Hilltop Court Nursing Home

At our last inspection, we found 4 breaches of regulation. At this assessment, we found that some improvements had been made and the warning notice had been met. The provider was no longer in breach of regulation in relation to staffing and safe care and treatment. However, the provider was in continued breach of legal regulation in relation to good governance and dignity and respect.

We observed some kind and caring interactions between people and staff. It was clear that staff knew people well and had built good relationships. We also observed some more task-based interactions with some staff at busier times. Feedback from people and relatives was positive about how caring staff and the management were. Our observation outcomes were mixed in relation support at mealtimes and in relation to treating people with dignity. Some people did not always look well kempt and had unclean fingernails, teeth and unclean clothing. We were not assured that care records were accurate in relation to people receiving baths and showers on a regular basis.

Improvements were found in risk assessments and care plans for people’s individual needs, and these were reviewed regularly. Care documentation was more robust, detailed and person-centred. However, we found concerns in relation to people who needed enhanced care provision in relation to their nutrition and weight, wound care documentation and managing people’s distress due to their condition.

Refurbishments of the home had taken place since the last inspection such as redecoration and a new reception area. We found safety checks had been carried out. However, we had some concerns relating to environmental safety and access to unsuitable areas. We also had some infection control concerns regarding bathrooms, and some odours were still present in the home.

People’s mental capacity had been assessed and where appropriate, best interest decisions had been recorded. We discussed concerns with the registered manager around the approach to the significant use of sensor beams to alert staff of people’s movements.

The provision of activities at the home had improved significantly since the last inspection, with many events regularly taking place. An activity co-ordinator was now in place and was caring and enthusiastic and worked hard to provide a programme of activities to enhance people’s wellbeing. However, we found the homes outside space was poor and the provision of 1:1 activities and dementia-specific activities required improvement. The registered manager told us of their plans to improve both 1:1 activities and ensure the home was more dementia-friendly, including improvements to access to appropriate outside spaces.

Staff told us they had experienced improvements at the home, and the registered manager was supportive and approachable. Training and staff supervision was in place, and competency checks were carried out. Staff retention and morale had increased since the last inspection.

Medicines were managed and administered safely. Storage of medicines was appropriate, and information was in place to safely administer people’s medicines. Effective and appropriate individual care plans were in place in relation to medicines.

It was evident that some improvements had been made since the last inspection and the registered manager had made a significant impact. However, we still found some areas of concern during this inspection and the service remains in breach of 2 regulations. The progress already made by the registered manager needs to be embedded into practice to demonstrate a sustained and continuous improvement. The registered manager was knowledgeable about the specific needs of people with dementia and what good dementia care looks like and is working to make improvements. This needs to be supported by the provider to enable these improvements. The registered manager was helpful, engaged and responsive when we fed back concerns during the inspection.

We have asked the provider for an action plan in response to the concerns found at this assessment.