidence of the use alternative, non-restrictive practice in one person’s care plan where staff were directed to first use non-pharmacological interventions to support someone’s distress due to their dementia.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Some refurbishments of the home had taken place since the last inspection such as redecoration and the home appeared lighter and brighter and welcoming with a new reception area. We found safety checks had been carried out by the maintenance officer. We had some concerns relating to environmental safety, for example, we found some doors unlocked, emergency cords not set to standards and uncovered radiators. The first floor bath had been out of use for several weeks; however, we were advised after the inspection that this had been resolved. The fire risk assessment and review indicated there were outstanding actions and the fire drill records indicated improvements were needed; we were advised after the inspection that these actions had been resolved.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always work together well to provide safe care that met people’s individual needs.

At the last inspection we found concerns in relation to the recruitment of staff and staffing levels. At this inspection we found these concerns had mostly been addressed; however, some concerns regarding staffing remained.

We saw that staff were present in the home and mostly responsive to people’s needs throughout our site visits. We received mixed feedback from people, relatives and staff about the staffing levels at the home. One relative told us, “The staff do care and they could sometimes do with more, but they do work very hard.” Another relative told us, “They [staff] can’t do enough for you. They all support [person] really well.” Staff told us they were able to manage the needs of people when there were 4 staff on duty; however, it was difficult when there were only 3 staff on duty; especially at mealtimes when people required assistance. The use of agency staff had also reduced since the last inspection, and this meant people were supported by permanent staff who knew their individual care needs.

We found improvements since the last inspection with safe recruitment checks; however, we found a small number of gaps in the recruitment records. Our concerns were shared with the registered manager, and we were advised after the inspection that the outstanding information was now in place.

Improvements were noted in relation to staff retention and staff morale; staff told us they felt well supported and had regular supervisions. They told us things had improved under the new registered manager.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

The home had a team of ancillary staff for cleaning and laundry. We found the home had some bedrooms that were malodorous and there were some shortfalls in cleanliness. Not all areas of the home were fully clean and required some refurbishment. We found the first floor shower room, including the shower chair, to be unclean, and there were broken wall tiles. The ground floor bathroom was cluttered and contained trolleys housing soiled laundry.

We observed some people had dirty fingernails and, although electronic records indicated people were being supported to wash, it was not clear these areas of personal care were being closely attended to or that records of personal care were accurate.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

This inspection was supported by a Specialist Advisor (SpA) nurse. The SpA found no concerns in relation to their review of the management of medicines and provided positive feedback about the clinical lead. Storage was appropriate and information was in place to safely administer medicines. Effective and appropriate care plans were in place in relation to medicines.