We carried out a review of the data available to us about Hylton View on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Hylton View, you can give feedback on this service.
We found the following examples of good practice.
Staff used PPE correctly to help prevent the spread of infection. They had completed relevant IPC training, which included the correct use of PPE.
The home was clean and tidy. Enhanced cleaning had been introduced to help manage the recent COVID-19 outbreak. This included extra cleaning of frequent touchpoints.
The service had effective screening measures to help ensure visitors were safe to access the home. This included a negative COVID-19 test and wearing of PPE.
People were supported to maintain contact with relatives. Staff provided activities to engage people who lived at the service.
Hylton View is a residential care home providing personal and nursing care to 34 people aged from 65 and over, some of whom were living with a dementia. The service can support up to 40 people in one large adapted building.
People’s experience of using this service and what we found
People told us they were comfortable, happy and safe living at Hylton View. Relatives were positive about the service and were welcomed by staff. Staff positively engaged people in conversations and activities.
Medicines were generally managed safely, and the registered manager had created bespoke checks to remove any potential risks to people through unsafe administration. We found some areas relating to the use of topical medicines needed to be reviewed but these issues did not place anyone at risk of harm.
Care needs were fully assessed and used to create individual care plans. People’s support needs were reviewed regularly, and care plans were updated to reflect any changes.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were asked for their choices regarding their care and support needs. Sometimes relatives and advocates supported people to make sure their views were heard and recorded
The registered manager had worked to improve the service and regularly asked for feedback from staff, people, relatives and visitors to find new ways to develop the service. There was a robust quality assurance system in place to monitor the care provided. Results from this were used as a direction for improvement by the registered manager.
Staff were safely recruited and were provided with on-going training to make sure they had the essential skills and knowledge to support people. New staff were provided with an induction from the provider and supported by other staff to help them integrate into the staff team. The registered manager supported staff and ensured they received regular supervisions.
The premises were clean, safe and nicely decorated. Risks people may face were fully identified and mitigated. There were emergency procedures in place to keep people safe, for example evacuation and business continuity plans.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 5 May 2018) and there was a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was due to ineffective quality assurance systems and records not being fully accurate.
There was also an inspection on 8 April 2019. However, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the service had made sustained improvements and addressed all of the issues identified at the last inspection.
Why we inspected
This is a planned re-inspection because of the issue highlighted above.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions is the service safe, caring and well-led to at least good. We requested the provider supply the Commission with regular updates to enable close monitoring of progress. We found progress had been made and the provider was now meeting the regulation. We noted that throughout our inspection staff supervised communal lounges at all times to help keep people safe. People told us staff responded to their requests for assistance quickly. Improvements had been made so that medicines were manged appropriately. Records and our own observations confirmed people received their medicines safely.
Hylton View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hylton View accommodates up to 40 people across two separate units, each of which have separate adapted facilities. At the time of our inspection there were 35 people using the service, some of whom were living with dementia.
Since our last inspection the home had employed a new registered manager. A registered manager is a person who has registered with the Care Quality Commission 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. People, relatives and staff described the registered manager as approachable and supportive.
During this inspection we found the provider had breached the regulation relating to good governance. Quality assurance audits had not always been effective in identifying concerns, such as the lack of an in-depth falls analysis and inaccurate information in falls care plans and risk assessments.
You can see what action we told the provider to take at the back of the full version of the report.
Although we found improvements were required to the oversight of falls management in the home, the provider had ensured the relevant practical steps were in place to minimise the risk of individual people from falling. For example, increasing observations, providing specialist equipment and referring people to the falls team.
People, relatives and care workers told us the home was a safe place to live. People also described their care as good and said staff were kind and considerate.
Staff were knowledgeable about safeguarding and were aware of the provider’s whistle blowing procedure. Staff knew how to report concerns and confirmed they would have no hesitation in doing so if required. Previous safeguarding and whistle blowing concerns had been dealt with appropriately.
The provider completed various pre-employment checks to help ensure new care workers were suitable to care for people living in the home.
Regular health and safety checks were carried out to help keep the premises and specialist equipment safe to use. For example, checks of fire, gas and electrical safety. The provider also had policies and procedures to deal with emergency situations.
Staff told us they were well supported and received the training they needed. Supervisions, appraisals and training were up to date.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Staff supported people with maintaining their nutritional requirements in line with their individual needs. Where prompts or assistance were needed this was provided in a timely way.
People had input from external health professionals depending upon their individual circumstances. For example, GPs, community nurses and speech and language therapists.
People’s needs had been assessed both before and on admission to the home to identify their individual care needs. Although falls care plans were not accurate, the other care plans we viewed reflected people‘s needs and were up to date.
