Archived: Hillcrest House

Hillcrest House is a nursing and residential care home. The care home provides care and support for older people. The home can accommodate a maximum of 88 people and has a specific area of the home which supports people living with dementia. The home and garden have been adapted to meet the needs of the people living there. 74 people were living in the home at the time of the inspection.

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

People lived in a service where the provider's aim was to provide individualised care, with a focus on continuous improvement. This was embedded in the culture of the service. People, relatives and visitors to the service, without exception, described Hillcrest as a high-quality service that they would recommend. Staff told us they were proud to work at the service and showed a commitment to the provider’s aims.

People had various ways they could influence the design of the service, including via people who acted as ‘resident ambassadors’. Time was allocated for people to reflect on their care package with relatives and staff who were important to them; and time was allocated for staff to reflect on their practice. The provider and senior staff dedicated time to staying up to date with best practice; and were proactive in finding and joining local and national organisations and initiatives, to enhance people’s lives. All this information was used to improve the service and ensure people’s individual needs were met.

People lived in a service that ensured their needs were met in line with best practice. People were supported to maintain their health and staff were creative in providing ways that encouraged people to eat and drink. People were supported to have choice and control of their lives.

People, relatives and professionals praised the service and staff for their ability to understand what was important to each person and for using this to design their care and support. One person told us the staff motto was, " Anything is possible”! We found many examples of how people’s care or the design of the service had been changed to better suit the people living there.

People received individualised care from staff who had time to understand and fulfil people’s needs and wishes. For some people with more complex needs, this meant staff employing a range of skills to understand when people’s needs were not being met and what changes they needed.

People were cared for by staff who they had developed close relationships with. People described staff as like friends and family and relatives valued staff’s ability to provide emotional support to their loved one. Staff took time to seek and understand people’s views and enabled them to take the lead in their care.

People told us they felt safe living in the service. People’s risks were assessed, and staff understood how to support people when they felt anxious. People received their medicines as planned and staff followed good infection control practice. Recruitment checks did not always comply with the providers policy. We have made a recommendation about the provider’s recruitment procedures.

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

Rating at last inspection: The last rating for this service was good. (Report published 07/12/2016).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hillcrest House is a care home with nursing for up to a maximum of 88 predominately older people. At the time of the inspection there were 66 people living at the service. Some of these people were living with dementia. The building is split into two units known as, the general unit and Trevena. Trevena is for people who are living with dementia. The general unit is based over two floors. One of the floors is for people who have nursing needs and the other is a residential floor.

The service is required to have a registered manager, there were three registered managers in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered managers had clearly defined roles and areas of responsibility. They were supported by a compliance and quality assurance manager, a clinical lead based in Trevena and a deputy matron based in the general unit.

The service was exceptionally caring. Management and staff valued the importance of personal relationships to people and were committed to supporting them. Families and friends were welcomed into the service at any time and encouraged to join their loved ones for meals. Staff worked to develop relationships with people and demonstrated an understanding of their needs and backgrounds. The way in which care was delivered reflected people’s individual preferences.

People’s preferences were identified and respected in all areas of their lives. There were systems in place to seek out people’s opinions about the way in which the service was run. Two people had been nominated as ambassadors and their role was to speak to others about the service they received and feedback any concerns or potential areas of improvement to the management team.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people's daily life were assessed and planned for to minimise the risk of harm. There were sufficient numbers of staff to help ensure people’s needs were met. Domestic staff had received additional training so they were able to support people during meal times and alleviate the pressure on care staff at this busy time.

People were supported by a team of staff who were skilled and given on-going training and opportunities to develop. People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

Improvements had been made to the environment. These had been carried out to meet the needs of people living with dementia. There was clear signage, particularly in Trevena. Seating had been arranged to encourage social interaction.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

People had access to meaningful activities. Four activity co-ordinators arranged regular events and pastimes for people. These included competitive sports, pampering sessions and craft sessions. They also co-ordinated organised visits from outside entertainers. The management team worked towards social inclusion and was committed to developing and maintaining strong links with the community.

The management team kept up to date with any developments in the care sector and any research into dementia related conditions. They demonstrated a commitment to driving continual improvement within the service and enhancing people’s lives.

This is a summary of what we found-

The inspector was joined by an expert by experience. An expert by experience is a person who has experience of using care services. During our inspection of Hillcrest House, they spent time talking with people who used the service and observing the environment.

