Hylands House Care Home

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 good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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.

Meetings with people were seen as an opportunity for learning. We saw records documenting when improvements had been made following people’s feedback. Relatives confirmed they had no concerns about safety and were informed of any falls or incidents involving their family member.

Staff told us communication was effective, and they were kept informed of any changes to people's needs. One staff member told us, “Any problem is passed over during handover, and we would document it on the resident’s record, so everyone is aware.” Another said, “I can be honest with them [registered manager] if we make a mistake. They would organise training and help me improve.”

The provider ensured consistent communication throughout the staff team through handovers, daily meetings and messages on the electronic care planning system. The management team monitored incidents, accidents and any illnesses in the home. This information was analysed to identify any trends and themes to make improvements to people’s care plans.

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.

When people needed extra support, the registered manager arranged for staff to accompany them to hospital appointments. We were told of an example where 1 person had been supported to 4 consecutive appointments by the same member of care staff. This staff member knew the person well and demonstrated ways to best support the person when they were in pain or distress. This promoted continuity of care and ensured effective sharing of information. One healthcare professional told us concerns were raised promptly, and they were always supported by the registered manager when visiting people in the home. They said, “She appears to know her residents very well and gives me a clear history about each resident I am asked to review.” Another health and social care professional told us they mostly communicated with the registered manager who was, “On it” and “Shares relevant information throughout the team so everybody knows the plan for the individual.”

The provider followed the “red bag scheme” which is a pathway of care for people in care homes who require hospital treatment. The bag contains essential items for a hospital visit including information about the person’s medicines and allergies and any support they need with eating, drinking and moving around safely. This ensured people’s needs could continue to be met during a transition between services.

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.

Relatives told us they had no concerns over their loved one’s safety but if they did, they would feel comfortable raising them with the registered manager. People told us they felt safe living at Hylands House with 1 person commenting, “The carers here never do things wrong, so I don't need to worry about that.”

Staff could recognise the different types of abuse and received regular training about safeguarding. They were aware of processes to follow if a safeguarding concern was identified and felt confident to raise concerns to the registered manager. They also felt assured any safeguarding concerns would be taken seriously and acted on. One staff member described not meeting people's needs or offering them choices as a form of abuse and added, “I would hope they (managers) would do something but if they didn’t, I would take it further, to CQC and adult safeguarding.”

The registered manager worked to avoid safeguarding incidents from happening. Safeguarding referrals were submitted to the local authority in a timely manner when needed, for example, when someone had a fall resulting in a serious injury. Information about the local safeguarding processes was displayed and accessible to staff and visitors in the home

When receiving care and treatment, people can only be deprived of their liberty with the appropriate legal authority. In care homes, this can be done through a procedure called The Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act (MCA) 2005. We checked how the provider managed DoLS within the home. Where people had restrictions in their care plans that they had been assessed as not having the capacity to consent to, the provider ensured DoLS applications had been submitted to the relevant supervising body.

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.

People had assessments in place which identified risks and provided guidance to staff on how to provide care, which encouraged independence but also kept people safe. This included information about the number of staff and the equipment required to move and transfer people safely or to reduce their risk of falling. One relative told us how staff used alternative cutlery and crockery to minimise identified risks to their loved one’s health and safety whilst still promoting their independence. We saw guidance for staff related to this, recorded in the person’s care records.

Staff told us they used guidance in care plans to keep people safe. For example, 1 staff member described the checks they completed when providing personal care to identify any damage to people’s skin. Another spoke of the importance of making sure people had suitable equipment available and within reach when mobilising around the home.

People had a variety of equipment available to support their mobility and independence. We observed that staff monitored people as they moved around the home. They walked alongside people at their pace and did not rush them, providing a supportive hand, encouragement and reassurance where needed.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The provider had processes to ensure equipment and essential services such as gas and electricity were regularly checked and maintained in good order. Care plans prompted staff to check the safety of equipment before use. One staff member confirmed issues with faulty equipment were promptly addressed. We reviewed maintenance records and saw evidence of staff identifying and reporting faults, and these being rectified by the provider in a timely way.

