Hillcrest

Hillcrest is a residential care home providing personal care to 31 people aged 65 and over, some of whom may be living with dementia at the time of the inspection. The service can support up to 52 people. Hillcrest is a purpose-built care home that provides accommodation over three separate units. Each unit has its own communal living room and dining room. Two of the units specialise in providing care to people living with dementia.

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

Whilst we found overall improvements had been made in the management of risk, we found some areas relating to the security of rooms and cabinets that required further work. The registered manager responded immediately to this and took actions to reduce this risk going forward.

Other risks to people, including from the environment were managed and responded to. We found improvements relating to the support of people at risk of skin breakdown. Regular fire and water safety checks were carried out. Improvements had been made to the management of medicines in the service. These were managed safely, and people received their medicines as prescribed. There was enough staff to meet people’s needs. Improvements had also been made in relation to infection control. The service had undergone a period of refurbishment and was clean. Information on safeguarding was provided to people, relatives, and staff. This included information on how to report concerns. Actions to safeguard people had been taken appropriately including reporting to the required authorities.

Further work had been taken to improve the governance of the service which had resulted in positive outcomes. People were supported by staff who understood person-centred care. The support provided met people’s individual needs, including cultural needs. There was an inclusive approach. People and relatives felt listened to and involved in the service. Staff were encouraged to take part in quality monitoring processes. The staff team worked well together and spoke about positive team working.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 April 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

Prior to the inspection we carried out a monitoring review of the service. A monitoring review considers a range of information such as the current rating, any ongoing or planned regulatory activities, information about safeguarding, whistleblowing, incident reports (we call these statutory notifications) and whether the service has a registered manager, feedback from people who use services and their family and friends, and other contextual information. This prompted us to carry out this inspection.

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 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 is a residential care home providing personal and nursing care to 39 people aged 65 and over at the time of the inspection. The service can support up to 52 people. Hillcrest provides accommodation via three separate units in one adapted building. Each unit has its own communal living room and dining room. Two of the units specialise in providing care to people living with dementia.

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

People were not always kept safe because risks had not always been identified or mitigated appropriately. Risks relating to infection control were not thoroughly managed due to issues of cleanliness in the environment. People’s medicines were not always managed safely and administered as the prescriber intended. Quality assurance systems had not been wholly effective at ensuring issues were identified, addressed, and regulatory requirements met. We have made a recommendation that the service acts to improve quality assurance systems.

People were supported by enough staff but staff were not always present in communal areas. We have made a recommendation regarding the assessment of staffing levels in the service. Staff had not always implemented guidance from health care professionals or sought advice. We have made a recommendation regarding ensuring advice from health care professionals is sought and fully implemented.

Systems and processes were in place to safeguard people from the risk of abuse. Safeguarding concerns had been identified, reported, and responded to appropriately. Incidents that occurred in the service were reviewed and used as learning opportunities so risk could be reduced.

People were supported to access a range of health and social care professionals. Holistic assessments had been carried out when people’s needs or circumstances changed. People were supported by trained staff who knew their needs. People were supported to eat and drink enough. Meal times were well organised, and people received support to eat where required. A refurbishment plan was in place to update the general environment and décor. People were supported to have rooms that met their individual needs and preferences. 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 were supported by kind and caring staff who knew them well. Where people were distressed or needed additional reassurance this was identified by staff and responded to. Systems were in place to support people to discuss and make decisions about their care. People were supported to be independent as much as possible, staff were mindful of people’s dignity.

People received care that was responsive to their individual needs and preferences. Systems were in place to help provide people with information in a way they could understand. People were supported to think about their needs and wishes at the end of their life. A range of planned activities was in place, this also included providing social stimulation to people who needed to be cared for in bed. People were supported to maintain important relationships. Concerns and complaints were taken seriously, investigated, and responded to.

People and staff were consulted and involved in the running of the service. Relationships had been built with external communities for the benefit of people living in the service. The management and staff team were committed to developing and improving the service, they had utilised networks and resources to help them do so.

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 1 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to safe care and treatment. Please see the action we have told the provider to take at the end of this report.

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.

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager in post. 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.

People living in the service told us that they did not always feel the care provided took account of their individual needs and preferences. Some improvements were needed to ensure activities met people’s individual needs and interests. Further work was also required to improve signage in the home to help orientate people living with dementia to their environment and to support them to meet their needs independently. There was limited opportunity for people to discuss their care plans including how they wanted their support to be delivered and any concerns they might have.

