Hillcrest House

Updated 15 October 2022

Inspection team

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 carried out by three inspectors and a member of the medicines team.

Service and service type

Hillcrest House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post. However, they were regularly working in a nursing role at the time of this inspection and told us they were not carrying out the full registered manager role.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection, we reviewed information we held about the service and the provider which included any statutory notifications sent to the CQC. A notification is information about important events which the service is required to send us by law. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We used all of this information to plan our inspection.

During the inspection

We reviewed six people's care plans and risk assessments. We looked three staff files in relation to recruitment. We reviewed other records relating to the management of the service. We spoke with ten people, five relatives and eight staff as well as the registered manager, the general manager, the compliance manager and the area manager. We spoke on the phone with two relatives of people who were living at Hillcrest House, about their experience of the care provided.

Following the inspection visit we continued to seek clarity from the provider regarding staff training and supervision, audits and surveys.

Updated 15 October 2022

About the service

Hillcrest House is a residential care home providing personal and nursing care to up to 88 people. The service provides support to older people and people with physical disabilities. At the time of our inspection there were 53 people using the service.

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

Prior to this inspection CQC had received concerns from people regarding the standard of food provided and low staffing levels. We were told meal provision had been inconsistent and below the previous standard. We found that staffing levels had on occasions dropped below what had been planned.

Some people and staff told us they felt unsettled since the new provider had taken over Hillcrest House. Comments included, “Things have changed and not for the better. The food is not good and staffing has been low” and “Communication has been bad in this change over. The chef left and then we had little support. It has been difficult to provide food as expected recently, but it is now improving as we have a new chef.”

Some people told us they had not been able to get a timely response from staff when they rang their bell, and not been able to have a shower when they wished. We discussed this with the management team who confirmed that staffing levels had been challenging over the summer but assured us the service was now fully staffed.

Residents meetings had been held to seek the views of people and share information. However, we were told that responses to the repeated concerns raised had not always been provided. The service had people living at the service, who represented the views of others, and attended regular meetings with management. They told us, “We keep raising concerns about low staffing, not having showers and the poor food, but we get no feedback and nothing seems to change.”

Changes had taken place with the snack provision, in the evenings, by the new catering company. This had not been discussed with people who told us they felt resentful of losing their evening snacks.

Staff meetings had been held to seek the views of staff and share information. However, we were told there had been a lack of effective communication between the new provider and staff. Comments included, “I have not met with anyone from Minster so far, I have no idea about any new processes or policies” and “Communication has been really bad. The gossip machine has filled in any gaps and so morale is not good.”

There was a lack of robust oversight in place to make sure people always received their medicines as prescribed. There were gaps in the medicine administration records (MAR) which had not been reported as errors. Handwritten MARs did not always contain the required information for staff to administer medicines effectively.

There was a team of managers at the time of this inspection. The new general manager, the registered manager, the compliance manager and the new area manager. The registered manager was on shift covering a nursing role on the day of this inspection. The respective roles and responsibilities for each manager had not been clearly defined. This meant there was no consistent oversight of the quality of the service provided at Hillcrest House.

Regular fire alarm tests were not possible at the time of this inspection due to a defect in the fire panel circuit board, which had burnt out. A new fire panel was on order but was delayed in Ukraine. We reported this concern to the Fire Service who told us they would make a visit to the service to ensure adequate management steps had been taken to address the potential risk.

There were systems to help protect people from abuse. Staff had received training on how to recognise abuse.

People's care and support needs were assessed before they started using the service. People received support to maintain good health and were supported, if required, with their meals. Some people were having their food and drink intake recorded and were regularly weighed.

Recruitment procedures were robust. This helped ensure staff were safe to work with vulnerable people.

People were supported by staff who had been appropriately trained and were skilled in their role. However, under half of the staff team had received recent supervision. The recent challenges faced by the service of COVID-19 outbreaks and a scabies outbreak had put pressure on the management team and taken them away from such tasks.

There was an audit programme in place. However, the most recent audits were last completed in June 2022. There had not been an audit of people’s food allergies or of the kitchen and dining experience recently.

Care plans provided person-centred information about each person and guided staff on how to meet their needs in a way that the person preferred.

Mental capacity assessments had been carried out where it was indicated. Deprivation of Liberty Safeguards (DoLS) authorisations had been applied for appropriately. There were no authorisations for restrictive care plans in place at the time of this inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s preferences and choices had been recorded.

People were able to join in with activities if they wished. There were activity co ordinators who worked with people on a one to one basis or in small groups.

Staff understood the importance of respecting people's diverse needs and promoting independence. People and relatives told us that the staff were caring and responded when they called. We saw many kind and caring interactions between staff and people during this inspection. Relatives comments included, "I cannot fault the care" and "I think the staff are lovely, very kind."

People, staff and relatives had been asked for their views by the previous provider through a survey, responses had been audited in 2021. A further survey was about to be issued by the new provider in the coming weeks.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

We registered this service on 10 November 2021 and this was the first inspection. The last rating for the service under the previous provider was rated good, published 4 July 2019.

Why we inspected

We were prompted to carry out this inspection due to concerns we received about staffing levels and poor food provision. A decision was made for us to inspect and examine those risks.

A recent Direct Monitoring Assessment (DMA) had identified some issues that required further review.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.