Hillcrest House

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

Safe- this means we looked for evidence that people were protected from abuse and avoidable harm. 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 41 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Families did not share any concerns with us in this area. However, we found that action was not always taken to understand why a person had become distressed or why an incident occurred and what could be changed to prevent further occurrences. Staff told us they would report incidents and that any lessons learnt would be shared with them through staff meetings and training. However, staff also told us that information was not always being shared when needed.

Families told us people had access to other health professionals when needed. One relative said, “When [Name of person] needed to go into hospital 2 staff went with me to support him.” Staff did support people attending health appointments. However, we saw when one person needed medical assistance and became very distressed in the hospital, the person’s Positive Behaviour Support Plan was not reviewed. There was no recognition of the potential trauma this caused the person and there was no recorded review about how staff should support the person in future to meet their needs and avoid reoccurrence. We found a similar incident of distress occurred at a GP surgery which could have potentially been avoided. There had been no recent admissions to the home. However, we did have concerns about how the provider ensured the compatibility of people living in the home. We have sought assurance from the provider that compatibility does form part of the process as and when a future vacancy arises. The registered manager did explain that visits to the home would be planned for any new person looking to move into the service.

Families told us they felt people were kept safe at the home. One relative said, “I do feel he is safe there. Staff listen and if I didn’t feel that I’d ring the headquarters.” However, processes to safeguard people were not always followed and understood by staff. The registered manager had not always followed the safeguarding process. This meant that appropriate action had not been taken in a timely manner when a person had raised a concern around staff action. We raised this with the provider who immediately took action. Staff and the registered manager did not have sufficient knowledge and understanding around restrictive practices. This meant when physical restraint was observed during the inspection, the registered manager and senior staff failed to recognise this or intervene and assess as to whether the restrictive practice was legally justified, proportionate, necessary and as a last resort.

People’s families did not raise any specific concerns about being involved in managing risk for their loved-one. One relative told us when they had raised a concern they were listened to and action was taken. However, on reviewing people’s care records we found that risks to people’s health and safety were not always being identified and plans put in place to mitigate those risks. For example, we found following an injury sustained by one person, no risk assessment was completed and no care plan put in place to provide the guidance staff needed to support the person whilst their injury healed. The person found medical appointments difficult, liked to pace at times in their room and was known to self-harm. This meant the service could not be assured the person was being cared for safely and exposed them to the risk of further harm. We found there were several incidents where people, staff and others were at risk of being harmed because of people’s distress. There was no risk assessment process that ruled in or ruled out the use of physical restraint to maintain safety in a crisis. This meant people were exposed to the risk of harm.

People had their own rooms which we saw some had been personalised and reflected the person’s character and interests. However, we found that not all rooms were safe for people. For instance, one person was at risk of pulling large pieces of furniture on themselves if they became distressed, the provider had failed to ensure furniture was secured. We raised this during the assessment and the registered manager took immediate action to resolve this. In another person’s room we saw dents in the wall where the person had damaged the wall, we could find no information to suggest the provider had considered any other type of wall covering which would minimise the risk of the person hurting themselves. Communal areas were not homely and sparse of furniture. This was in part due to the needs of one person, the provider had not considered the impact on the other people living in the home. There were regular health and safety checks in relation to water, electricity, gas and fire. However, the registered manager and staff commented that responses to repair to equipment sometimes took time.

People were at risk of harm as the provider had failed to ensure all staff deployed had the appropriate up to date training, they required to safely undertake their responsibilities. For example, training records showed that 11 staff had not received Positive Range of Options to Avoid Crisis and Use Therapy Strategies for Crisis Intervention and Prevention training (PROACT-SCIPr) which was stated as a requirement for staff to have in people’s positive behaviour plans. Staff we spoke with did not always understand how to recognise restrictive practices, which meant people may have experienced an unnecessary restrictive practice and the provider could not be assured if, when or why a restrictive practice was experienced. Staff were recruited safely, and all pre-employment checks were in place. However, we saw from recruitment records the provider had failed to ensure the registered manager had any knowledge of or understanding around legislation and best practice guidance to lead and manage a specialist care home. This meant people were exposed to practice which was not always up to date. When people received one to one support, the staff’s skills and experience were not always matched to the needs of the person. This meant people were not always enabled to work towards and achieve their aspirations and goals. Relatives told us they felt there were sufficient staff to meet people’s needs. One relative said “There always appears to be enough staff from what I’ve seen, there are waking night staff. I visit at different times and there are plenty of people in the building.” We saw from staff rotas there were enough staff deployed each day to meet people’s needs. Relatives did comment there had been a high turnover in staff which meant at times staff did not know people as well.

Feedback from relatives did not highlight any concerns about cleanliness and hygiene at the service or how staff minimised the risk of infection. Staff had received appropriate training in infection prevention and control and were aware of safe hygiene practices. We saw staff wore protective preventative equipment appropriately when they needed to. The provider had policies and procedures in place regarding Infection Prevention Control and had systems in place to monitor. There were arrangements in place to make sure the environment was cleaned by staff at regular intervals and people were encouraged to keep their bedrooms clean. However, the provider needed to ensure they could gain access to all bedrooms to fully monitor the whole building. We spoke to the provider about this and they gave us the assurance they were addressing this with one person who used the service who preferred staff did not enter their room. We observed a clean environment.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People’s medicines were regularly reviewed. Staff had received training and undertook competency testing to ensure they were safe in administering medicines. Some improvements were needed around the level of detail recorded in relation to the administering of ‘as and when required medicines’, and consistency of information in some care records. We raised this during the assessment and the service addressed this.