Hillcrest House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Families told us they had been initially involved with an assessment when their loved-one had first come to Hillcrest house and felt overall the staff knew and understood their loved-one’s needs. Staff told us they were given time to read people’s care plans. However, they did not always feel the care plans reflected people’s current needs. We saw that people’s needs had been assessed prior to coming to Hillcrest house. However, records were not always detailed enough to thoroughly guide staff and they were not always up to date. No account was taken of how compatible people’s needs were, which had impacted on how the staff had supported people. No plans were signed by the person or their relative. This meant they were not robust enough to guide staff.

The service had not always taken into account recognised evidence-based practice when reviewing people’s needs. For example, following an incident where a person had become very distressed whilst attending hospital, there was no recognition of the potential trauma this caused the person. There was no recorded review about how staff should support the person in the future to meet their needs and avoid reoccurrence. Staff did not always complete records required to monitor people’s health. We saw that staff had completed the wrong paperwork when they were monitoring a person’s bowel health which meant their recording may not been seen by other staff or managers.

Families told us people had access to other health professionals when needed. This included access to an ophthalmologist, neuro consultant, GP and dentist. People had hospital passports which detailed their needs and staff supported people at any health appointments. Staf told us about the arrangements in place for some people to attend health appointments to minimise the distress experienced by some individuals. However, when a person was moving from the service the only transition plan we saw had been sent from the new provider. The service did not complete their own plan for the person which may have impacted as to how successful the transition was.

Families were confident that the service would contact the GP or other health professionals when needed. One family member commented the staff would contact the local GP surgery if the person became unwell and ensured they had regular medical check-ups. We saw from records when people had attended medical appointments. However, we found staff had not always understand and consistently followed advice given which we addressed with the registered manager.

While families we spoke with had no concerns in this area, our assessment found elements of care did not meet the expected standards as tools for monitoring outcomes were not robust. Audits of incidents failed to identify and respond to risk effectively. Staff routinely omitted details about the type of physical intervention they used to keep people and others safe. This included whether the intervention included staff blocking the person's movement, deflecting the person, breaking away from the person's physical touch or if staff were physically restricting the person's movement. This meant there was no way of identifying and reducing restrictive practice. A Bowel Health Plan was not reviewed which meant there was no way of identifying patterns of when a person became unwell.

Families we spoke with had no concerns in this area, they said they had been involved with decisions about people’s care and had attended reviews when asked. Staff understood the need to ask people’s consent and had received training in relation to mental capacity. However, we found paperwork was not always fully completed, mental capacity assessments had not been completed for all important decisions about people’s care and people, with capacity, had not always been involved in decisions about their care. For example, one person had not been consulted about the level of support they required when accessing the community.