Archived: Hillcrest Care Home

Updated 30 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The comprehensive inspection took place on 2 October 2018 and was unannounced. We carried out a further two announced visits on 10 and 25 October 2018 to complete the inspection. The inspection was carried out by an inspector, a specialist advisor in nutrition and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to our inspection, we checked all the information we had received about the service including notifications the provider had sent us. Statutory notifications are reports the provider must send us about deaths and other incidents that occur within the service, which when submitted enable us to monitor any issues or areas of concern.

We contacted the local authority’s safeguarding and contracts and commissioning teams. We also contacted Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used their feedback to inform the planning of the inspection.

We did not request a provider information return (PIR) prior to the inspection. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection, we spoke with 10 people who lived at the home, four relatives and one visitor. We also consulted with a community matron for nursing homes and a community matron.

We spoke with the regional manager, the registered manager, a nurse, an agency nurse, two senior care workers, five care workers, the activities coordinator, a housekeeper, the maintenance man and the chef. We also spoke with one agency nurse and three care workers on night duty to find out how care was provided at night.

We examined six people’s care plans and associated care records. We also checked records relating to staff and the management of the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 30 November 2018

Hillcrest is a 'care home.' People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides accommodation and care for up to 52 people, some of whom are living with dementia. Accommodation was divided into two units across two floors. Those who had a dementia related condition lived in accommodation on the ground floor and those with nursing needs lived on the first floor. There were 49 people living at the home at the time of the inspection.

This inspection took place on 2 October 2018 and was unannounced. This meant that the provider and staff did not know that we would be visiting. We carried out two further announced visits on 10 and 25 October 2018 to complete the inspection.

We last inspected the service in August 2017, where we found two breaches of the regulations. These related to meeting nutritional and hydration needs and good governance. We rated the service as requires improvement.

Following our inspection, the provider sent us an action plan which stated what actions they were going to take to meet the regulations.

At this inspection, we found that the provider had taken action in relation to meeting nutritional and hydration needs and good governance.

There was a registered manager in post. She had become registered with CQC following our previous inspection. 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 and associated Regulations about how the service is run.

The service was going through a period of change. The registered manager told us that she was trying to ensure the smooth running of the service amidst the changes which were happening to make sure people experienced the best possible outcomes at Hillcrest Care Home.

Whilst staff carried out their duties in a calm unhurried manner in the dementia care unit; staff in the nursing unit appeared to be constantly busy, moving from task to task, leaving little time to communicate on a social level. Some staff told us that team work could be improved between the units and also between the different shifts. We have made a recommendation about staff deployment.

There were systems and procedures to help protect people from the risk of abuse. People and relatives told us people were safe. Medicines were managed safely.

There was a training programme in place. Staff said however, that most of the training was online. They explained that it was sometime difficult to get online and said that they did not find e-learning as interesting or engaging as face to face training. We have made a recommendation about this.

There was a supervision and appraisal system in place. Supervision and appraisals had not been carried out as regularly as planned because several nurses and a senior care worker who supported the registered manager undertake these with staff, had recently left. There was a plan in place to address this shortfall.

People were supported to eat and drink enough to maintain a balanced diet. Nutritional care plans were individualised and included information about where the person liked to have their meal together with their likes and dislikes. Special recommendations from health care professionals were also recorded.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We observed positive interactions between staff and people who lived at the service. Staff talked about caring for people like members of their family.

There was an activities programme in place. An activities coordinator was employed to meet people’s social needs. The registered manager said they were reviewing the home’s activities provision to ensure that activities were person centred and promoted people’s maximum involvement.

There was a complaints procedure in place. Records were available to document what actions had been taken to resolve the complaints.

Audits and checks were carried out to monitor the quality and safety of the service. Action was taken if shortfalls were identified. An overarching action plan was in place which was linked to CQC’s five key questions.

This is the fourth time the service has been rated requires improvement.