Hilltop Lodge

Hilltop Lodge is a care home providing residential and nursing care to up to 61 older people, including people living with dementia. At the time of our inspection there were 51 people using the service.

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

Overall people and their relatives were happy with the care they received. However, aspects of the service did not operate in the safest possible way.

Medicines were not consistently well-managed, and we saw this led to errors and some people’s prescribed medicines being missed. Plans were put in place to reduce risk relating to people’s health and safety, and staff understood how to protect people from the risk of harm.

There were enough staff available to keep people safe, but feedback and observations confirmed there was scope to improve staffing arrangements at the service. Immediately after the inspection the provider adjusted their staffing allocations on each floor of the service to respond to feedback. The home was clean and tidy, and infection prevention control practices were well-embedded.

The meal experience was mixed. We saw people were offered a choice of balanced and nutritious meal options. However, inaccurate records exposed people who were on modified diets to unnecessary risk.

Most staff were trained to provide effective care but did not always receive regular planned support in their role. The induction of new starters was not effectively managed, with some waiting two to three months to receive a full programme of training.

The provider adapted the environment to promote choice and autonomy for people living with dementia. Rooms were accessible and clearly marked.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

The service has had a change of registered manager four times since 2019. This lack of consistency has had an impact on the oversight and governance at the service. Discussions with the provider confirmed they were aware of issues facing the service and they were committed to providing good quality care. The provider had allocated a significant amount of their resources to encourage rapid improvements at the service and issues identified at inspection were acted on quickly to keep people safe.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 14 November 2019 and this is the first comprehensive inspection. We completed a focussed inspection of the key questions safe and well-led on 13 January 2021 (published on 10 February 2021).

Why we inspected

The inspection was prompted in part due to concerns received about the management of people’s medicines. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the Safe sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of medicines, governance, record keeping and staffing at this inspection. Please see the action we have told the provider to take at the end of this report.

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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hilltop Lodge is a residential care home providing personal and nursing care to older people, some of whom were living with dementia. The service can support up to 61 people. There were 42 people living at the home at the time of inspection.

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

Overall medicines were managed safely. People received their medicines as prescribed. We have made a recommendation that the provider and registered manager ensures care plans and risk assessments contain sufficient detail to enable staff to provide consistent care and support for people.

People’s relatives told us they felt their family members were safe living at Hilltop Lodge. Staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by their managers. Robust recruitment procedures were followed. Risks to people’s safety and welfare were identified and managed.

Cleaning and infection control procedures had been updated in line with Public Health England (PHE) Covid-19 guidance to help protect people, visitors and staff from the risk of infection. During the summer months some families had met people in the garden and window visits. New arrangements were in place for families to meet in the bistro as this was a designated safe area of the service during the winter months.

The management team were open and clearly committed to the continuous improvement of the service. People were listened to and complaints were taken seriously.

The provider had system in place to monitor the quality and safety of the service. These were effective in making improvements to the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 14/11/2019 and this is the first inspection.

Why we inspected

We received concerns in relation to the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

This report only covers our findings in relation to the key questions ‘is the service safe?’ and ‘is the service well-led?’ which contain those requirements.

We looked at infection prevention and control measures under the key question ‘is the service safe?’ 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 coronavirus and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.