Hilltop Hall Nursing Home

Updated 15 March 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was undertaken by 3 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Hilltop Hall is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Hilltop Hall is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The current home manager told us they intended to begin the process of registration with CQC.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. This included information of concern and notifications the service is required to submit regarding any significant events happening at the service. We sought feedback from the local authority, and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We reviewed staffing levels and walked around the building to ensure it was clean and a safe place for people to live. We observed how staff supported people and provided care.

We spoke with 6 people who use the service, 4 family members and 13 members of staff, including the manager, deputy, clinical lead, nurses, care workers activity workers and other auxiliary staff.

We reviewed a range of records including the full care plans for 5 people, and additional care records in relation to the management of other specific needs. We looked at 3 staff files in relation to recruitment, additional records in relation to staff training and support, and the management of agency staff. A variety of records relating to the management of the service, including policies and procedures were examined.

Updated 15 March 2024

About the service

Hilltop Hall Nursing Home is a care home providing personal and nursing care to up to 54 people. The service provides support to older people. At the time of our inspection there were 38 people using the service. The care home accommodates people in one adapted building across 3 floors.

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

People were not always supported safely to receive their medicines. People were not always supported appropriately with their needs and action to mitigate individual risk was not always taken. Shortfalls in recruitment processes had not been fully addressed and systems to safely manage the use of agency staff were not being followed. People did not always feel there were enough staff to meet their needs.

The provider did not have enough oversight to ensure the shortfalls identified at previous inspections, and through their owns system of checks, were effectively addressed. Many of the issues identified at this inspection were identified and referenced within actions plans but the required action had not yet been made. The service had not had a registered manager in post for some time and there had been a high turnover of managers. The providers interim arrangements for oversight between management changes had been insufficient to drive the required improvement. Systems were in place to investigate concerns and respond under the duty of candour and staff worked in partnership with external services to meet people’s needs.

The home was generally clean and a plan to address environmental issues and improve infection control was in place. There were systems to ensure lessons were learnt from accidents and incidents but lack of detail and consistency in record keeping meant meaningful analysis was not always possible.

People were not suitably supported to eat and drink well and people with specialist dietary needs did not get choice. People told us the food provided was often cold. People did not always receive care in line with their individual needs. Care records were not always clear, accurate or detailed and did not always readily identify people’s needs and risk.

People were not supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests; the policies and systems in the service were not effective to ensure good practice. The service was not working within the principles of the mental capacity act and people were not always asked for consent before they were supported. Staff were not consistently supported through regular training and appraisals and training requirements were not in line with best practice guidance. Staff worked with other agencies to meet people’s needs and appropriate referrals for specialist advice.

People and relatives generally felt able to raise concerns and there was evidence that these were investigated. People spoke highly about the activity team and were supported to access a range of activities both in groups and on a one to one basis.

People did not always feel staff were kind and caring and interactions observed during inspection ranged from positive chats from staff who knew people well to interactions where people did not receive the support or reassurance they needed. It was not always clear that people were supported to make decisions about their care and choice was not always promoted.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 July 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Hilltop Hall Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the management of medicines, risk management, how the service ensured the need for consent to care was followed, person centred care, how people were supported to eat and drink, staffing levels, staff training and induction and the providers oversight of the safety and quality of the care provided.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.