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Inspection carried out on 14 August 2018

During a routine inspection

Hylton House is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hylton House accommodates eight people with a learning disability in one adapted building. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. At the time of this inspection there were eight people using the service.

This inspection took place on 14 August 2018. At our last comprehensive inspection of the service in July 2017 we found the provider in breach of legal requirements regarding need for consent. We also found staff did not feel valued or rewarded by the provider which was having an impact on morale and motivation within the staff team. We gave the service an overall rating of ‘requires improvement’ as well as in the key questions ‘is the service effective?’ and ‘is the service well led?’.

At a focused inspection in October 2017 we found the provider had acted to improve and had met legal requirements regarding need for consent. We changed the rating for the key question ‘is the service effective?’ to good and the overall rating for the service to ‘good’.

At this inspection we found the evidence continued to support the overall rating of ‘good’. Additionally, we found the service had improved to ‘good’ for the key question ‘is the service well led?’. The provider had used the learning from our last inspection to make themselves more available and accessible to staff and had better insight into staff’s issues and concerns about their roles. They had also introduced new initiatives to reward and motivate staff. Staff told us they felt better supported by the provider and morale amongst the staff team was now good.

People were safe at Hylton House. Staff knew how to safeguard people from the risk of abuse and understood how to report any concerns about people to the appropriate person or authorities. Risks to people's health, safety and wellbeing were assessed and reviewed and staff followed current guidance on how these should be minimised to keep people safe from injury or harm. The provider acted to make improvements when things went wrong. At this inspection we saw improvements had been made following an injury incurred by a person that would help to reduce the risk of a similar injury reoccurring.

The provider maintained a servicing programme of the premises and the equipment to ensure areas covered by these checks did not pose unnecessary risks to people. Hylton House was clean and clear of slip and trip hazards. Staff followed good practice to ensure risks to people were minimised from poor hygiene and cleanliness when providing personal care, when cleaning the premises and when preparing and storing food.

There were enough staff to meet people’s needs. The provider continued to undertake recruitment checks to verify staff's suitability to support people. Staff received training to keep their knowledge and skills up to date with best practice and were set work objectives that were focussed on people experiencing good quality care and support. Staff knew people well and understood people’s needs, preferences and choices. They were aware of people’s preferred communication methods and how people expressed their needs.

People and their representatives continued to be involved in planning their care so that they received personalised support. Staff adhered to current best practice, legislation and standards to support people to experience good outcomes in relation to their healthcare needs. People’s needs were discussed and reviewed regularly to ensure the support provided continued to meet these needs and to identify any improvements or changes required.

People were supported to keep h

Inspection carried out on 30 October 2017

During an inspection looking at part of the service

We carried out a comprehensive inspection of this service on 26 July 2017 at which a breach of legal requirements was found. We found the provider was not fully aware of the requirements of The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They were placing restrictions on one person at the service without the necessary legal authorisation to do so. After the inspection, the provider wrote to us with a plan for how they would meet legal requirements in relation to this breach.

We undertook this focused inspection on 30 October 2017. We checked the provider had followed their plan and made the improvement they said they would to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hylton House on our website at www.cqc.org.uk

Hylton House is a small care home which provides care and accommodation for up to eight adults. The service specialises in supporting people with a learning disability, physical disability and/or sensory impairment. At the time of our inspection there were eight people living in the home.

The service is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The previous registered manager left the service in December 2015. A new permanent home manager was appointed in August 2016 and at the time of this inspection was waiting to hear the outcome of their registered manager application to CQC.

At this inspection we found the provider had taken the action they said they would and now met legal requirements.

Following our inspection, senior staff had taken prompt action to submit an application to lawfully deprive the person they had been placing restrictions on, of their liberty, and this had been authorised by the appropriate body. We saw the provider was complying with the conditions applied to this authorisation.

Senior staff had reviewed their understanding of their legal responsibilities in respect of the MCA and DoLS to ensure they were up to date with current guidance. They had met with all staff to ensure they were also up to date in terms of their knowledge and understanding of their legal responsibilities and were confident that they were. To support all staff with their understanding the provider had updated their policy for DoLS and we saw this had been expanded to include people using the service on short term respite care.

To seek additional assurances that legal requirements were being complied with, the home manager as part of their monthly checks of the service, reviewed all current DoLS authorisations to ensure these were being complied with and continued to be appropriate for the person.

