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Reports


Inspection carried out on 20 November 2018

During a routine inspection

This inspection took place on 20 November 2018 and was unannounced.

Hylands House is a residential home which provides care to older people including some people who are living with dementia. Hylands House is registered to provide care for up to 21 people. At the time of our inspection there were 17 people living at the home. The home has spacious living areas and is set over two floors with lifts to enable people to easily access both floors. The home is set in a residential area with easy access to the local community and has a large garden.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

This service was last inspected in June 2016 when we rated the service as ‘Good’ overall. However, we found some improvements were required in the leadership of the service because systems of audits were not managed or regularly completed so it was difficult to see what had been identified as requiring improvement and what actions had been completed. At this inspection we found similar issues, so whilst the rating of the service remains ‘Good’ overall, further requirements are required to ensure checks and audits are recorded and effective and records are consistently maintained.

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 registered manager had recently gone on extended leave of absence and the provider had recruited a new manager to lead the service while the registered manager was away. The new manager had been in post for two weeks at the time of our inspection visit and was in the process of registering with us. This meant they would have the legal responsibilities of a registered person during the other registered manager’s absence.

People’s needs were met by sufficient numbers of staff. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Staff recognised the signs of potential abuse and knew how to protect people from harm. Staff had undertaken training to help them provide effective care to people. Staff had not always had opportunities to speak with a manager about their developmental needs, but this had been recognised by the new manager and action had been taken.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Deprivation of Liberty Safeguards applications had been submitted to the local authority when people’s care plans contained restrictions to keep them safe which people did not have the capacity to consent to.

People had sufficient amounts to eat and drink to ensure their dietary and nutritional needs were met. Staff supported people to access other health and social care services when they needed to and attend healthcare appointments when required. People received their medicines as prescribed.

People were treated with kindness by staff who knew them well and understood them. People were happy with the caring attitude of staff. Staff were respectful of people and promoted their dignity by supporting them to maintain their appearance.

People had person centred care plans which were inclusive of people’s views and wishes. Support plans were regularly reviewed so staff had the most up to date information to support people. Good communication between staff meant people’s changing needs were responded to appropriately.

Records and checks were not consistently maintained. The new manager spoke openly about some policies and procedures that ne

Inspection carried out on 2 June 2016

During a routine inspection

This inspection took place on 2 June 2016 and was unannounced.

Hylands House is a residential home which provides care to older people including some people who are living with dementia. Hylands House is registered to provide care for up to 21 people. At the time of our inspection there were 19 people living at the home.

This service was last inspected on 21 April 2015 and we found two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. Breaches were found regarding a lack of mental capacity assessments and we did not always receive statutory notifications when important incidents had occurred. At this inspection we looked to see if the home had responded to make the required improvements in the standard of care to meet the regulations. Whilst we found some areas of improvement had been made, for example with statutory notifications, further improvements were required regarding completion of mental capacity assessments for people who lacked capacity.

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.

Staff knew how to keep people safe from the risk of abuse. People told us they felt safe living at Hylands House and felt protected from abuse or poor practice.

The provider assessed risks to people’s health and welfare and wrote care plans that minimised the identified risks. However, some care plans and risk assessments required updating to make sure staff provided consistent support that met people’s needs.

There were enough staff on duty to meet people’s health needs although some people told us they wanted more activities and interests to keep them stimulated.

People’s medicines were managed, stored and administered safely in line with GP and pharmacist prescription instructions.

People were cared for by kind and compassionate staff, who knew people’s individual preferences and how they wanted their care provided. Staff understood people’s individual needs and abilities and they received updated information at shift handovers to ensure the care they provided, supported people’s needs. Staff received regular training and support that ensured people’s needs were met effectively.

Senior and care staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We saw improvements had been made to record when people lacked capacity, but more information was required to show what specific decisions people needed support with. The registered manager acknowledged people’s care plans did not always record this information but we saw staff knew how to support and encourage people to make choice. Records showed consideration had been made if a persons’ liberty may be deprived, as the provider had made nine applications to the local authority that had been approved.

People were offered meals that were suitable for their individual dietary needs and met their preferences. People were supported to eat and drink according to their needs, which minimised risks of malnutrition. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health, and when their health needs changed.

People and their representatives felt involved in care planning reviews and said staff provided the care required. Care was planned to meet people’s individual needs and abilities and care plans were reviewed although some information required updating to ensure staff had the necessary information to support people as their needs changed. People were supported to pursue their interests and hobbies and live their lives how they wished, b

Inspection carried out on 21 April 2015

During a routine inspection

This inspection took place on 21 April 2015 and was unannounced.

Hylands House is a two storey residential home which provides care to older people including people who are living with dementia. Hylands House is registered to provide care for 21 people. At the time of our inspection there were 21 people living at Hylands House.

There was a registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run.

People told us they felt safe living at Hylands House and staff knew how to keep people safe from the risk of abuse.

People said staff were respectful and kind towards them and we saw staff were caring to people throughout our visit. Staff protected people’s privacy and dignity when they provided care to people and staff asked people for their consent before any care was given.

