Hoylands House

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 assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

The provider was previously in breach of the legal regulation in relation to staffing. Improvement was found at this assessment, and the provider was no longer in breach of this regulation.

This service scored 69 (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. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. We found the management team were open and transparent and wanted to drive improvement at the service. Accidents and incidents were reviewed and analysed to identify themes and trends and where appropriate measures put in place to prevent them happening again. Lessons learned were shared within the service and where appropriate the wider organisation.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Where people were moving into the service the provider worked with people, professionals and those close to them to establish their plan of care and ensure detailed transition plans were in place. Visits to the service were available so people could spend time getting to know their new environment and staff before they moved in permanently. This approach helped to reduce risks, lessen anxieties and to ensure the person received continuity of care. One family member told us about the transition for their relative and commented, “It went really smoothly.” Electronic care plans were also being introduced which would allow easier transfer of information to other professionals. Hospital passports were in place should people need to access healthcare support in an emergency.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff 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 provider shared concerns quickly and appropriately. Effective systems to provide oversight of accidents and incidents including safeguarding’s were in place. Most notifiable incidents were appropriately reported as required to external parties. However, some incidents were not always reported externally. We discussed this with the provider and they agreed to liaise with the local authority safeguarding team to ensure they were meeting their requirements for reporting and to revise their systems to ensure all parties received necessary information in a timely way. Staff had completed safeguarding training and the provider’s safeguarding policy guided staff about different types of abuse and how to raise a concern to ensure people were protected. One staff member told us, “I would report suspected abuse to the line manager or designated safeguarding leader.” Another staff member told us, “Report it straight away.” We observed that people were comfortable and at ease with staff. Staff were attentive and alert to any changes that might indicate people needed support. A family member told us when asked if they felt their relative was safe, “Yes I do.” Another family member commented, “They keep [person] feeling [person] is in a very safe place.” 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. We checked whether the service was working within the principles of the Mental capacity Act, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. All legal applications had been made in accordance with Deprivation of Liberty Safeguards (DoLS). This meant people’s rights were fully respected. The registered manager kept a record of DoLS applications and authorisations, and this was regularly reviewed to make sure authorisations were current.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risks to people had been assessed and risk assessments were in place to ensure people’s safety. People's risk assessments were reviewed regularly or as required, such as in response to their changing needs or after a significant event and appropriate referrals made to professionals. However, we asked the registered manager to ensure professionals were aware of any changes to behaviours which may require further guidance from professionals to fully mitigate any identified risks. We also asked the registered manager to review some care records and include interim guidance for staff whilst waiting for input from external professionals. Where we identified improvement, this was actioned by the registered manager immediately. Staff knew people well and understood when people required support to reduce the risk of avoidable harm. Staff had completed a range of training including training to support with managing risk. One staff member told us, “I have learned the importance of employing a low arousal approach ….. and work in a way that reduces risk and promotes well being.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The home was safely maintained; all necessary safety checks had been completed in relation to the premises. We asked the provider to reconsider timescales for completion of some maintenance items identified in a fire risk assessment audit which they agreed to do. The provider had policies in place for maintaining health and safety within the service. In addition to each person having their own self-contained apartment they had access to communal spaces, an activities area and a large secure garden. Apartments were personalised and reflected the people that lived there. People were supported to choose paint colours for their rooms and personalise their environment. One family member told us, “Everything in there, [Name] has chosen. It's completely [person’s] apartment.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. At the last assessment the provider was found to be in breach of the legal regulation relating to staffing. Improvements were found at this assessment, and the provider was no longer in breach of this regulation. However, the provider needed to continue to focus on recruitment, reducing agency usage and on providing a stable and regular staff team to ensure people had consistent and reliable support from staff that they knew well. The registered manager also needed to evidence more clearly cover provided for absence including cover provided by the senior team. Overall staff felt that staffing levels were safe and short notice cover provided. Some staff felt that staff vacancies at times affected teamwork, consistency and activities. One staff member commented, “The more staff, the better we can make the lives of residents. More activities in the community. Fun days out.” Staff were supported with their learning and development needs and encouraged to continually improve in their role. Staff had undertaken training to support the needs of people who lived at the service. Staff were trained appropriately in how to interact with autistic people and people with a learning disability. One staff member told us, “I have learned to understand a person and their individual behaviours with empathy and a proactive approach.” The provider operated safe recruitment practices and only suitable staff were employed to work at the service. Staff told us overall they felt well supported and were receiving regular supervision. Records showed supervisions and appraisals being completed with staff.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The environment was safe, clean and well cared for. Infection prevention control risks were safely managed. Staff were trained and understood their roles and responsibilities regarding safe infection control practices. Personal protective equipment (PPE), including gloves and aprons, were available and used by staff as required. We observed that people were clean, tidy and suitably dressed. Feedback from relatives did not highlight any concerns about cleanliness and hygiene at the service or how staff minimised the risk of infection.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. People were supported by staff who followed systems and processes to administer, record and store medicines safely. Regular medicines audits were carried out to ensure systems remained safe. However, the labels on some creams and liquids were smudged and unreadable and staff were not always recording the date of opening. The provider had already actioned the purchase of label covers to address the new labels smudging and agreed to remind staff to always record a date of opening. Staff received the necessary training, and their competence was assessed regularly. They worked closely with other healthcare professionals to ensure people’s medicines were reviewed regularly. They did this taking into account the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) and made sure people's medicines were reviewed by prescribers in line with these principles. One relative told us, “We always go to medicines reviews and staff keep us up to date with anything.”