Hylton Grange

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. ​

At our last inspection we rated this key question good. At this inspection the rating has change to requires improvement. This meant people were not protected from abuse and avoidable harm.The service was in breach of legal regulations in relation to safe care and treatment.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Any incidents about people's safety were discussed with staff in a timely way, with action taken to reduce further risks. A staff member commented, “Learning is shared at the daily team meetings at 08:00 and the ‘huddle’ meeting mid-morning.” However, lessons were not consistently learned from incidents, to prevent similar incidents occurring and to raise awareness of complying with standards and safe working practices. For example, with regard to medicines management.

Staff at the service worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. Staff made sure there was always continuity of care, including when people moved between different services. Detailed information was collected before people started to use the service, and ‘passports’ were available with information to take when attending hospital or other health appointments.

Staff at the service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared safeguarding concerns quickly and appropriately. People and relatives told us they felt safe, they would speak with staff if they were worried, and they always felt listened to. Their comments included, “I am safe, staff do as much as they can” and “[Name] is safe, it is very good here.”

Staff always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that met people’s needs and was safe, supportive and enabled people to do the things that mattered to them. Risks were assessed to ensure people were safe and staff took action to reduce any identified risks. A person told us, “There is a sensor on my door, so if any of the residents come into my room, that raises the alert to staff, that there is someone in the room.” Risks were identified and transferred to care plans, including for the management of distress and agitation to reduce risks and help to keep people safe, however not all care plans for agitation and distress or 'when required protocols' included guidance regarding use of ‘when required’ medicines as a last resort. Staff supported people safely and appropriate equipment was available where people needed assistance.

The provider was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care. Equipment was regularly serviced to maintain safety. A person commented, “They [staff] got us a shower chair and comfy chair.” Another person commented, “I am waiting for wheelchair services to deliver, so I can get outside the building.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff members confirmed they received opportunities for training and development. Their comments included, “When I started, I did 3 shadow shifts and had a good introduction to the people here”, “We have training about positive behaviour support.” Staff worked together well to provide safe care that met people’s individual needs. A staff member commented, “It is challenging, but rewarding work” and “I think the managers are committed to getting staffing right. There are less agency staff now, we tend to have regular agency staff, so they get to know the people.” Several people were provided with 1 to 1 support. People told us they felt safe with staff support, and people and most relatives thought there were sufficient staff. Their comments included, “Generally, there are enough staff” and “[Name] is never alone, once I am here, staff leave us.” Staff were recruited safely.

Staff assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff told us personal protective equipment (PPE) and all cleaning materials needed were available. They confirmed they had received infection control training. A person commented, “My room is lovely. It is cleaned every day, it is clean and tidy.”

Staff at the service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.At the last inspection improvements were needed to medicine management. At this inspection there were the same areas of improvement still required or where they had been made, they had not been sustained. Although people were not harmed, there was a breach of regulation for safe care and treatment due to the risk of harm.

Records of regularly prescribed medicines followed national guidance, including recording people’s allergies. However, staff had identified that stock did not balance with records and stock adjustments had been made on the electronic medicine record without investigation, which is not in line with the provider’s policy. This meant we could not be sure medicines were administered as prescribed. Duplicated records meant that 1 person had medicine administered at an incorrect dose. Doses of a time sensitive medicine for another person were administered too close together, which meant this was not safe.

For creams applied by care staff as part of personal care; some guidance was missing, and records were not fully completed. Patch application records were not fully completed to show rotation in line with manufacturers guidance to prevent side effects.Some people were prescribed medicines to be taken on a ‘when required’ basis or with a variable dose. Information for how these medicines should be administered needed further person-centred detail. Where administration was dependent on monitoring and staff observations, these records were not fully completed.For 2 people with diabetes there was no evidence that testing had been done in line with their care plan.

Medicines were stored securely including controlled drugs. Temperatures were recorded for the medicine rooms and fridges; however, there were some gaps, and the minimum and maximum temperatures had not been recorded in line with policy. The fridge maximum temperature had been out of range on 1 unit and had not been investigated to ensure medicines were safe to use.

Audits were completed regularly but had not picked up some of the issues identified at inspection.