CQC report explained · a nursing home
What the CQC found at Hilltop Court Nursing 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, January 2023
Rated Requires Improvement; inspectors found caring staff and some safety improvements, but governance remained in breach.
This was an unannounced inspection on 07 December 2022. Inspectors spoke with people living at the home, relatives and staff. They also checked care records, medicines records, staff files and management records.
The home was not always safe, effective, responsive or well-led. Inspectors found gaps in care planning, medicines records, oral care and legal records for people who could not make some decisions for themselves. Activities and communication with some relatives also needed improvement.
There were positive findings. Staff were caring, asked for consent and understood people's preferences. Staffing was safely planned, medicines were safer than at the previous inspection, people could access healthcare, and infection control arrangements were satisfactory.
The overall rating remained Requires Improvement. The home had met previous warning notices and was no longer in breach of Regulations 9 and 12, but it remained in breach of Regulation 17 because its systems did not reliably identify and address problems.
Respectful care
Inspectors saw staff asking for consent and respecting people's privacy before entering bedrooms.
“During the inspection we observed staff asking people for consent before they delivered care and knocking on closed bedroom doors before entering.” from the report
Staffing and recruitment
Recruitment checks were completed, staffing levels were planned around people's needs, and staff were visible in communal areas.
“Throughout our inspection, we observed staff present in communal areas to ensure people's needs were met.” from the report
Healthcare access
People were supported to see GPs and other health professionals when needed.
“People confirmed they were supported to access their GP and other health services when required.” from the report
Communication needs
People's communication needs were assessed, recorded and supported with different formats or languages when requested.
“The communication needs of people were assessed and understood.” from the report
Weak management checks
seriousThe home's audits and oversight did not reliably identify risks or show that care was consistently personalised. This was a continued breach of Regulation 17.
“Systems were not robust enough to assess, monitor and mitigate risks to the health, safety and welfare of people using the service.” from the report
Incomplete care and medicines records
needs fixingRecords did not always show whether thickener had been added to drinks, and some cream records were inconsistent. This could make it harder to confirm that important care had been given.
“Administration records were inconsistent and didn't always confirm whether thickener had been added.” from the report
Expired legal authorisation
seriousSome records about decisions made for people who lacked capacity were out of date. One authorisation allowing restrictions on a person's liberty had expired.
“Records were not always up to date and one person's DoLS authorisation had recently expired.” from the report
Limited activities
minorInspectors saw few activities and received mixed feedback about the range available. The provider was asked to develop activities that better reflected people's hobbies and interests.
“Feedback was mixed about the variety of activities on offer and we observed limited activities taking place during our inspection.” from the report
Communication with relatives
minorSome relatives said management changes had affected the information they received and that it could be difficult to speak to the home by telephone.
“Some family members told us frequent management changes had impacted on the communication they received.” from the report
- 01How are you checking that thickener and prescribed creams are recorded correctly every time?
- 02How do you make sure all legal authorisations and decision records are current?
- 03What is the current plan to improve oral care, and how will you check that people's needs are being met?
- 04What activities are now available for people with different interests and for people living with dementia?
- 05How will relatives receive regular updates from the new management team?
This was a focused inspection of Safe, Effective, Responsive and Well-led; Caring was not inspected and its previous rating was carried forward into the overall rating. This explanation was written from the published report of 27 January 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, April 2022
Rated Requires Improvement; inspectors found risks with medicines, person-centred care and management oversight, with warning notices issued.
This was an unannounced focused inspection on 1 and 9 February 2022. Inspectors looked at Safe, Responsive and Well-led. They spoke with people, relatives and staff, and checked care records, medicines records, staff files and management records.
Medicines were not always managed safely. Records gave different instructions about thickened drinks, some medicines lacked clear guidance, and some medicines were stored incorrectly. This placed people at risk of harm, including choking.
People did not always receive personalised care or enough activities and social interaction. Some staff were caring, but inspectors also saw staff speaking sharply or not interacting with people appropriately. The home was clean and infection control arrangements were in place.
The home remains Requires Improvement, as it was at the previous inspection and for the last three inspections. The provider was still in breach of Regulations 9 and 17, and was also in breach of Regulation 12 at this inspection.
Clean and infection controlled
The home was clean and inspectors were assured that infection prevention measures, personal protective equipment, testing and visiting arrangements were in place.
“The home was clean and had infection control measures in place.” from the report
Safeguarding awareness
Staff had training about protecting people from abuse and understood how to report concerns. The manager reviewed incidents and safeguarding investigations.
“Staff had received up-to-date training about how to protect people from harm and abuse.” from the report
Safe recruitment and checks
The home carried out police checks and obtained references before employing staff. Environmental safety checks and emergency evacuation plans were also in place.
“These checks included police checks and references from previous employers.” from the report
Some improvements since the last inspection
Inspectors found improvements in oral healthcare, monitoring and bedroom privacy. The management team also responded quickly when concerns were raised during this inspection.
“Some improvements had been made since the last inspection in the provision of oral healthcare, monitoring and bedroom privacy since the last inspection.” from the report
Unsafe medicines management
seriousSome people were at risk because thickened drinks were not always prepared to the correct consistency. There were also gaps in guidance, storage, disposal, temperature checks and records for some medicines.
“People had been placed at the risk of harm from unsafe administration and management of medicines.” from the report
Care was not personalised
seriousCare plans did not contain enough information about people's histories, preferences and choices. Inspectors also saw people eating in unsuitable positions and staff using inconsistent practices during meals.
“People were not provided with individualised care that met their needs.” from the report
Too few activities and interactions
needs fixingPeople had received very little or no activity in the previous month. Some people were left without stimulation, and inspectors saw staff telling people to sit down when they wanted to walk around.
“People were sat or walking around the units with no stimulation or social interaction.” from the report
Weak management oversight
seriousAudits, meetings and daily checks had not found the problems identified by inspectors. Similar concerns had remained across several inspections.
“We have not been assured the provider is able to make and sustain improvements from previous inspections.” from the report
- 01What has changed to make sure thickened drinks are prepared to the correct consistency, and how is this checked?
- 02How are medicines that are given when required, covertly or from refrigerated storage now documented and monitored?
- 03How will you record each person's history, preferences and choices so agency and new staff can provide personalised care?
- 04What activities and meaningful interactions are now available, including for people who spend much of their time in bed?
- 05How do your audits now identify and act on medicine safety, staff interactions and person-centred care problems?
This was a focused inspection of Safe, Responsive and Well-led; the Effective and Caring ratings were not inspected and were carried forward from the previous inspection. This explanation was written from the published report of 14 April 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 Hilltop Court Nursing Home
9 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- January 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- April 2022Requires improvementstayed Requires improvementSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2021Requires improvementstayed Requires improvementSafe: GoodEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2020Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Inadequate
- August 2019Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Good
- August 2018Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- April 2018Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2017Goodup from Requires improvementSafe: Requires improvementResponsive: Good
- November 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- November 2014
Report published without a new overall rating.
- July 2014
Report published without a new overall rating.
- March 2014
Report published without a new overall rating.
- March 2014
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- November 2012
Registered with the Care Quality Commission on 27 November 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.
“Primrose is a very kind and compassionate healthcare professional”
“She is an exemplary carer, she is knowledgable empathetic and very respectful in the home.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.