Inspection carried out on 26 July 2017

During a routine inspection

Hylton House is a small care home which provides care and accommodation for up to eight adults. The service specialises in supporting people with a learning disability, physical disability and/or sensory impairment. At the time of our inspection there were eight people living in the home. At the last Care Quality Commission (CQC) inspection in June 2015, the service was rated Good.

At this inspection we found senior staff were not fully aware of the requirements of The Mental Capacity Act 2005 (MCA). They were placing restrictions on one person at the service without the necessary legal authorisation to do so. We identified a breach of the regulations. This was in regards to need for consent. You can see the action we have told the provider to take with regard this breach at the back of the full version of this report.

We received mixed feedback about the management and leadership of the service. There was no registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider appointed a new home manager for the service who at the time of this inspection was in the process of finalising their application to CQC to become the registered manager for this service. People’s relatives and representatives, staff and healthcare professionals said the home manager and the rest of the senior staff team were open, transparent and supportive. However staff did not feel valued or rewarded by the provider which was having an impact on morale and motivation within the staff team.

Senior staff carried out regular checks of the service to monitor and review the quality of care and support provided to people. They sought feedback from relatives and representatives, staff and healthcare professionals about how the service could be improved.

Notwithstanding the issues above, feedback from people’s relatives and representatives, and healthcare professionals, indicated a high level of satisfaction and confidence with the service. The provider maintained appropriate arrangements to deal with people’s concerns or complaints if they were unhappy with any aspect of the support provided.

People continued to be safe at Hylton House. Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people in the home and community. There were enough staff at the time of this inspection to keep people safe. The provider had appropriate arrangements in place to check the suitability and fitness of any new and existing staff.

Staff were kind, caring and attentive. They treated people with dignity and respect and ensured people’s privacy was maintained at all times particularly when being supported with their personal care needs. People at the end of their life experienced comfortable and dignified care that met their needs and wishes.

People had a personalised support plan which set out how their care and support needs should be met by staff. These were reviewed regularly. Staff received regular and relevant training and were supported by the senior staff team to help them to meet people’s needs effectively.

People remained active and participated in a broad range of activities and events to meet their social and physical needs. The service continued to work with external organisations to support people, particularly with their communication needs and emotional wellbeing. They used learning from this to develop their understanding of people's needs and how to support people to achieve positive outcomes in relation to their health and wellbeing. Staff communicated with people using their preferred methods of communication.

Staff ensured that people ate and drank sufficient amounts to meet their

Inspection carried out on 23/06/2015

During a routine inspection

This inspection took place on 23 June 2015 and was unannounced. At the last inspection on 18 October 2013 we found the service was meeting the regulations we looked at.

Hylton House is a small care home which provides personal care, support and accommodation for a maximum of six adults. People using the service have learning disabilities, physical disabilities and/or sensory impairment. There were five people living at the home at the time of our inspection. The service also provided a respite service, to a sixth person who uses the service some weekends.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Relatives, visitors and health and social care professionals all told us people were safe at Hylton House. Staff knew how to protect people if they suspected they were at risk of abuse or harm. They had received training in safeguarding adults at risk and knew how and when to report their concerns if they suspected someone was at risk of abuse. The provider had a formal procedure in place for staff to follow to ensure concerns were reported to the appropriate person.

There were appropriate plans in place to ensure identified risks to people were minimised. Staff had access to appropriate guidance and knew how to minimise identified risks in order to keep people safe from injury or harm in the home and community. Managers ensured regular maintenance and service checks were carried out at the home to ensure the environment and equipment was safe. Staff kept the home free of obstacles so that people could move freely and safely around.

There were enough suitable staff to care for and support people. Managers continuously reviewed and planned staffing levels to ensure there were enough staff to meet the needs of people using the service. They carried out appropriate checks on staff to ensure they were suitable and fit to work at the home. Staff received relevant training to help them in their roles. Staff felt very well supported by managers and were provided with many opportunities to share their views and ideas about how people’s experiences could be improved. Staff were motivated, enthusiastic and told us they enjoyed working at the home.

People experienced outstanding care. People's feedback about the service universally praised the care and kindness shown by staff towards not only people living in the home but to their relatives and others that visited the home. We observed many instances of warm, kind and gentle interactions between people and staff in which people’s needs, wishes and choices were always respected. Staff’s priorities were clearly focussed on ensuring that people's care and support needs were met and they had an excellent understanding and awareness of how to do this. This included ‘going the extra mile’ as one visitor to the home described to us. The way staff supported people during the inspection was always kind, thoughtful and caring.