On the day of our inspection we spoke with eight people who lived at Hillcrest House, the registered provider/manager, two registered managers, 12 members of staff, four relatives/representatives and one volunteer.

Is the service safe?

At the time of our inspection we found the service to be safe.

Care and treatment was delivered in a way that was intended to ensure people's safety and welfare.

There were enough qualified, skilled and experienced staff to meet people's needs.

We spoke with people who lived at Hillcrest House about staffing at the care home. People told us, 'Nursing is good.....staff are good....don't always come straight away but they do their best...general things...toileting they try to get there straight away but it does not always work', and 'Nurses they are lovely I would not tell a lie...so understanding...about getting a bath they say take your time'.

We spoke with staff about whether they felt that there was enough staff and that they had time to carry out their duties. Some comments included, 'I think that there are plenty of staff' and 'we have worked here forever...we are a big family'.

Is the service caring?

At the time of our inspection we found the service to be caring.

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People who lived at Hillcrest House told us, 'I am quite happy with my care 'and 'I'm looked after very well here. I don't think there is anything to improve'.

Relatives we spoke with were complementary of the home and of the staff, comments included, 'They took time with my granddad to make sure he saw his favourite TV programme' and 'The care is very good...they are attentive and helpful'.

Is the service well led?

At the time of our inspection we found the service to be well led.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them, a volunteer helper, and from looking at records. If you want to see the evidence to support our summary please read the full report.

Is the service safe?

People were treated with dignity and respect by staff. We spoke with four people living in the home and they told us they felt safe living there.

People were cared for in an environment that was safe, clean and hygienic.

People who lived at the home were not protected from the risks of abuse as the incidents and accidents that staff had recorded had not been analysed. The registered manager told us they were aware of the new guidance in respect of the Deprivation of Liberty Safeguards (DOLS) but they had not submitted any applications at this time. They agreed to do this immediately.

People's needs were not always met because care records did not accurately reflect their current needs. Vital information for staff to follow to ensure people's safety and welfare was not always recorded in care records.

There were not always enough staff on duty to meet the needs of the people living at the home. We have asked the provider to tell us what actions they intend to take to meet the requirements of the law in relation to people's care and staffing levels.

Is the service effective?

During our inspection we observed staff caring for people. It was clear from our

observations and from speaking with people that staff had an understanding of people's needs.

People's health and care needs were assessed and mobility and equipment needs had been identified where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

We identified during this inspection that the low levels of staff on duty impacted on the ability of staff to meet people's needs effectively. We therefore concluded the service was not effective.

Is the service caring?

During our inspection we spoke with four people who used the service and observed staff interaction with people. People we spoke with told us staff were caring and attentive to their needs. We observed staff responding to people in a kind and caring manner.

Therefore we concluded Hillcrest house was caring at the time of this inspection.

Is the service responsive?

The home provided some group activities such as arts and crafts, singing sessions and exercises. Most people we spoke with did not express a view about the activities on offer.

People who used the service, and staff, told us there was a lack of choice in the time a person got up and retired to bed. People who used the service, and staff, told us that this was because there were insufficient staff on duty at these times. We concluded that Hillcrest house was not responsive to meeting people needs at the time of this inspection.

Is the service well-led?

The home worked with external health professionals to ensure people's health needs were met.

The provider had an effective system to regularly assess and monitor the quality of service that people received. The provider asked people who used the service, their families and professionals for their views about their care and treatment and used any feedback to improve the service.

However the provider did not have an effective quality assurance process about how they provided care, for example reviewing care plans, levels of accidents/ incidents in the home or ensuring that staffing levels met people's dependency needs. Therefore we concluded Hillcrest house was not well led at the time of this inspection.

We saw care plans were detailed and gave direction as to the care and support people needed. They had been regularly reviewed. We saw they were developed and reviewed with the person using the service and /or their relatives where appropriate.

We saw the home was clean and tidy. Infection control procedures were robust and in line with laid down legislation. There was information about infection control readily available throughout the home.

The five staff files we looked at showed there was a robust recruitment system in place and all the appropriate pre- employment checks were carried out. This meant people who used the service were protected from unsuitable staff.

We saw evidence of ongoing audit in areas including infection control, complaints, falls and health and safety. Results of satisfaction surveys were shared with people who used the service and their representatives.