There were daily opportunities for people to participate in activities. These included trips out, memory quizzes, cinema nights, keep fit, singers, board games, cards and dominoes.
People gave us positive feedback about the care they received. Previous complaints had been investigated and resolved in line with the provider’s complaints procedure.
The registered manager held daily meetings with key staff to share important information about people using the service.
People and staff had regular opportunities to share their views about the care provided at the home through attending meetings.
The home provides nursing and residential care for up to 40 older people, some of whom are living with dementia. At the time of this inspection there were 39 people living at the home.
The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.
During this inspection we found the provider had breached the regulation relating to safe care and treatment because the arrangements for managing medicines were not always safe. Medicines records were not always completed accurately, such as for the administration of medicines, the application of topical medicines, the application of transdermal patches and for the safe storage of medicines. We also found people were left unsupervised for prolonged periods.
The monthly medicines audits had not been effective in identifying the issues we found with medicines management. Following this inspection there had been a further two serious incidents involving medicines. We have written to the provider separately about this matter and we will closely monitor the action the provider takes to make medicines management safe.
People, relatives and care workers said the home was safe. People also told us they received good care from kind care workers.
Care workers had a good understanding of safeguarding and the provider’s whistle blowing procedure. They knew how to report concerns but said they had not previously needed to use the procedures. Care workers also said the provider and registered manager would take concerns seriously and deal with them properly.
Assessments were carried out regularly to help protect people from potential risks, such as risks associated with poor nutrition, skin damage and mobility.
Although care workers confirmed there were sufficient care workers on duty, we observed there were occasions when people were left unsupervised in communal areas. The registered manager was taking action to improve the communication between care workers to ensure people were appropriately supervised.
An effective recruitment process was in place to check new care workers were suitable to work at the home. This included carrying out a range of checks before new care workers started working at the home.
Health and safety checks were carried regularly including checks of fire safety, specialist equipment, the electrical installation, gas safety, water safety and portable appliance testing. There were also documented procedures to deal with emergency situations including personal emergency evacuation plans (PEEPs) to help keep people safe.
The provider logged, investigated and analysed incidents and accidents. Action had been taken to help prevent accidents recurring such as referrals to the ‘falls team’, replacing inappropriate footwear and increased observations.
Care workers received the support and training they needed to fulfil their caring role. Records showed supervisions, appraisals and training were up to date for most care workers.
The provider followed the requirements of the Mental Capacity Act 2005 (MCA), including the Deprivation of Liberty Safeguards (DoLS). DoLS authorisations had been approved for all relevant people. Care workers got people’s consent before providing care. Care workers used various strategies to support people with making choices and decisions.
Care workers supported people to have enough to eat and drink in line with their needs. For example, one person required full assistance from a care worker which was provided appropriately. Other people received prompts and encouragement throughout the lunchtime. We saw one person who did not eat their full meal was not offered an alternative. Menu choices were limited with little availability of fresh fruit and vegetables. We have made a recommendation about this.
People had input from a range of external health professionals when required, such as GPs, specialist nurses, district nurses, speech and language therapists and dietitians. People’s care records included the advice and guidance from health professionals.
Since our last inspection care plans had been updated to ensure they reflected people’s current needs. We found they had been personalised to include information about people's care preferences.
People’s needs had been assessed to identify the care they required.
People had the opportunity to participate in a range of activities, such as outings, pub meals, quizzes and parlour games.
People told us they had not needed to complain about their care. Previous complaints had been investigated and resolved in line with the provider’s complaints procedure.
An annual audit plan had been developed and regular audits were taking place. Apart from medicines audits other audits were identifying areas for improvement and ensuring action was taken to address any concerns.
Care workers had opportunities to give their views and make suggestions through attending regular staff meetings or taking part in consultation.
Incidents and accidents were regularly analysed to check appropriate action had been taken and to identify trends and patterns.
The home had a long-term improvement plan with work on-going to complete the identified actions.
Hylton View is a purpose built care home which provides nursing and personal care for older people, some of whom may be living with dementia. It is registered to provide up to 40 places. All of the bedrooms are for single occupancy and are en-suite. At the time of this visit there were 37 people living at the home.
The last inspection of this home was carried out on 3 January 2014. The service met the regulations we inspected against at that time.
This inspection took place over two days. The first visit on 23 June 2015 was unannounced which meant the provider and staff did not know we were coming. Another visit was made on 29 June 2015.
The previous registered manager had left the service in April 2015. A new manager commenced work at the home in May 2015 but had not yet applied for registration. A registered manager is a person who has registered with the Care Quality Commission 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.
During this inspection we found the provider had breached a regulation relating to the prevention and control of infection. This was because some areas of the premises could not be kept fully clean, especially in bathrooms and toilets, because they had surfaces that were not sealed. Several armchairs that people sat on only had foam pads which were not covered so could not be kept clean. This compromised the control of infection as well as the dignity of the people who lived there.