However, whilst we found no harm had occurred to people, some elements of the management of the environment needed to be developed further. For example, two types of window restrictors were being used in the home, and we found one type did not meet health and safety standards because they could be easily overridden by people. We also found that checks did not adequately assess the effectiveness of the second type of window restrictors, and the provider had not taken adequate steps to ensure these would keep people safe. We shared our concerns with the operations manager who escalated them to the provider. The registered manager gave us assurance that actions would be taken to ensure all window restrictors were compliant. Following our inspection, they sent us evidence of the systems they had implemented to improve safety and oversight.

We reviewed records related to fire safety and found assessments had been updated and equipment was checked regularly to ensure its efficiency in the event of a fire. However, when fire drills had taken place, records were not kept of which staff had attended the drills, or how they had responded to the alarm. This meant the provider could not be assured of the effectiveness of training on staff practice and whether action was needed to improve their responses to any future incidents. Following our feedback the provider was able to identify which staff needed additional practice and developed systems for learning.

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.

People told us staff came when they needed them, and they did not have to wait. Relatives told us they felt there were enough staff to ensure people at the home were safe. One relative told us, “There is always someone about, [Name] never has to wait if they need something. Staff do well with the resources they have.” One person told us “I don’t usually have to wait long.”

People benefitted from a consistent staff team, many of the staff having worked at Hylands House for several years. This meant people received care from skilled and experienced staff who had a good understanding of their needs. The registered manager regularly reviewed people’s needs to identify required staffing levels. This ensured there were enough skilled and experienced staff to deliver the care outlined in people’s care plans.

Staff raised no concerns about staffing levels within the home and said they had time to spend with people. Staff told us the team knew each other well and helped each other to ensure they were providing good care. Staff told us that when issues arose such as emergencies or staff sickness, they were supported by the management to ensure people’s immediate needs were met. When management were not available, the provider sourced agency provision to ensure safe staffing. Our observations confirmed there were enough staff available to respond to people’s needs and maintain a presence in the communal areas.

The provider followed recruitment processes to ensure all required checks were completed before staff started work at the service. Enhanced Disclosure and Barring Service (DBS) checks were caried out. DBS provides information about convictions and cautions held on the police national computer. The information helps employers make safer recruitment decisions.

Staff had received training to ensure they had the skills and knowledge to carry out their work safely. When a need for extra learning had been identified within the service, the registered manager had identified and sought training to promote good practice.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading.

Relatives told us they felt the home was clean, laundry was managed well and they had no concerns. Overall, we found the home was clean and well maintained. However, we did identify some areas which needed improvement. Some bins in bathrooms were not foot operated or were missing lids and some woodwork had chipped paint which made it difficult to clean. This increased the risk of the spread of infections. The operations manager told us there was a refurbishment plan in place, to improve the safety and decoration of the service, and that they would replace any bins that didn’t meet requirements as a priority.

Personal Protective equipment (PPE) was available to staff around the home and accessible guidance was on display to promote good practice to protect people from the risk of infection. Staff were given opportunity to have their uniform washed and laundered at the home, minimising the risk of cross-infection.

We observed staff following safe practices around cleaning, handwashing and to protect people from risks from chemicals. Domestic staff demonstrated knowledge around different types of infections and precautions they took to promote good infection control.

The provider did not always make sure that medicines and treatments were safe and met people’s needs.

Whilst we did not identify any negative impact on people, we found there was not a robust process in place to ensure time specific medicines were consistently given at the times indicated on people's prescription. Failure to receive medicines as prescribed could lead to a worsening of symptoms.

Where people received their medicines via a patch applied to their skin, there was not consistent documentation which evidenced these were rotated in accordance with the manufacturer’s instructions. Failure to rotate patches applied to the skin, may alter medicine absorption and could cause skin irritation.

Following our feedback, the registered manager demonstrated their commitment to ensuring people received their medicines safely by immediately implementing more robust processes. The revised checks will help to ensure the registered manager will be further assured people will receive their medicines safely and as prescribed. They also made improvements to the processes for the application of topical creams.

Medicines were ordered and administered by staff who had received training in safe medicines practices. Staff’s competency to administer medication was checked regularly.

Medicines were ordered in good time, stored securely, and disposed of safely.

The provider’s systems ensured that when people required medicines as needed, for example laxatives, pain relief or medication to ease anxiety, these were given as required. Staff had guidance to ensure these medicines were given consistently.

Healthcare professionals reviewed people’s medication regularly to ensure their prescribed medicines remained necessary and appropriate.