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.

The service was in continued breach of legal regulation in relation to how risk was assessed, managed and mitigated; and a new breach of regulation in how the provider ensured sufficient numbers of suitably experienced and skilled staff were deployed across the service.

This service scored 50 (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.

It was not clear that appropriate action had been taken in response to incidents. The service had previously had an incident where a person had choked whilst eating food in bed. The provider had not ensured staff were aware of any lessons learnt following that incident, and during our visit we noted one service user attempt to eat whilst reclined. Staff did not recognise the potential risks here, or take the action needed to reduce this risk. This person’s care records evidenced that it was a known behaviour for this person, but no measures had been implemented to mitigate the risk until this was highlighted to the home manager by the inspection team.

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. Feedback from some partner agencies was that communication with the home was difficult. It was not evident that there were clear and consistent approaches to transitions between services. One professional noted, “When returning a resident to home [we are] told they cannot return over the weekend due to lack of staff to support, [although] this is their current home. If you contact the [home manager] this is changed [and the person can return home].”

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

The home manager was not able to demonstrate that processes for oversight of people’s safety, and safeguarding concerns were being effectively maintained during our visit. During the inspection we noted limited oversight of how care was delivered within the home, and a lack of oversight in how agency staff were supporting and meeting people’s assessed needs. Safeguarding polices were in place and the home manager made referrals to the local safeguarding team as needed. One professional commented, “[Home manager] has always been open and transparent with the team.”

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

Records did not demonstrate that people or families had been involved in developing plans of care and decisions about how risk could be managed. The high use of agency staff and a lack of awareness in relation to people’s risk meant that risk was not always well managed. We found instances where people who should have been weighed weekly had not been weighed at all recently. Some people who had skin integrity risks required a specialist mattress. These had not always been set correctly. It was not evident that the systems in place were being utilised to ensure care was being given in line with people’s needs. Information about people’s specific needs and risk were not always easily identifiable within the lengthy and cumbersome care plans.

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.

The service provided support for people who were living with dementia. A programme of redecorating was underway. However, there was limited evidence that best practice to ensure a dementia friendly environment had been considered. People’s bedrooms were often very bare and lacking in personalisation.

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

We consistently received feedback that there was not enough staff available to meet people’s needs. One professional commented, “When I have been to the home, I have been aware that staff morale has seemed lower and they have been expressing concerns about some of the agency staff working at the home; specifically, their skills and knowledge around working with cognitively impaired residents.” Family members also raised concerns in relation to staffing levels and the quality of care people received. We observed staff were not suitably deployed across the home with a higher use of agency staff on one unit whilst the other unit has more consistently staffed and was generally more settled. People were not being supported to engage in meaningful activities and stimulation, and when staff were present there was not always meaningful interaction with people.

There was limited evidence of oversight of agency staff to ensure a suitable skills mix and the system in place to ensure staff had the appropriate skills was not being effectively used. Recruitment processes were not always being utilised effectively. We found several staff files where there were large gaps in employment history and this had not been followed up and explored by the provider to reduce any potential risk.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The home was clean and tidy. Staff were seen to use personal protective equipment appropriately. Suitable policies and training were in place.

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.

Care plans had up to date information about how to support people with their medicines. People who had thickening powder added to drinks because of swallowing difficulties were administered this safely and records were completed accurately. Records showed that medicines were given at correct times and appropriate intervals were left between doses. Controlled drugs were stored and recorded appropriately. For people with diabetes, blood tests were carried out regularly and recorded accurately. We saw good practice systems in place for the safe management of medicines patches. Creams stored in people’s rooms were not always risk assessed to prevent inappropriate access. However, the service implemented a new storage system immediately post-assessment. Managers told us that staff had completed medicines training and had been assessed to ensure that they gave medicines safely. We were shown evidence of training records to confirm this.