Staff treated people with great respect. Staff spoke with people in a warm and respectful way and ensured information they wanted to communicate to people was done in a way that people could understand. Staff knew how to ensure that people received care and support in a dignified way and which maintained their privacy at all times. Staff also positively supported people, where appropriate, to retain as much control and independence as possible, when carrying out activities and tasks.

People were supported to keep healthy and well. Staff ensured people were able to access other healthcare services quickly when this was needed. Staff worked proactively with healthcare professionals to ensure people got the care and support they needed. Medicines were stored safely, and people received their medicines as prescribed. People were encouraged to drink and eat sufficient amounts to reduce the risk to them of malnutrition and dehydration.

Support plans had been developed for each person using the service which reflected their specific needs and preferences for how they were cared for and supported. Support plans gave guidance and instructions to staff on how people’s needs should be met. Staff ensured that people, their relatives, advocate and other relevant healthcare professionals were all actively involved in making decisions about their care and support needs. These were discussed and reviewed with people regularly.

People told us the home was always open and welcoming to visitors and relatives. People were encouraged to maintain relationships that were important to them. People were also supported to undertake activities and outings of their choosing. Relatives and visitors said they would feel comfortable raising any issues or concerns directly with staff. There were arrangements in place to deal with people's complaints, appropriately.

Managers demonstrated good leadership. All of the people we spoke with commonly referred to managers as 'excellent’, 'approachable' and 'supportive' and that this was the reason why people experienced good quality care. They proactively sought the views of people, relatives, visitors, staff and other healthcare professionals about how the care and support people received could be improved. They ensured staff were clear about their duties and responsibilities to the people they cared for and accountable for how they were meeting their needs.

The provider and managers carried out regular checks of key aspects of the service to monitor and assess the safety and quality of the service that people experienced. Managers took appropriate action to make changes and improvements when this was needed. Managers used learning from incidents and inspections to identify how the service could be improved. They worked proactively with healthcare professionals to share and learn best practice so that the quality of care and support people experienced was continuously improved.

Managers had sufficient training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) to understand when an application should be made and in how to submit one. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

Inspection carried out on 18 October 2013

During a routine inspection

Due to their complex needs, the five people living at Hylton House were unable to share direct views about their care. We therefore used observations and looked at care records to help us understand their experiences. We met with the registered manager and four members of staff.

People living in the home had learning and physical disabilities, sensory needs and could not communicate verbally. During our visit we saw positive interactions between staff and people who use the service. The staff showed understanding and insight into people's different needs and knew how to respond to individual communication styles and body language of people using the service. We saw that people were relaxed and comfortable around the staff.

People using the service had personalised care plans that were regularly reviewed to make sure they got appropriate care and support. Where people did not have mental capacity to consent, care was provided in their best interests. A wide range of health and social care professionals were involved in people's care. Others close to them, such as their family members, were also involved in decisions about their care.

People had the right specialist equipment to promote their independence and meet their assessed needs. Arrangements were in place to check that equipment was safe for people to use.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were safe and effective staff recruitment processes in place. This meant people were protected from the risk of being cared for by unsuitable staff. There were enough staff on duty to provide the level of care and support each person needed. People were supported by staff who knew them well and understood their needs.

Inspection carried out on 15 February 2013

During a routine inspection

Due to their complex needs, the people living at Hylton House were unable to share direct views about their care experiences. In order to make judgements about the care that individuals received, we observed care practices; staff interactions and checked three people's records of care. We met with the deputy manager and four members of staff. We also spoke to the relatives of three people. Comments from relatives included, �it�s a lovely home, and the residents seem to be loved and well cared for� and �X gets the best possible care.�

People living in the home have learning and physical disabilities, sensory needs and no verbal communication. During our visit we saw positive interactions between staff and people who use the service. People were offered choices, supported to feel involved and staff knew how they should respond to their communication styles or body language. We saw that people were relaxed and comfortable in their surroundings.

People benefitted from a stable staff team who have worked at Hylton House for several years. Relatives described the staff as �really, really nice�, �very compassionate� and �warm, caring people.� Staff told us that they were happy working at the home and felt well supported by the manager.

Plans of care were person centred, well created and closely reflected the specific needs of the person. People's needs were regularly reviewed to make sure they got the right care and support.

Reports under our old system of regulation (including those from before CQC was created)