Care records did not always contain sufficient detail regarding people’s personal histories and preferences; they were not always updated sufficiently when people’s needs changed. Systems in place did not always sufficiently monitor records in the service and we have made a recommendation that the provider reviews how this is managed.

Complaints were responded to thoroughly although it was not clear that everyone living in the service felt comfortable raising concerns.

People were safe living in the home. Risks to people including those from the premises were responded to and managed. Staff demonstrated an awareness of adult safeguarding and knew how to identify possible concerns. The service reported safeguarding concerns appropriately and when required.

There was mixed feedback regarding staffing levels as some people felt staff were not always visible in communal areas of the home. However, we found staffing levels were sufficient to meet people’s needs and keep them safe.

Medicines were managed and stored safely, although we found some improvements were required regarding the recording of medicine administration in the service. Regular audits were completed on medicines to check and ensure they were managed safely.

Staff received appropriate support and training to effectively undertake their roles. The registered manager had oversight of staff training and a training plan was in place to ensure staff received updated training when required.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and report on what we find. The registered manager understood their responsibilities under the Act and the service was working in accordance with this legislation.

People received appropriate support to eat and nutritional risks to people were managed. People had a choice of what they wanted to eat and told us they enjoyed the meals provided.

Staff worked closely and proactively with health care services to ensure changes in people’s health care needs were responded to and people were supported to access a range of health care services.

People were supported by staff who cared for them and treated them respectfully. Staff supported and encouraged people to be as independent as possible.

People, relatives, and staff spoke positively about the service and the registered manager. Staff found the management team approachable and supportive, with clear direction being provided regarding their roles and responsibilities. Although some people and relatives felt communication in the home could be improved.

There were systems in place to manage and monitor the quality of the service being provided. Where issues had been identified the management team took prompt and thorough action to address these in order to make the improvements required.

This inspection was unannounced and took place on 2 June 2016.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Staff had yet to receive training in this subject and those spoken with during this inspection were not able to demonstrate that they were aware of the principles of the MCA or DoLS and their obligations under this legislation.

Care plans did not contain all of the relevant information that staff required so that they knew how to meet people’s current needs. We could not be confident that people always received the care and support that they needed.

Staff deployment was not well managed which meant that people could not always be assured that their needs would be met in a timely manner

The provider had a recruitment process in place and staff were only employed within the home after all essential safety checks had been satisfactorily completed.

People were cared for by staff that understood their care and support needs. People’s privacy was respected most of the time. Most staff were seen to knock on the person’s bedroom door and wait for a response before entering.

People were provided with a varied, balanced diet and staff were aware of people’s dietary needs. Although we noted that menus were not available in appropriate formats so not all people were aware of the options on offer. Staff referred people appropriately to healthcare professionals. People received their prescribed medicines in a timely manner and medicines were stored in a safe way.

The provider had a complaints process in place and people were confident that all complaints would be addressed.

The provider did not have effective quality assurance systems in place to audit all areas of the home to identify areas for improvement. Therefore they were not able to demonstrate how improvements were identified and acted upon.

We observed how staff interacted with people and saw that they were kind, caring and patient. People were spoken to politely, using their preferred name. People were offered choices and staff were seen and heard to respect the choices people made. Care and support was provided discreetly.

We looked at care documents and these set out how the person wished to be cared for. The care plans were kept under review, although some were overdue an update. Medication records were up to date and there were no unexplained gaps in the administration records. Medicines were stored securely. We also looked at staff records and saw that they were up to date and demonstrated sound recruitment and selection processes. Records were stored securely and were readily available to staff and also for inspection. Records were audited by the home to ensure they were kept up to date and also to demonstrate that all maintenance of the environment was undertaken on time.

We saw people in all areas of the home being treated with respect and dignity by staff. Some people were taking part in a reminiscence group activity, another group were arranging flowers and some preferred to stay in their own room. People told us "I have lived here for a long time and enjoy the company." "The staff are very good and help me when I need it, nothing's too much trouble." Another told us they enjoyed the meals because it was 'good wholesome food'.

We checked people's care records and found them to correspond with what they told us. We looked at records of people's finances and complaints. We were aware of past complaints and found they had been investigated appropriately. None of the six people raised any concerns when spoken with. We spoke with various staff members who told us they knew their residents needs and could support them to be as independent as possible. One comment we received regarding a member of staff had been passed to the manager to deal with.

We observed how people were treated, we saw staff knock on people's doors before entering and when assisting people sat with them when assisting with their meal and drinks. We saw that bedroom doors were being converted into front doors with a post box and door knocker added with each a different colour.