Hilltop Court Nursing Home

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 requires improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in continued breach of legal regulation in relation to the systems for governance to assess, monitor and improve the quality and safety of the services provided.

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 provider 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.

The provider told us there was a drive to improve the culture within the home. However, at the time of this assessment, there were shortfalls in oversight and further work was needed to create a cohesive and positive culture within the service. For example, further work was needed to ensure staff worked together effectively to meet people’s needs and that all staff felt equally well supported and valued by the provider and home manager.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Feed back about the managers and leaders was mixed. Some staff told us there was limited oversight and the manager was not visible within the home, whilst other staff members indicated they felt supported in their role.

People did not feel they could speak up and that their voice would be heard. We had received a number of whistleblowing concerns prior to our site visit raising concerns about how the service was managed and asked the provider to investigate and address these. However, during our assessment we continued to receive the same concerns about how the service was managed and were not assured enough action had been taken to ensure staff felt able to raise concerns without fear of reprisal.

The provider did not value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff did not consistently feel valued or well-treated by the provider. There were shortfalls in the training and support offered to staff and limited evidence staff were receiving appraisals to support ongoing development within their role.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. The was a lack of evidence of sustained improvement and we found concerns in many areas which had been raised at previous inspections. There was a lack of evidence that action identified from inspections, safeguarding’s or feedback from other professionals was effectively embedded, with oversight to ensure the change was sustained.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

We found that information was not always effectively shared. For example, following a choking incident it was not clear that the provider had taken sufficient action to make sure staff were aware of risks related to people eating whilst in a reclined position. Some professionals fed back concerns about their advice not always being followed by staff.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not 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.

The provider had an improvement plan in place. However, many actions had been signed as completed although we found evidence that this was not the case during our site visit, for example in relation to person-centred care plans. There was limited evidence to demonstrate how the provider was continuously learning and ensuring action taken was effective. For example, whilst there was an agency file, this was not maintained to support good oversight of the agency staff to ensure suitable skills mix within the home. It was not clear that best practice was used to develop and improve the service, for example in relation to dementia care. People were not being supported to lead full and meaningful lives through ongoing stimulation, access to interest and activities and engaging with the local community.