Archived: Hillcrest Manor Nursing Home

We found the service had good systems in place to ensure the safe management of medicines. We found good medicine administration and disposal records meant that we were able to see that people using the service were having their medicines administered as prescribed. We found that medicines were being stored safely and the service had good systems in place to monitor the management of these medicines. This meant that people using the service were protected against the risks associated with medicines.

We observed positive interactions between the staff and the people who lived in the home and also between staff and relatives visiting. We spoke with people who used the service, their relatives and the staff during our inspection. Relatives told us, 'All the staff are wonderful and very helpful. They come when they are needed'. One person who lived at the home had not wanted to be assisted to get up earlier in the day. Their relative told us, 'Mum is being washed now and it's lunch but that's ok!' This showed that people's choice and wishes were respected.

Care plans were written in a way that ensured people were given choice about living their lives.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse from happening.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We reviewed information from other agencies that had visited the home to monitor infection control arrangements. It was considered that people who used the service were protected from the risk of infection because appropriate guidance had been followed.

We looked at the provider's quality assurance systems and found a range of monitoring processes in place to monitor the quality of the service provided.

We reviewed this area of people's care and found that improvements had been made. There was a system in place that people were assessed and monitored with regard to their individual hydration needs. Staff reported the system is working well. Relatives and friends of people who lived at the home told us they were happy with the care of their relative/friend received and that they had no concerns about their hydration.

We re-inspected these areas at our July 2013 inspection. Our conclusions were mixed.

Although people's care plans had been reviewed, we found that people were not receiving appropriate care based on an assessment of their needs. Not all information about people's needs was included or correctly recorded in care plans. For example people's fluid intake, or the minimum amount of fluid someone should be expected to drink in a day was not consistently recorded.

We found that the reporting of incidents into the safeguarding of vulnerable adults process had improved. However we found two incidents that had not been reported that potentially placed people at risk.

The home did not have effective systems in place to manage the risk of the spread of infection.

We found that systems to manage people's medication administration were not robust enough to ensure that people received the medication prescribed for them.

There was an improved robust recruitment procedure in place.

Staff received regular training and supervision.

The provider did not have an effective system to regularly asses and monitor the quality of the service that people received.

We returned to the home on 29 July 2013 following concerns that we had been made aware of. Our findings were the same as our previous visit.

Everyone we spoke to told us they were satisfied with their care although everyone raised the issue of constant manager changes and several people told us the home appeared to be short staffed.

During our visit we observed poor moving and handling practice. Staff told us that care plans were 'not good.' We were therefore unable to ascertain if an appropriate level of care was being provided, in line with their assessed needs.

We found that systems were not in place to protect vulnerable people from abuse. The provider had not followed reporting procedures following an allegation of abuse.

We found that previous managers had not carried out robust checks to ensure that staff appointed were suitable to work with vulnerable people. The home could not demonstrate that staff had been inducted to ensure that they had the skills and competencies required to carry out their roles effectively. The interim manager had commenced work the day before our inspection and acknowledged the service shortfalls.