The provider had also breached a regulation relating to personalised care because people’s individual care records were not always complete or up to date. This meant that it was not always possible to be clear if a person was appropriately cared for and supported in the right way.
The provider had also breached a regulation relating to quality assurance. This was because its quality assurance system had not been followed as there had been no visits to monitor the service since December 2014. Internal audits had not identified shortfalls, for example to care records and infection control, so they had not been effective in addressing areas that needed improvement.
You can see what action we told the provider to take at the back of the full version of the report.
The accommodation was not specifically adapted for people living with dementia, even though the home purported to provide a dementia care service. We have made a recommendation about this.
People said they felt safe and comfortable at the home. For example one person told us, “I’m safe as houses here.” Staff knew how to recognise and report any suspicions of abuse. Staff told us they were confident that any concerns would be listened to and investigated to make sure people were protected. Potential risks to people’s safety were assessed and managed. People’s medicines were managed although plans about ‘as and when’ medicines could be more specific.
People told us there were enough staff to meet their care needs. Care professionals told us it was a better service when agency staff were not used as they did not know people’s individual needs. People felt staff came “quickly” or “quite quickly” when they asked for assistance. The manager was going to look into how staff were deployed at mealtimes as several people needed support at those times. Staff were recruited in a safe way so that only suitable staff were employed.
The manager understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision and deprivation of liberty safeguards to make sure they were not restricted unnecessarily. Staff were to receive additional training in this area so that they understood people rights to an independent lifestyle, unless it was in their best interests to be safeguarded. People told us staff always asked for their consent before carrying out care tasks. They told us they made their own choices over their own daily lifestyle.
The people we spoke with felt staff were competent in their roles and they supported them in the right way. Staff had training in health and safety as well as care. The manager was arranging further training to make sure staff were fully up to date with the latest standards in care.
People were supported to eat and drink enough to meet their nutrition and hydration needs, although records about this needed to be more meaningful. The menus were repetitive, and did not include many options for vegetables, salads or fruit but people told us they could ask the cooks for alternative meals if they did not fancy the two main dishes. Dietetic and speech and language professionals told us they had no concerns at this time with the way people were supported with their nutrition.
People and relatives made many positive comments about the “caring” attitude of staff. One person told us, “The staff are smashing.” Another person commented, “Staff are lovely. When I’m feeling down they come in and help put a smile on my face.”
Relatives said there was a good atmosphere in the home and staff were friendly. One relative commented, “You are always made to feel very welcome here and staff are very obliging.” Staff were helpful and encouraging when assisting people.
People had opportunities to go out on local trips from time to time. There were also daily in-house activities and occasional entertainment. People had information about how to make a complaint or comment and these were acted upon.
People and relatives said the new manager was approachable. They felt they were asked for their views and opinions and there were regular residents’ meetings. Staff told us they felt the manager was approachable and open to their views. There were regular staff meetings for staff to be kept informed of the standards of care and expected practices.
We spoke to six people who used the service, two relatives and one visitor from another local service. We also spoke to staff members. We did speak to other people living at the home, although some found it difficult to express themselves.
We saw staff knocking on people's doors before entering and treating people with dignity. One staff member said, in relation to a resident choosing to lock their bedroom door at times, 'It may be more difficult for us to check that they are ok, but it's their (people's) decision at the end of the day.'
The majority of people, visitors and staff told us that they thought the home provided good quality care and treatment. We observed friendly caring conversations being exchanged between people and staff. We saw assessments of people's needs, with corresponding care plans and risk assessments too.
People were protected from the risk of abuse because safeguarding procedures were in place and staff were able to explain them.
We found that the home had generally good practices in the management of medicines.
There were complaints procedures in place and people were given opportunities and encouraged to tell staff if they had any concerns.
Records we looked at showed people's needs were assessed and care and treatment was planned and delivered in line with the individual care plan. We found a 'Do Not Attempt Resuscitation Order' in one file which had been appropriately completed, signed by a doctor and also by the person's next of kin. This meant the proper legal procedures were followed in ascertaining the wishes of the person.
People we spoke with told us they received regular medical care from their GP and from other healthcare professionals such as dentists, opticians, chiropodists and dieticians when required. This showed that people were receiving appropriate care and support from the NHS.
People we spoke with told us they felt comfortable and that they liked their bedrooms. One person told us, 'It is always nice and airy in here'. Another person said, 'I like my room and it is clean, nice and comfortable'.
People also told us that the food was good and they have always enjoyed their meals. One person told us, 'There is always plenty to eat and drink'. Another person said, 'if you don't like what is available they will give you something else that you fancy, but within limits, of course'.