CQC report explained · a residential care home
What the CQC found at Hillbrook Grange
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People were still at risk because medicines were not always given safely or recorded properly. Inspectors also recommended stronger monitoring of individual risks and up-to-date refresher training.
- Effective?
- Good
- This area was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
- Caring?
- Good
- This area was not inspected during this focused visit. Inspectors did observe kind and caring interactions and reported positive feedback about care.
- Responsive?
- Good
- This area was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
- Well-led?
- Requires improvement
- Management audits did not always identify or deal with problems found by inspectors. The provider had not shown continuous and sustained improvement or full oversight of the home.
What inspectors found, February 2023
Hillbrook Grange is rated Requires Improvement; inspectors found unsafe medicines management and weak oversight, although care was kind and improvements had been made.
This was an unannounced, focused inspection on 10 and 11 January 2023. Inspectors looked mainly at safe care and leadership. They spoke with people, relatives and staff, and reviewed care, medicine, recruitment and management records.
The home had improved its medicines systems since the previous inspection, but staff did not always follow them. Some medicines were given at the wrong times, guidance for as-needed medicines was incomplete, and records did not always show that creams had been applied correctly.
Inspectors found kind and caring staff, a clean home, safe recruitment checks and suitable infection control arrangements. However, risk monitoring, staff refresher training and management checks were not always reliable.
The overall rating remained Requires Improvement. Safe and Well-led were both rated Requires Improvement. The other three areas were not inspected at this visit, so their previous ratings were used in the overall rating.
Kind staff
People and relatives gave positive feedback about the care. Inspectors observed kind and caring interactions between staff and people.
“We observed kind and caring interactions between people and staff.” from the report
Safeguarding
Staff understood how to recognise and report possible abuse. Accidents and incidents were recorded, reviewed and followed up.
“Staff demonstrated their knowledge around safeguarding and how to identify if someone was at risk of abuse.” from the report
Clean and infection-ready
The home was clean and inspectors were assured about its infection prevention and control arrangements.
“The home was clean and tidy, and people were supported to receive visits from family and friends.” from the report
Safe recruitment
The home carried out checks before employing staff, including criminal record checks and references from previous employers.
“The service had safe employment checks in place to ensure suitable staff were employed to care for people at the service.” from the report
Medicines not consistently safe
seriousSome medicines were given at the wrong times. Guidance for as-needed medicines was not always available or personalised, and records did not always show that creams were applied correctly.
“Medicines which were prescribed to be given at specific times or with specified time intervals between doses were not always given at the correct times.” from the report
Risk monitoring records
needs fixingSpecific charts were not always used to monitor risks such as skin breakdown and repositioning. Inspectors recommended more robust monitoring systems.
“Although people's risks were assessed, specific charts to monitor these risks were not in place.” from the report
Training gaps
needs fixingThe training system was in place, but several staff did not have up-to-date refresher training. Inspectors recommended that the provider address this.
“The training matrix indicated several staff did not always have up to date/refresher training in place.” from the report
Weak management checks
seriousAudits did not always find or act on the problems inspectors identified. Care plans were not formally checked for accuracy and completeness.
“These audits had not always identified and actioned the concerns we found at this inspection.” from the report
- 01What changes have you made to ensure medicines are given at the right times and that as-needed medicines have clear, personalised guidance?
- 02How do you now record creams, medicated patches and laxatives, and who checks these records?
- 03Which individual risks need monitoring charts, and how do managers check that staff complete them?
- 04How many staff still need refresher training, and when will this be completed?
- 05How are audits now checking care plans and medicines closely enough to identify and fix problems?
This was a focused inspection of Safe and Well-led only; the other key question ratings carried over from the previous inspection. This explanation was written from the published report of 22 February 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, August 2022
Requires Improvement; inspectors found unsafe medicines management and quality checks that were not yet reliable.
