Hilltop Court Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People felt safe and staff understood their responsibilities to safeguard people. Action to manage and mitigate risk was not always taken in a timely way and we found examples where there had been a delay in medical treatment being sought for 1 person. Staff had not always the skills and training to support people, for examples when people became distressed. The service mostly had safe systems for appropriate and safe handling of medicines. Managers were aware of shortfalls in the management of people’s non medicated creams and lotions and a new recording system is to be introduced next month.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

During our assessment visits we did not observe any concerns to suggest people were not being treated with dignity and respect or their safety was not being maintained. Relatives told us they felt their family members were safe at Hilltop Court. One relative told us, “[Family member] is safe here, we have trust in the home. The staff will always keep me, and my family informed if anything happens.”

Staff had received training in safeguarding vulnerable adults and understood their responsibilities to keep people safe. Staff told us they could report any concerning information and would be listened to. No concerns were shared with CQC during our two day site visits although we had received several anonymous concerns shared with CQC prior to the site visit.

People felt safe being supported by the staff team. People and their relatives felt any concerns could be reported in confidence and the manager would be acted upon this. Feedback from people’s relatives provided additional assurances they felt their family members were protected from abuse. One relative commented, “Yes. I think [family member) is safe. It is combination of things really that make me feel [family member] is safe.”

A safeguarding policy was in place. The manager understood the reporting processes of the local authority and these processes were being with the manager working with other service to investigate any concerns.

Relatives told us they felt their family members were safe and people’s risk were managed at Hilltop Court. When a person had fallen over, we observed staff respond calmly and efficiently to ensure all steps were taken in keeping the person safe and reassurance given. However, records showed two incidents where poor risk management had impacted people. In one example a person had not received appropriate medical treatment for 3 days after sustaining a broken leg. The providers policies and procedure were not followed.

Potential risks to people's health and wellbeing had not always been assessed to mitigate risk. During a review of incident records, we identified a person had come to harm, as a result of poor risk management. Some people had behaviours that may be challenging to staff and others. Care plans had recently been updated to provide staff with strategies on how to de-escalate and calm situations, but this had not yet been embedded in staff practice. Systems were in place to record accidents and incidents, however there was no meaningful analysis taking place to identify patterns and trends which put people at risk of further falls and incidents. We observed one incident where a person became agitated and injured a staff member, no record of this incident was recorded. There were not enough handheld devices available for staff to ensure information was recorded in a timely way on the electronic care planning system. Records were not up to date when people’s needs had changed and risk assessments were not consistently fully completed, meaning that staff did not always have access to current information about people’s needs. For example, staff were not updating wound assessment and evaluation plans consistently including information about the wound condition. The clinical lead had identified this and was following up with staff.

Staff were not always able to effectively support people to mitigate risk. Delays in developing relevant strategies to manage distressed behaviours, and a lack of specialist training impacted on how positively people were supported. Observations of how staff responded and interacted with people was mixed. We were not assured on this occasion that all staff were equipped to safely manage behaviours that challenge others.

Staff were aware of any risks people presented with through care records and updates from the manager. However it was not evident this was being applied in practice due to shortfalls observed, and procedures were not consistently being followed. Staff were complimentary about the new manager and felt they were making positive strides in the home. Stakeholders fed back that the service engaged well and were making the changes need with the service.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff had access to ongoing training. However, specific training had not been completed in managing behaviours that may challenge others or positive behavioural training although the service supported a high number of peoples with these needs. The provider told us all staff would receive positive behavioural training. Whilst the recruitment drive was continuing the service was using agency staff, but this was as a last resort. Formal mechanisms were in place for staff already employed at the home to indicate when they could cover particular shifts, for absent colleagues or vacant posts. Any shifts still not covered were then offered to agency staff. The service had processes for managing and inducting agency staff but accurate records to demonstrate oversight were not in place. We therefore were unable to be certain agency staff had appropriate skills and knowledge of the service to ensure they could effectively support people. The manager provided assurance that this area would be immediately addressed.

People and families’ views of staffing levels were mixed, and overall families did not feel there was always enough staff available to support people effectively. One relative told us, “Sometimes they do struggle for staff, and I know it happens everywhere. The staff seem really good. They are always busy, and they do what they are supposed to do.” Another relative commented, “There seems to be (enough staff). It is awkward at weekends, and they have temporary staff in to cover.”

Staff reported they were sometimes left short staffed, particularly at weekends. Staff reported often agency workers can be difficult to manage as they do not always understand what they needed to do and do not know the people living at the home. Staff reported agency workers had recently been sent home and not replaced. We asked staff if they felt there were enough staff and if staff came in a timely manner when they called for assistance. Comments were mixed. They told us, “We tend to have four staff during the day, most of the time we have enough. But sometimes we will be short if staff call in sick” and “It is improving picture, but we could always do with more.”

During the inspection we observed the staffing arrangements. At times we found staff didn’t always interact with people. Some staff would sit in the lounge and be inputting information into the electronic care planner. We observed a staff member was supporting a resident who was agitated and trying to take their clothes off. There was no communication attempted with the distressed individual to explain what needed to occur to safely support them. We observed staff place baby dolls on people’s laps without any communication. We also observed one person being given a large book to read, the person gave it back to the staff member . On the second day of our visit, we found staff interactions with people was much improved. The atmosphere was calm, with classical music played in the background. We observed staff spending time with people, talking, doing cross words and arts and crafts.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff understood people’s needs. When people’s health needs changed staff asked their GP to review them at the GP’s weekly visit to the home. Medicines management was well organised. The clinical lead was responsible for medicines management and proactive in introducing improvements. Staff told us they were well supported when the home moved from paper to digital medicine administration records (eMARs). Staff received the necessary training.

People were given their medicines in a kind and safe way by staff. Staff knew how people liked to take their medicines and their choices were respected. One person was given their antibiotic medicine at 11.30 as they did not like being woken in the morning. The medicine was prescribed to be taken every 8 hours which meant the third dose was due in the night. Staff had not asked the GP or pharmacist for advice. One person was prescribed a moisturising lotion. The lotion was labelled ‘Apply frequently to legs each day to prevent cracking’ but was being applied once daily, each morning. Carers’ daily notes stated that a person’s drink had been incorrectly thickened on one occasion. This could put the person at risk of choking.

The home had a detailed medicine policy that was available for staff to consult. The policy was followed in practice. The clinical lead received drug safety alerts and checked if any action was required. The clinical lead conducted medicine audits and acted if shortfalls were found. Carers recorded the application of people’s emollient and barrier preparations on the Patient Care System (PCS). The name of the product was not entered on one PCS we looked at. The manager told us they knew the use of these products was poorly managed. Electronic topical administration records (eTARs) are being added to the digital medicine administration record (eMAR) system next month. Medicines storage facilities were clean and tidy. Medicines (including controlled drugs) were stored safely. We checked the stock balance of four controlled drugs and these were correct. Records in the CD register were completed accurately.