Hilltop Hall Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

There was a continued breach of how the provider demonstrated compliance with the requirements of the Mental Capacity Act and limited evidence to show where people had capacity they were fully involved in decisions about their care. However, oversight of people subject to restrictions and assessments, and best interest decisions in relation to any restrictions had improved. People’s needs were not always appropriately assessed and updated, and care was not always delivered in line with assessed needs. Records lacked the detail and information needed to help staff identify any changes. The service was working alongside other services to meet people’s needs. The provider had taken enough action to address the concerns we had about how people were supported with food and fluids.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt their needs were being met. One person told us they had been supported to positively lose weight and another person told us staff effectively managed their diabetes and the monitoring of blood sugars.

Staff stated they knew basic information about people prior to their admission to the service. However, it was not always clear that staff knew the latest information relating to people.

The provider had not taken the action needed to ensure assessments were completed prior to people’s admissions to the service. It was, therefore, not clear how the service had assured themselves they were able to meet people’s needs prior to admission. There continued to be shortfalls in the ongoing assessments of people’s needs and care plans were not always updated following significant changes in their needs and the support they required. People’s communication needs were not always adequately assessed. Where difficulties in communication were identified there as a lack of guidance for staff on how to support people to be involved and make decisions about their own care.

People did not consistently have access to evidence-based care and treatment. For example, people did not always have access to dental care. One person told us they had no teeth or dentures, and it was not clear that this had been actioned or addressed by the provider. People spoke positively about the improvements in food provided. People told us they were weighed regularly, and we saw people being given support and encouragement to eat well. Some people told us they had choice about what they could eat but other people felt they would like a bit more variety. One family commented, “The food use to be so bad that we spend money bringing food in…[family member] are happy with the food now.”

Most staff told us they had time to read people’s care plans and get to know their needs and preferences.

The provider had made some improvements in how people were supported eat and drink. The provider had taken action to address the previous concerns we and other stakeholders had about how people were supported in these areas and provided a kitchen onsite. The service used a specialist service for pre prepared food and purchased a range of meal options which were in line with dietary needs, including those who needed modified diets or had specific food allergies. However, one person was assessed as requiring soft diet but did not like the options provided at the home. It was not clear how the provider was working with the person to find suitable alternatives to ensure they had a suitable modified diet and maintained weight. Processes for oversight to identify and action where people were at risk of weight loss due to poor diet were not being used effectively and needed to be embedded. There were shortfalls in the oversight of how oral care was being delivered and we were not assured that the action needed had been taken to ensure people were receiving good levels of oral care.

People did not always experience effective team working. There had been significant improvements in the food provision at the service since the last inspection. However, staff did not always work together consistently to ensure people ate sufficiently. One person had been encouraged by staff to have a main meal at lunch time but was then only provided with a dessert. Some people commented on some communication difficulties with some staff members. One person commented, “There’s a bit of a language barrier at times with some staff but we eventually get there.”

Staff told us they had good relationship with local care services and felt able to contact them if anyone needed additional support. Due to concerns about the service, stakeholders were frequently available and regularly visited the home.

Some partners agencies felt they did not consistently receive the information they required from the service to support them to carry out their role.

Staff did not always have clear roles and work together well. Information that was received from other healthcare professionals was not consistently included in people’s care plans and communicated well with staff. The provider’s processes were not suitably robust to have ensured that communication and teamwork was effective.

People generally felt they had the support they needed to live healthy lives. They told us they had access to a GP who visited the home weekly.

Staff told us they understood the importance of supporting people to live healthier lives and to engage in decision-making about their care.

Records varied about whether people who had capacity had been appropriately supported to engage in decisions about their own care and processes to ensure people were supported to live healthier lives had not yet been embedded. However, for some people staff respected their decisions when this differed from advice given by healthcare professionals.

People were not consistently receiving care in line with their assessed needs. Improvement continued to be needed in the maintenance of accurate and contemporaneous records. However, people were supported regularly with offers of drinks, there was some oversight of people’s weights and people were supported to have personal care a couple of times a week. It was not clear if this was always in line with people’s preferences as this level of detail was not contained within the care plans.

Staff told us they took responsibility for escalating concerns about people’s health and wellbeing and at the time of assessment were able to make more time to support people.

The provider had not ensured processes to monitor and improve outcomes had been actioned or embedded and we continued to find shortfalls in the oversight of the service. For example, people with specific conditions such as mental health issues did not have detailed and specific care plans to ensure staff understood people’s triggers and how to support them in a crisis. Records did not always demonstrate that aspects of care such as follow up phone calls with doctors were completed or followed up with the memory clinic. The service continued to conduct regular clinical risk meetings which supported them to have oversight about people’s care and their current presentations. However, the processes continued to be ineffective and there continued to be shortfalls in people needed to be reviewed at these meetings. The meeting minutes showed that weights which were referred to as part of the review had not been updated to provide up to date information for review. One person had had two falls at the service which both resulted in hospital admissions. This person had not been reviewed as part of the clinical risk review process.

People were not always involved in making decisions for themselves around the care and treatment they received. For example, it was not clear that one person who had capacity had been involved in making a decision to not resuscitate.

Staff demonstrated an understanding of the need for consent. They gave examples of respecting people’s decisions to decline their support with personal care.

The provider had failed to action and embed processes needed to ensure consent and the principles of the mental capacity act were being followed. There were continued concerns in how people were involved, and we found one person’s care plan had no clear guidance for staff on how to manage consent and assess capacity which fluctuated where there were challenges around communication and language barriers. The provider had improved their systems of oversight of people who were deprived of their liberties, and we noted some people’s care plans indicated they were supported to make choices which may be unwise and against health professionals’ advice and this was respected. However, at this time there was limited evidence to demonstrate the provider was able to embed and sustain these processes.