This was an unannounced focused inspection on 11 and 15 July 2022. Inspectors looked at Safe, Responsive and Well-led. They reviewed records, medicines, staffing, the building and infection control, and spoke with people, relatives, staff and a healthcare professional.
People generally said they felt safe and were treated well. The home was clean, staff followed safer recruitment checks, risks were assessed and infection control arrangements were satisfactory. People could raise concerns, and activities and support for relationships were available.
The main problem was medicines. Some people received paracetamol doses too close together, records did not always show which creams had been used, and information for some medicines was incomplete. Care plans also needed to be more personal and consistent, while management checks had not reliably prevented these problems.
The overall rating remained Requires Improvement, as did Safe and Well-led. Responsive was rated Good. Effective and Caring were not inspected during this visit, so their previous ratings were used in calculating the overall rating.
People generally felt safe
People said they felt safe and staff understood how to raise safeguarding concerns. Incidents were investigated and lessons were considered.
“People looked well cared for and told us they felt safe at the home.” from the report
Clean and safer environment
The home was clean and tidy. Risk assessments, fire checks, equipment checks and infection control arrangements were in place.
“The home was clean and tidy, and people were supported to receive visits from family and friends.” from the report
Kind and approachable staff
People and relatives spoke positively about staff. Staff were described as kind, caring, polite and welcoming.
“A relative told us, "I think the home is lovely and I could happily live here. The staff are always polite and welcoming.” from the report
Activities and personal interests
An activities coordinator offered group and one-to-one activities, including community trips and support to attend religious ceremonies and leisure facilities.
“They told us they would try to offer any activities that people wanted and had developed a 'walking group', trips out to the local community” from the report
Willingness to improve
The provider and manager responded to feedback and worked with other services. A healthcare professional had noticed better care since the new management team started.
“I have seen a definite improvement in the care of the residents since the new management team started at the home.” from the report
Medicine errors
seriousThree people received paracetamol within the minimum four-hour gap, creating a risk of overdose. Some medicines were not recorded clearly, and information for covert and as-needed medicines was incomplete.
“For three people paracetamol had been administered within the minimum four hour gap.” from the report
Quality checks were not reliable enough
seriousManagement systems had led to some improvements but had not consistently prevented medicines problems. The provider remained in breach of the regulation on safe care and treatment.
“They had not yet been sufficiently embedded to ensure that medicines were being safely managed at this inspection.” from the report
Care plans needed more detail
needs fixingSome care plans were general, confusing or not sufficiently person-centred. Inspectors also found occasions when people were not left with a drink or call bell within reach.
“However, others were less detailed or confusing.” from the report
Staffing pressure
needs fixingStaff and people had mixed views about staffing. Staff were often busy, agency staff were used at times, and the layout made it harder to oversee people in quieter areas.
“We noted staff were very busy.” from the report
Some people wanted more activities
minorActivities were available, but cover when the activities coordinator was away was not clear and some people said they were bored or wanted more to do.
“I do get bored, there aren't many people to talk to.” from the report
- 01What changes have you made to ensure there is always at least a four-hour gap between paracetamol doses?
- 02How do you now record each individual cream or other topical medicine that has been applied?
- 03How do you make sure staff have complete, up-to-date instructions for covert and as-needed medicines?
- 04What is the current staffing plan for weekends and for times when the activities coordinator is away?
- 05How have you improved care plans so they clearly record each person's preferences and the support they need?
This was a focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 26 August 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Hillbrook Grange
7 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- February 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2022Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- August 2021Requires improvementup from InadequateSafe: Requires improvementResponsive: GoodWell-led: Requires improvement
- August 2021Inadequatedown from GoodSafe: InadequateResponsive: Requires improvementWell-led: Inadequate
- January 2019Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2016Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2014
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- April 2012
Registered with the Care Quality Commission on 12 April 2012.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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At least 100 live-in carers within about an hour of Stockport
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 88 can care for a couple. 10 years' experience on average.
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“She is an exemplary carer, she is knowledgable empathetic and very respectful in the home.”
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