Staff knew what support people required and staff provided the care in line with people’s care records. Care plans contained relevant information for staff to help them provide the individual care people required, although some care plans required a thorough review to ensure they continued to support people as their needs changed. We found people received care and support from staff who had the knowledge and experience to care for people.

People told us they received their medicines when required. Staff were trained to administer medicines and had been assessed as competent which meant people received their medicines from suitably trained and experienced staff.

Staff demonstrated a good awareness of the importance of keeping people safe. Staff understood their responsibilities for reporting any concerns regarding potential risks of abuse. The registered manager had not sent us statutory notifications when people were placed at risk of harm, however the registered manager told us the local authority responsible for safeguarding concerns had been informed.

The registered manager and staff had little understanding of how the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) affected the service people received. Staff understood they needed to respect people’s choices and decisions and where people had capacity, staff followed people’s wishes. Where people did not have capacity to make certain decisions, decisions were made on people’s behalf, sometimes with the support of family members. However, we found assessments of people’s capacity and records of best interests’ decisions had not been completed.

DoLS are safeguards used to protect people where their freedom or liberties are restricted. We found examples where people’s freedom maybe restricted but there were no applications made to the authorising body that showed these restrictions were authorised and least restrictive.

People told us they were pleased with the service they received. If anyone had concerns, these were listened to and responded to in a timely way which helped prevent formal complaints being received.

Regular checks were completed by the registered manager to identify and improve the quality of service people received, however actions and improvements were not always followed up and recorded.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 6 May 2014

During a routine inspection

A single inspector carried out this inspection.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Prior to our visit we reviewed all the information we had received from the provider. During the inspection we spoke with a total of seven people who used the service and three relatives and asked them for their views. We also spoke with three care workers, two senior care workers and the registered manager. We looked at some of the records held in the service including the care files for ten people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

The summary below describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People's needs had been assessed and individual care plans drawn up to meet people's needs. These assessments and plans included consideration of risks to the person and how these could be managed to keep the person safe. There were arrangements in place to deal with foreseeable emergencies. We were told by staff members we spoke with that they were able to contact a manager when they needed to.

We found that people had been cared for in an environment that was safe, clean and hygienic. A relative told, "The home is always clean, always spotless".

People were protected from the risk of abuse because the provider had ensured that safeguarding policies and procedures were in place and available to staff. Staff had been trained in safeguarding and knew what to do in the event of abuse being suspected, witnessed or alleged.

There were enough staff on duty to meet the needs of the people living at the home. People we spoke with told us there were enough staff to meet their needs. The family representatives we talked with also told us there were enough staff to meet their relative's needs. We were told by people who used the service and staff members that when there were three staff working it was harder for staff to meet people's needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. We saw people being cared for and supported in accordance with their plans. Staff had received training to meet the needs of the people living at the home.

We found that people had given their consent for the care and support they received. We saw that written consent was in place for personal care and for medical treatment. We discussed this with people and their family representatives who told us they had signed their consent forms and understood what they had signed.

Is the service caring?

People were supported by kind and attentive staff. We saw staff talking with people in a kind, calm and respectful manner. We observed staff supporting people to move about the home with patience and consideration. Staff we spoke with were knowledgeable about the individual needs of people. Staff told us they felt it was important to support people to remain as independent as possible. One staff member said "The number one thing is the people we support, it's a privilege to look after them".

People we spoke with told us, "Staff are excellent, all are very patient" and, "I can't fault the staff, they're great". Family representatives told us they were happy with the way their relative was cared for and supported.

Is the service responsive?

People's needs had been assessed before they moved into the home. We found that one person who had recently moved in to the home had been involved with their family members and other professionals in planning for their care. Individual arrangements were then put into place and implemented.

We found that each person's needs were regularly reviewed with care plans updated if needed. Records showed that people were supported in line with these plans.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We found that quality assurance processes were in place. People's views had been obtained by the provider along with the views of family representatives and staff.

Family representatives told us, "The staff are always supervised". People told us "This is a well run, small home with excellent staff". Staff told us, "The manager is very supportive" and "There's a great team here".

We found that staff received training and the manager was able to provide evidence that most of the staff held vocational qualifications relevant to their role. Staff told us they were clear about their roles and responsibilities.

Inspection carried out on 11 November 2013

During a routine inspection

We spoke with two relatives of people using the service and three people using the service. People expressed their satisfaction with the service that they or their relatives had received. One person spoke about the care their relative had received, ''X is well cared for. X looks immaculate.''

We found that systems were in place to allow people choice and independence. We found that people's individual needs had been met and care identified to support those needs. The people we spoke with identified satisfaction with their diet and told us they had been given food choices at each meal time. We saw during our lunch time observational exercise that people's nutrition and hydration needs were being met.

We spoke with staff and relatives about staffing levels at the home. People's relatives told us that there were sufficient staffing levels and there were always staff available to talk with. The staff we spoke with told us that generally staffing at the home was satisfactory and that any shortfalls in staffing were replaced. We looked to see whether staff were sufficiently skilled within their roles and saw evidence of on-going training in place to maintain staff skills and knowledge.

We found that the one complaint received had been dealt with quickly and relatives told us that they felt able to approach staff with any concerns or complaints they had. This showed that the provider had an effective complaints process in place.