Hoylands House

Hoylands House is a residential care home providing personal care to up to 8 people with a learning disability and autistic people. At the time of our inspection there were 6 people using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right support:

Staff supported people to have some choice and control in their everyday 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. Their ability to do this had been impacted by staffing shortages in the service which meant people were not always able to attend planned events and sometimes had to share support. The registered manager told us they had struggled to recruit staff. Staff recruitment is a known difficulty across the adult social care sector.

Right Care

People were not always supported by enough staff on duty who had been trained to do their jobs properly. The provider used effective infection, prevention and control measures to protect people from infection control risks. We were assured that the provider was using PPE effectively and safely. Staff supported people safely with their medicines and worked with health professionals to achieve good health outcomes. People lived in a safe and well-maintained environment which was set up to maximise their independence.

Right Culture

There were a number of areas we identified as requiring improvement during the inspection. Whilst the provider had systems in place to identify these, the systems had not been effective in ensuring the required changes had been made in a timely way.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 11 December 2018).

Why we inspected

We received provider level concerns. During the inspection we identified concerns relating to the staffing levels , staff training and governance.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the safe key question. We looked at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hoylands Hall on our website at www.cqc.org.uk.

Hoylands House is a ‘care home’ for adults with autism and additional learning disabilities or other complex needs. People in care homes receive accommodation and nursing or 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.

People living at the home had their own bedroom and en-suite bathroom. The home has communal lounges, a dining room, a sensory room and other multi-purpose rooms for art therapy and other activities. There is also a shop and activity centre on site. The care home can accommodate up to eight people and at the time of our visit seven people lived at Hoylands House. One bed was used for regular respite care.

There was a registered manager in post. 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.

The provider ensures the service operates 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. People with learning disabilities and autism using the service are helped to live as ordinary a life as any citizen.

Staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing development needs.

Relatives told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. Appropriate referrals were being made to the safeguarding team when this had been necessary.

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.

People were supported to maintain good health. This included access to healthcare professionals, and support with medicines. Medicines were being stored and managed safely.

Staff knew about people’s dietary needs and preferences. We saw when people indicated they wanted drinks or food; staff made this available. Relatives told us there was a good choice of meals and said the food was very good. They told us an ample supply of drinks and snacks were made available for people.

The service had made extensive efforts to integrate the service within the local community. Activities were on offer to keep people occupied both on a group and individual basis. Visitors were made to feel welcome and could have a meal at the home if they wished.

The service met the requirements of the Deprivation of Liberty Safeguards (DoLS) and was acting within the legal framework of the Mental Capacity Act (MCA).

We have made a recommendation to the service about the reviews of best interest decisions.

There was a comprehensive complaints policy and this was available to everyone who received a service including relatives and visitors. The procedure was on display in the service where everyone was able to access it.

Relatives and staff spoke highly of the registered manager who they said was approachable and supportive. The provider had effective systems in place to monitor the quality of care provided and where issues were identified, action had been taken to make improvements.

There were appropriate governance systems in place to ensure quality of care was monitored and improved. The service engaged positively with people using the service and relatives spoken with felt they were listened to and their contributions were valued.

Hoylands House is a care home for adults with autism and additional learning disabilities or other complex needs. People living at the home had their own bedroom and en-suite bathroom. The home has communal lounges, dining room, sensory room and multi-purpose rooms for art therapy and other activities. There is also a shop and activity centre on site. The home could accommodate eight people, at the time of our visit seven people lived at Hoylands House. One bed was used for regular respite.

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.

There was a strong person centred and caring culture in the home. (Person centred means that care is tailored to meet the needs and aspirations of each person, as an individual.) The vision of the service was shared by the management team and staff.

Staff told us they worked as part of a team that was a good place to work and staff were very committed to providing care that was centred on people’s individual needs. Staff received the training they needed to deliver a high standard of care. They told us that they received a lot of training and could access any training specific to their job.

Everyone we spoke with, including people who used the service, their relatives and external professionals said people received individualised care. They said the service provided specialist care for people who at times presented with behaviour that may challenge others.

There were systems in place to manage risks, safeguarding matters and medication and this ensured people’s safety. Where people displayed behaviour that was challenging the training and guidance given to staff helped them to manage situations in a consistent and positive way which protected people’s dignity and rights.

People received care and support that was responsive to their needs. Care plans provided detailed information about people so staff knew exactly how they wished to be cared for in a personalised way. People were at the for front of the service and were cared for as individuals and encouraged to maintain their independence. A wide and varied range of activities was on offer for people to participate in if they wished. Regular outings were also organised outside of the home and people were encouraged to pursue their own interests and hobbies.

CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The members of the management team and nurses we spoke with had a full and up to date understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. We found that appropriate DoLS applications had been made, and staff were acting in accordance with DoLS authorisations.

We saw that staff recruited had the right values, and skills to work with people who used the service. Where any issues regarding safety were identified in the recruitment process appropriate safeguards had been put in place. Staff rotas showed that the staffing levels remained at the levels required to ensure all peoples needs were met and helped to keep people safe.

Systems were in place which continuously assessed and monitored the quality of the service, including obtaining feedback from people who used the service and their relatives. Records showed that systems for recording and managing complaints, safeguarding concerns and incidents and accidents were managed well and that management took steps to learn from such events and put measures in place which meant lessons were learnt and they were less likely to happen again.

People experienced care, treatment and support that met their needs and protected their rights. Relatives of people living at the home told us 'It's absolutely first class', and 'I have absolutely nothing negative to say about the place.'

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 and prevent abuse from happening.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff were able to undertake further training in order to improve and develop their skills.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.