Hillcrest

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.

At our last inspection in February 2015 we rated Hillcrest ‘Good’, and did not identify any breaches of regulations. At this inspection we found the service remained Good.

Why the service is rated ‘Good’.

People told us they felt safe, mainly due to the staff being present. Risks associated with care and the environment in and around the home were well assessed.

Staff were recruited safely, and understood how to recognise and report any safeguarding concerns they had. There were enough staff on duty in the home.

People’s medicines were managed safely.

Staff had a thorough induction and had access to on-going training and support. The registered manager carried out checks to ensure training was effective.

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. The provider asked for people’s consent to care and treatment. Some key information relating to this was in accessible formats.

People enjoyed their meals and were asked what they wanted to be on menus. We saw some innovation in the approach to nutrition which had a positive impact on people’s health. The provider supported people to access health and social care professionals when needed.

We saw relaxed and good natured interactions between people and staff. People had access to activities which reflected their interests. Staff understood how to respect people’s privacy and dignity.

There was person-centred information in people’s care plans. Accessible formats had been used effectively to enable people to write detailed plans for end of life care.

Staff told us they enjoyed working at the provider’s services within the complex and said they had a good relationship with the registered manager. They told us the registered manager was supportive and approachable.

The provider was monitoring quality in the service. People were consulted and the registered manager undertook regular audits to ensure areas for improvement were identified and addressed. We received good feedback about care standards from a visiting health professional we spoke with.

We spoke with people living in the home, staff and the registered provider. We found staff involved people in decisions about their care and daily lives. We saw staff supported people to maintain their independence. People told us they went out regularly and enjoyed the different activities that were available.

We found the home was homely and comfortable and saw that staff had a good rapport with people. We saw staff gave people the support and assistance they needed. The care records we reviewed were person-centred, holistic and provided detailed information. We saw people's nutritional needs were met. We found there were sufficient staff to meet people's needs. There were systems in place to deal with complaints.

Our observations of the service showed that care staff spoke with and interacted with people who used the service in a patient and pleasant manner. Care staff supported people in a sensitive way using differing methods of communication to ensure that people understood what was going to happen.

The people who used the service appeared happy and comfortable with the surroundings. They appeared to be relaxed with the staff in their interactions with them. We noted that people who used the service had access to a wide range of activities which were personalised to their individual needs.

Relatives we spoke with during our visit were very satisfied with the care and activities within the service. They told us the care was very good and the staff were very nice. One said that the care was 'Brilliant' and another 'I cannot speak too highly of the home.'