Hilltop Lodge

Updated 4 August 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by three adult social care inspectors, one medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. They completed telephone interviews remotely.

Service and service type

Hilltop Lodge is a ‘care home.’ People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Hilltop Lodge is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was no registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the provider registered. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with three people who used the service and eight relatives about their experience of the care provided. We spoke with 12 members of staff including the provider, nursing staff, senior care assistant, care staff, activities coordinator, domestic staff and kitchen staff. We spoke to the service’s regular GP.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included three people’s care records and multiple medication records. We looked at two staff files in relation to recruitment, along with the provider’s supervision and training records. A variety of records relating to the management of the service, including quality assurance audits, were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 4 August 2022

About the service

Hilltop Lodge is a care home providing residential and nursing care to up to 61 older people, including people living with dementia. At the time of our inspection there were 51 people using the service.

People’s experience of using this service and what we found

Overall people and their relatives were happy with the care they received. However, aspects of the service did not operate in the safest possible way.

Medicines were not consistently well-managed, and we saw this led to errors and some people’s prescribed medicines being missed. Plans were put in place to reduce risk relating to people’s health and safety, and staff understood how to protect people from the risk of harm.

There were enough staff available to keep people safe, but feedback and observations confirmed there was scope to improve staffing arrangements at the service. Immediately after the inspection the provider adjusted their staffing allocations on each floor of the service to respond to feedback. The home was clean and tidy, and infection prevention control practices were well-embedded.

The meal experience was mixed. We saw people were offered a choice of balanced and nutritious meal options. However, inaccurate records exposed people who were on modified diets to unnecessary risk.

Most staff were trained to provide effective care but did not always receive regular planned support in their role. The induction of new starters was not effectively managed, with some waiting two to three months to receive a full programme of training.

The provider adapted the environment to promote choice and autonomy for people living with dementia. Rooms were accessible and clearly marked.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

The service has had a change of registered manager four times since 2019. This lack of consistency has had an impact on the oversight and governance at the service. Discussions with the provider confirmed they were aware of issues facing the service and they were committed to providing good quality care. The provider had allocated a significant amount of their resources to encourage rapid improvements at the service and issues identified at inspection were acted on quickly to keep people safe.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 14 November 2019 and this is the first comprehensive inspection. We completed a focussed inspection of the key questions safe and well-led on 13 January 2021 (published on 10 February 2021).

Why we inspected

The inspection was prompted in part due to concerns received about the management of people’s medicines. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the Safe sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of medicines, governance, record keeping and staffing at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.