Hillcrest

Updated 2 December 2023

The inspection

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors 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.

Service and service type

Hillcrest is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Hillcrest is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During our inspection we spoke with 3 people who used the service, 4 care staff, the assistant manager, senior support workers and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records relating to the management of the service including 4 people's care plans and records, medicines support records, health and safety records, and quality checks of the service. After our visit we also spoke with 7 relatives for their views on the service. We continued to seek clarification from the provider to validate evidence found.

Updated 2 December 2023

About the service

Hillcrest is home for up to 20 adults with learning disabilities. On the day of our inspection there were 20 people using the service. There are also 2 smaller houses, 1 Hill Close and 2 Hill Close, which are registered separately but form part of one complex with many elements such as staffing, and policies shared across all three buildings. We inspected these services in a 2-week period as much of the evidence we needed to gather was common to all 3.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We made a recommendation about following the Mental Capacity Act (MCA). People's care plans did not always contain information about how staff can support them safely, or to achieve their goals and aspirations. Fire risk assessments were not suitable or sufficient. The service gave people care in an environment that was not consistently clean and safe infection, prevention and control (IPC) practices were not always followed. Medicines management arrangements were not always effective and needed strengthening. The provider followed appropriate recruitment procedures to ensure only suitable staff were recruited to work at the service.

Right Care

Staff had training on how to recognise and report abuse and they knew how to apply it. People did not always lead empowered lives. There was a lack of evidence to show people had received all their funded hours and had used hours how they wished. Staff told us they received training and support but records to monitor this were not effective. Staff spoke about people with kindness and warmth. Overall, people were engaged in activities but records regarding this needed strengthening.

Right Culture

Audits and systems to check the quality and safety of the service were not robust and needed strengthening. Leaders of the service used slang terms to refer to people which was not respectful. Policies were in place but had not been reviewed to show they were up to date. Feedback from relatives and staff was positive about the leadership and management of the service. The provider worked with a range of external professionals to ensure people received joined up support.

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 (published 08 November 2017).

Why we inspected

We undertook this inspection as part of a random selection of services rated good and outstanding. We undertook a focused inspection to review the key questions of safe, caring and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, caring and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hillcrest on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safety and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.