Hilltop Hall Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

There was a continued breach of how people were supported with person centred care. There continued to be a lack of detailed personalised information about people’s likes, preferences and social stories. People were not always supported to make plans for the future. There was limited evidence to demonstrate how the provider challenged barrier to access in care and empowering people most likely to experience inequality. Systems for ensuring people were listened to and information was effectively provided to support decisions were not clear or embedded and we were not assured that people were meaningfully involved in decision making.

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.

Information about people’s likes, dislikes, interests and social history were not always in place in care plans to support people to receive personalised care. The provider had not taken the action needed to ensure people and their views and experiences were central to how all care was delivered and accurately reflected within records. People generally spoke positively about how they were treated and there was positive feedback in regard to activities provided for people.

Staff appeared to know the people they were supporting and their needs well. However, this was not always clearly reflected within care plans and in how care was delivered in line people’s preferences.

We observed that people were supported to engage in activities and stimulated their memories.

The service did not always demonstrate that timely action was taken to support people in a timely way and this placed people at risk. However, people told us they felt the service would seek support when needed.

Staff stated they were aware of changes to people’s needs following admissions to hospital. However, care plans were not consistently updated to maintain accurate records and did not demonstrate that staff had all the information they needed to meet people’s needs.

Partner agencies raised some concerns about how the service escalated people who were refusing care or where they were struggling to meet their needs. They were concerned that the provider continued not to demonstrate they had ability to support service users with complex care needs.

Processes in place continued to not be effective or embedded to ensure accurate and up to date information was maintained within care records. Feedback from healthcare professionals was not always updated on people’s care plans and fed into their support. There was a lack of organisation to ensure people received the care they needed in a coordinated way. The service had completed a lesson learnt to ensure people were supported to take their medication when attending appointments.

People had no concerns about how information was provided and generally felt involved in decisions about their day-to-day care. However, we noted that for one person tools for communication were not being used effectively to ensure staff could communicate information and support decision making effectively and people and families told us they were not aware of what information was in their care plans.

Staff told us they were kept up to date about changes to people’s needs although processes and records did not evidence how this was being done effectively.

There was limited evidence to demonstrate the provider had established and embedded effective processes to ensure people and families had the information they needed and were supported with decision making. There continued to be a lack of evidence to demonstrate people and families had been involved in developing and reviewing care plans. The service had developed a newsletter which they shared with residents about topical events and what was going on at the service.

The service used a resident of the day process to enable people to provide feedback about their care and review their care plans. However, this was not being used effectively, and we continued to find that people and families were not able to tell us how they had been involved in these discussions. People were not always clear on how their views had been sought through surveys and feedback although others told us about residents’ meetings they had attended where matters relating to the home were discussed. People felt able to raise concerns. However, it was not always clear when things had been investigated, such as items going missing, that feedback and a response was given to the complainant about the outcome.

Staff said that since the area manager was working consistently at the home they generally felt listened to and supported. However, concerns had been raised with CQC anonymously just before we visited the service indicating that the provider had not established an open and transparent culture for staff to raise concerns and feel confident that these would be appropriately addressed.

The processes for listening to and involving people needed to be embedded. Whilst meetings were in place for people, families and staff, these did not always demonstrate that these were used as opportunities to gain views and have meaningful discussion. The provider indicated that this was mainly due to lack of consistency with recording discussions in meetings. There was a process in place for addressing concerns and complaints, but the provider had not ensured this was used consistently meaning oversight and analysis of the issues would be ineffective to drive improvement and respond robustly to quality concerns.

People did not always have access to resources such as interpreters to ensure they were able to access and fully engage in their care. Some people told us they were able to access input from religious groups if they wished.

Staff told us they worked to support people as individuals and would access other healthcare professionals where this was needed.

Partner agencies did not raise concerns about equity in access for people but told us they had noted some shortfalls in how care was being provided to people including one to one interaction and personal care.

The provider had failed to ensure systems were in place to ensure people had access to the care support and treatment they needed. Care plans did not always demonstrate how people were involved in making decisions about their care and how support to access services was therefore maintained.

People did not share any experiences of discrimination.

Staff spoke positively about additional training they had received to support people with dementia and how this had supported them to gain a greater perspective of people’s needs.

It was not evident that the provider had effectively embedded processes to involve those most likely to experience inequality and remove barriers to maximise people’s positive experience. The service is registered for a wide variety of service user types, but adaptation had not been made to ensure the service was able to deliver positive experiences and outcomes for all the service user groups they supported including those with complex health needs and people with support needs in relation to learning disabilities.

Some people were aware of their declining health and felt confident that they would be supported by staff at the service when they approached the end of their lives. However, it was not clear that people were encouraged to have discussions about the future. Care plans were not reflective that these discussions had been completed and were subject to review with people. People’s decision not to have these conversations were respected by staff.

The management team acknowledged that further improvements were required in this area to drive the improvement needed in how people were supported to plan for the future and with the end-of-life care people received. The management team had ideas about how this would be improved and were implementing end of life care resources for staff and people living at the service.

Processes continued not to be effectively implemented to ensure care plans were sufficiently detailed about how people would be supported at the end of their lives. Care plans were not person-centred about the support people would like and what was important to them at the end of their life and where people chose to not speak about this it was unclear how care plans were developed in this area and these decisions were subject to review.