Hilltop Court Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

The home provides specialist dementia care, and we spoke with the registered manager about how the home provided this specific dementia care. Areas of the home had been refurbished; however, the home’s décor and layout did not contribute to helping people live well with their dementia. We found the upstairs main communal area had a loud alarm sounding when staff opened a door, which can be distressing for people with dementia. The home had a small, paved area at the front of the building and there was no provision of safe, stimulating and easily accessible gardens to enhance the wellbeing of people with dementia.

We spoke with the registered manager around available good practice dementia guidance on meeting people’s needs regarding the environment. The registered manager was knowledgeable about the specific needs of people with dementia and what good dementia care looks like and is working to make improvements. This needs to be supported by the provider to enable the improvements to the dementia provision, for example, improvements to meaningful and appropriate outside spaces and regular access to fresh air activities.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

People, relatives and staff spoke very highly of the registered manager and found them very approachable and caring. We received multiple positive comments around the improvements made at the home since the arrival of the registered manager and that staff culture had improved. One relative told us they had previously complained to the registered manager and appropriate action was taken to resolve the concern. Staff were confident they could raise concerns safely. The registered manager was visible around the home and knew people and staff well. During the inspection the registered manager was open, transparent and keen to ensure any concerns raised by us were acted upon.

The registered manager had introduced a positive culture to the home, and they told us they were proud of the caring and supportive atmosphere they and the staff had now created. We saw evidence of improvements to interactions between the home and the community through the activity provision. The registered manager told us they were working to ensure people were involved in community life.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff told us the registered manager was approachable, and they felt confident to raise any concerns and felt that action would be taken to resolve concerns. Staff had access to a freedom to speak up helpline. Where incidents had occurred at the home, we saw the registered manager had apologised and provided information about actions taken to prevent the same happening again.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff told us they felt supported in their role and raised no concerns about their employment or the management. Staff completed equality and diversity training and the provider employed and supported a diverse workforce.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The registered manager was supported by a senior management team, and they were working to a service improvement plan. Quality audits and walkarounds by the registered manager were thorough and had been completed; however, they had not always identified and actioned the issues we found during our site visits. For example, infection control concerns with the upstairs bathroom, bedroom odours, incorrect mattress settings, management of people’s distress and people’s diets and personal care. Oversight was improving but still required improvement to ensure people were receiving safe and effective care whilst always being treated with dignity and respect.

We noted multiple improvements made by the registered manager since the last inspection to many areas of the service, such as, staff support, detailed assessments and care plans, management visibility, activities, and oversight of incidents. While these improvements were positive and impactful, many had been implemented relatively recently by the registered manager and required further embedding and sustained oversight to ensure they became established practice. As a result, additional time was needed to demonstrate that the changes were consistently effective, sustainable and fully supported by the provider.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

The registered manager was working hard to improve the safe and effective care provision at the home since the last inspection and ensure staff morale and competencies were improved. Further, future work is required to ensure people, staff and partners are involved in business improvement plans for the home and to develop community networks. Future consideration to be given to local forums and schemes to share ideas and learning.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The registered manager demonstrated they had learned from the previous inspection findings and was working hard to make improvements at the home and improve people’s experience of care. They had introduced processes to ensure that learning happens when things go wrong and this learning is shared with staff. However, some improvements were still needed to demonstrate safe and effective care and the provider remained in breach of 2 regulations. Continuous learning and newly introduced processes for learning need to be embedded to demonstrate sustained improvements.