Hilltop Court Nursing Home

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 requires improvement. At this assessment the rating has remained 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 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Assessments were completed and people’s needs were reviewed by staff. However, it was not always evident that these processes were effective. Feedback received included concerns that some issues were not being picked up and addressed by staff, including pain management, infection and personal care needs. One professional fed back that the high levels of need of people living at the home did “not seem to have been considered by the home manager when assessing new residents and considering the level of [need] already in the home.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Processes for oversight were in place which included clinical risk meetings. However, these did not contain enough details to show risk was well managed with action identified and followed up to ensure effective outcomes. For example, the home provided care for people living with dementia, but adaptions to the home in line with best practice for dementia care were not evident. We observed that people appeared unkempt and records did not reflect good standards of personal and oral care were being provided.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

We received mixed feedback from professionals about how staff worked with other agencies. One professional commented, “When I have gone in to review how things are, there does not appear to have been any communication between staff about what I have implemented with a client and advice [given] not continued with supporting clients.”

Staff gave mixed feedback about teamwork and raised concerns about the high use of agency staff. One member of staff commented, “It can be a constant battle due to poor staffing levels and the use of agency staff.” We observed that how staff worked together and people’s experience at Hilltop Court varied across the units of the home.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Care plans were clinical and task focused with limited evidence of personalisation, promoting independence or aspirations and goals. Feedback from professionals was that advice was not always followed up and embedded into how people were cared for. We noted shortfalls in the quality of personal care people received especially around oral care. We were not assured that accurate records in these areas were being maintained to ensure areas of concerns or refusals of care were readily identified. Systems for oversight of clinical risk were in place, but not used effectively, with documentation disorganised and lacking evidence that clear plans were made and action was being taken.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves.

It was not evident that processes for oversight of people were being effectively used. People did not have ready access to drinks in their bedrooms and overnight, and people’s fluid monitoring charts indicated people were not consistently meeting their hydration targets. One professional told us, “My colleague visited only last week and enquired about a particular resident and was told they were fine and doing well. Yet the following day received an email to say that staff were concerned as they were eating/drinking very little.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People’s capacity was being assessed and appropriate referrals for Deprivation of Liberty Safeguards (DoLS) made where people were subject to restrictions. However, consent was not always clearly documented within the care plan and feedback from one professional was, “We have noted that often DoLS conditions are not adhered to.”