CQC report explained · a residential care home
What the CQC found at Hillcrest Residential Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, November 2020
Inspected but not rated; inspectors found good infection-control practice, but were only somewhat assured about shielding, social distancing, layout and hygiene.
This was an announced thematic inspection on 27 October 2020. It was part of the coronavirus response and focused on infection prevention and control in the home.
Inspectors found several good practices. Visitors were booked in safely, screened on arrival and given protective equipment and handwashing facilities. The home also used a summerhouse, portable sinks and a pen pal scheme to support visits, hygiene and people's social needs.
Inspectors were assured about most areas, including safe admissions, protective equipment, testing, managing outbreaks and the infection-control policy. They were only somewhat assured about shielding and social distancing, and about the layout and hygiene of the premises.
No overall rating or question ratings were awarded. This report should not be read as a full assessment of the quality of care or as an updated overall rating.
Safer visiting
The home booked visits to reduce contact between visitors, screened people on arrival and provided protective equipment and handwashing facilities.
“Visitors were screened on arrival and provided with PPE and handwashing facilities.” from the report
Supporting social needs
The home used activities and community contact to help compensate for fewer family visits and entertainers.
“This included a 'pen pal' scheme with the local community.” from the report
Hand hygiene
Portable sinks were placed near protective equipment stations so people could wash their hands close to where equipment was used.
“The service had bought portable sinks to ensure staff and visitors were able to wash their hands in the exact vicinity of the PPE stations” from the report
Infection-control arrangements
Inspectors were assured that the home was using protective equipment safely, providing access to testing and managing possible outbreaks.
“We were assured that the provider was using PPE effectively and safely.” from the report
Shielding and social distancing
needs fixingInspectors were only somewhat assured that the home was meeting shielding and social distancing rules. The report does not give further detail about the shortfall.
“We were somewhat assured that the provider was meeting shielding and social distancing rules.” from the report
Layout and hygiene
needs fixingInspectors were only somewhat assured that the premises' layout and hygiene practices promoted safety. The home was signposted to resources to develop its approach.
“We were somewhat assured that the provider was promoting safety through the layout and hygiene practices of the premises.” from the report
- 01What changes have you made to shielding and social distancing arrangements since the inspection?
- 02What improvements have you made to the layout and hygiene practices of the premises?
- 03What resources were you signposted to, and how did you use them to improve infection control?
- 04How do you currently screen visitors, provide protective equipment and manage handwashing?
- 05How do you now support residents' social needs when family visits or entertainers cannot take place?
This was an announced thematic review of infection prevention and control only; no ratings were awarded for the overall service or the other four questions. This explanation was written from the published report of 14 November 2020 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, November 2018
Rated Good; inspectors found kind, personalised care, with some safety and record-keeping issues needing attention.
Inspectors made an unannounced, comprehensive visit on 16 October 2018. They reviewed records, checked the building, watched staff supporting people, and spoke with people living in the home, a relative, staff and other professionals.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found safe medicines systems, suitable staffing, caring staff, personalised care plans, activities and regular checks on quality.
Inspectors also found some issues. A small number of windows were not secured safely, some fire exit doors on upper floors needed a formal risk assessment, light pull cords were not covered for infection control, some refresher training was overdue, and some mental capacity records were not decision-specific. The provider said it would act on these points, and immediately addressed the windows.
Kind and respectful staff
People said staff were kind and caring. Inspectors saw staff being patient, polite and respectful, including when a person became upset.
“Observations throughout the inspection showed staff were caring and respected people's privacy.” from the report
Safe medicines systems
Medicines were administered by trained staff whose competence was checked regularly. The records inspected had no gaps or unexplained problems.
“Medicine administration records that we looked at were completed correctly with no gaps or anomalies.” from the report
Personalised support
Care plans included people's needs, preferences, likes and dislikes. Reviews were completed monthly and people were involved in decisions about their care.
“Care plans included people's personal preferences, likes and dislikes.” from the report
Quality monitoring
Managers and the provider carried out checks on care plans, health and safety and medicines. Records showed that issues found in audits were acted on quickly.
“Records confirmed that where audits identified issues action was quickly taken to address them.” from the report
Upper-floor fire exit risk
seriousSome people living with dementia had bedrooms on upper floors near fire exit doors that led to an external staircase. The area was not staffed at all times, so inspectors asked for a formal risk assessment.
“As this area was not covered by staff at all times we raised concern that a person could access this door and come to harm.” from the report
Some safety and infection control points
needs fixingSome windows were not secured as safely as they should have been, although the provider acted immediately. Light pull cords did not have washable protective covers, which could make infection control harder.
“We did note that pull cords from lights did not have a protective plastic covering so that they could be readily washed to prevent the spread of infection.” from the report
Records and training needed updating
needs fixingSome annual refresher training was overdue. Mental capacity assessments and best-interest decisions were present, but were not specific to each decision.
“Mental capacity assessments and best interest decision were available within care records we looked at, however, they were not decision specific.” from the report
Limited dementia activities
minorThe home offered activities, but inspectors found they were limited for people living with dementia. There had also been no recent trips out.
“The provider acknowledged that activities were limited for those people living with a dementia” from the report
- 01What formal risk assessment was completed for the upper-floor fire exit doors, and what protections are now in place?
- 02Have all windows been secured, and have the light pull cords been given washable protective covers?
- 03Has all overdue refresher training been completed, and how is this now monitored?
- 04Have mental capacity assessments and best-interest decisions been rewritten so they relate to each specific decision?
- 05What additional activities are now available for people living with dementia, and are trips out being offered?
This was an unannounced comprehensive inspection covering all five rating areas; the report says Safe had improved to Good while the other ratings remained Good. This explanation was written from the published report of 20 November 2018 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 Hillcrest Residential Home
3 rated inspections over 4 years: the service has improved, from Requires improvement to Good.
- November 2020Inspected but not ratedcurrent ratingSafe: Inspected but not rated
- November 2018Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2016Goodup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Good
- January 2014
Registered with the Care Quality Commission on 29 January 2014.
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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