Hilltop Hall Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We found the provider had not taken the steps needed over the last three inspections to address concerns in relation to their responsibilities, to have oversight and governance, to ensure people had the care and support they needed and drive the quality and improvement of the service. Systems were not fully embedded, and the provider had not ensured sufficient oversight was in place to identify action taken was effective and embedded. Systems were not fully embedded, and the provider had not ensured sufficient oversight was in place to identify action taken was effective and embedded. The provider acknowledged further improvements were needed and was working with partner agencies to drive improvements, but progress had not been actioned in a timely way. A home manager was in place, but they had not successfully applied to register with CQC and whilst staff felt this has created some stability and improvement within the service this was only a short-term interim measure. It was not always clear that people, families and staff were supported to share views and feedback and there were concerns that staff did not consistently feel able to raise concerns with the provider but instead contacted third party agencies. The service demonstrated that some action was taken in response to feedback however this was not always done.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The management team were aware that further work was required at the service to both drive and sustain improvements at the service. Staff felt progress was being made by the provider. Some staff told us relations between staff and the management team had improved since the last inspection, with the area manager being permanently based at the home. However, the provider had initiated this measure as an interim measure only whilst a permanent home manager was recruited.

The provider had not ensured that quality improvement and a shared, open and transparent culture had been effectively implemented and embedded. The provider was working with other stakeholders on an action plan to drive improvement. However, we found there continued to be insufficient oversight to ensure action was embedded. We found areas of the action plan, such as agency staffing and care planning which had been marked as completed. The provider had failed to embed systems and processes to ensure shortfalls were not repeated as by the time of our site visit some areas of the action plan which has been signed as completed were not begin completed as business as usual and recurring shortfalls were identified. However, there had been some specific areas of improvement particularly in supporting people with time critical medication and improving the dining experience for people, but these had only recently been completed, and we were not assured they had been fully embedded and would be sustainable if the home was at full occupancy.

Staff gave positive feedback about the home manager at the service. Generally, staff told us they felt listened to and were confident they could raise any concerns they had with the manager although there continue to be concerns raised anonymously with CQC. However, staff had consistently expressed concerns about the frequency of change at management levels and the impact this had on how the service was managed.

Since the last inspection there has been a change in management at the service. The interim manager has provided stability at the service and has received positive feedback from staff at the service, but this management team had not previously been effective in driving the improvement needed. There have been limited improvements evidenced on this inspection, we are therefore not assured of the capability of the management team to improve.

Staff did not always feel able to speak up and concerns were at times raised anonymously via third parties with the provider. Some staff told us they felt able to raise concerns and felt listened to.

At the time of the inspection the provider had commissioned a third party to investigate concerned raised by staff about medicine management. It was, therefore, unclear that the process in place was suitably robust to do this without the input of external consultant. The investigation demonstrated concerns were investigated which identified multiple areas for improvement in how staff are supported to speak up including reviewing policies and how concerns are recorded, investigated and actions. How this is implemented will be reviewed at our next assessment. Since our last inspection we continued to receive concerns form staff about the running of the service.

Staff were not always receiving the support they needed through a robust supervision and appraisal framework. Supervision was not being used to support staff development and reflection, and appraisals were not in place to support staff to effectively progress within the organisation. However, staff told us they felt more supported by the management team and that there had been some recent improvements in communication with the wider management team. Staff were not able to assure us that these had been embedded.

The service had an equality, diversity and inclusion policy in place and staff had also completed training in this area. The provider had not ensured processes for workforce inclusion had been embedded as supervisions did not always provide staff with the opportunity to give feedback and have their voices heard. The provider had very recently begun the process of supervision which included the opportunity for staff feedback. Staff appraisals were also not taking place which had been highlighted on the action plans as an area for improvement.

The management team told us they were making steps to address previous concerns and were completing actions on the action plan. They were open and honest that significant improvements had only started around May 2024. However, during our discussions with the provider as part of our site inspection, they realised that access to the auditing system did not enable them to have oversight of actions required from audits. This error meant that actions identified from care plan audits were not visible to management review and had therefore not been followed up.

There continued to be significant shortfalls in the oversight maintained by the provider. Systems for checks and audits were in place but continued not to be effective and robust. The audits in place were not always sufficient to identify gaps in information and drive improvements. For example, the gaps in one person’s recruitment file were identified within the audit. However, at the start of the assessment this had not been addressed. Monthly audits of the health and safety checks were completed and marked as done with no actions or issues identified. However, the checks showed that all weekly checks had not been completed. Since the last inspection the service has been working with the local authority to make improvements in line with their action plan. Some items on the action plan had been marked as completed, however some of these improvements had not been sustained. For example, ensuring there are records in place for agency staff and that inductions are being completed.

People were not consistently benefitting from the service working with the local authority to drive improvements at the service. There continued to be shortfalls in how information and updates were communicated within the service to ensure care plans were detailed and accurate and people were receiving the care they needed.

The management team were meeting with partner agencies to support the improvements needed. The provider recognised that further improvements were needed and would need to be embedded and shown to be sustainable.

Partners agencies had identified and shared similar concerns with the service to those we identified during this assessment process. Partner agencies had ongoing concerns about the timeliness and level of improvement being made and the sustainability of these improvements as the provider had failed to sustain good quality care in the past.

The provider had an action plan in place with the local authority and had also had regular meetings. During the assessment, we found that some actions which had been marked as completed on the action plan were not completed at the time of the assessment. Some areas had either been addressed and then needed improving again or had not been improved. The home was working with other agencies to make changes but was not demonstrated that these were sustained.

The management team told us they were committed to making improvements at the service but acknowledged that improvements had only started to be implemented.

The provider had failed to take the action required to ensure improvements were being made and sustained and this is the fifth consecutive inspection where breaches of the regulations have been identified, and the repeat nature of concerns indicated a lack of effective action and sustainability. For example, the provider had started to implement ‘lessons learnt’ in response to complaints. However, they had not been completed for all incidents at the service meaning that opportunities for learning and improvements were not always maximised.