Hillcrest House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question outstanding. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities. Staff spoke about people being at the centre of their care, however, leaders had failed to recognise their approach to care was at times generic and service led. Closed cultures were not actively discussed so could not be quickly identified.

The provider had failed to ensure the registered manager had the skills and knowledge to manage a specialist service. During our assessment the provider had not been transparent with us about concerns they had about the management of this particular service. Staff told us they did not always feel listened to and when they had raised concerns the registered manager said one thing and then did something else. We found the organisation within the office was disorganised and staff were unable to locate certain records. During our assessment a new manager was appointed and immediately had a positive impact on the service.

People’s families said they felt able to speak up if they had any concerns and found the staff and management approachable. Relatives were included in annual reviews which gave them an opportunity to share their views. Staff said they could speak up but did not always feel they were being listened to. There was a Whistleblowing policy in place and information in the home for people about how to speak up.

There was a diverse workforce and the staff we spoke with said they felt they were overall fairly treated. However, little account had been taken to ensure staff and leaders were representative of and understood the cultural needs of the people using the service. The regional manager told us this was something they had noticed and was looking at how to address this.

The provider failed to ensure adequate systems and processes were in place to assess, monitor and improve the quality and safety of the care provided. The system to record and monitor incidents was not effective and robust enough in identifying and responding to risk. For example, staff 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 the provider could not identify when restrictive practices were being used to enable them to review and reduce restrictive practices and ensure any interventions were legal and in line with service user’s assessed needs. Audits of care records failed to identify inaccurate information. Audits in relation to medicines had failed to pick up on missing information or lack of information which we found during our assessment.

The service liaised with local medical services to manage people’s anxieties and ensure they got the care and treatment they needed. However, we saw no evidence of any collaborative work with local community groups to create opportunities for people to experience new activities or develop new interests or work opportunities to help them thrive and live the life they chose.

The service did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research. Following an inspection of another of the providers services an action plan was put in place which included an action to share the learning from the inspection across the provider’s services. However, we found that some of the issues and concerns we found during this assessment were the same as those found at another of the provider’s services.