Archived: The Hylands Retirement Home

The Hylands Retirement Home is a residential care home providing personal care for up to 46 people, some of whom are living with dementia. At the time of the inspection there were 35 people living at the service.

The care home accommodates people in one large adapted building with several communal areas. The service is located close to local amenities and is situated on the sea front.

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

This was a targeted inspection to consider concerns that had been raised in relation to the management of environmental risks and the risks this posed to people.

Risks to people in relation to their care and support needs and the environment were identified and recorded. Records did not always contain sufficient information on actions that had been taken to reduce risks. We have made a recommendation about this.

Accidents and incidents were recorded and audits were used to identify any themes or trends. Action was taken to reduce the risk of reoccurrence where possible.

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

Rating at last inspection and update.

The last rating for this service was requires improvement (published 27 November 2021). 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 improvements had been made with regards to managing and accessing risks, and the provider was no longer in breach of Regulation 12. We did not review the other 2 breaches that were identified at the last inspection.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the management of environmental risks and the risks this posed to people. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.

Recommendations

We have recommended the provider reviews risks to people and takes action to ensure any mitigation in place is thoroughly recorded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Hylands Retirement Home is a residential care home providing personal and nursing care for up to 46 people some of whom are living with dementia. At the time of the inspection there were 41 people living at the service.

The care home accommodates people in one large adapted building with several communal areas. The service is located close to local amenities and is situated on the sea front.

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

Potential risks to people were not always well-managed. Elements of the recruitment and induction process were not robust. Staff had not always had the required training to ensure they were knowledgeable and competent in their role. Staffing levels at night were not safe and regular fire drills had not been undertaken to ensure staff knew what actions to take in the event of an emergency. Quality assurance processes had not been effective in identifying the issues found during the inspection. The registered manager started taking actions to address these issues during the inspection.

We observed that staff were kind and patient in their interactions with people and people provided positive feedback about their experience of the service. Staff felt supported in their role.

Documentation did not demonstrate that people were supported to have maximum choice and control of their lives. Staff did support them in the least restrictive way possible and in their best interests.

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 13 December 2018).

Why we inspected

The inspection was prompted in part about concerns we received about the management of people’s skin in addition to there been an outbreak of COVID-19 within the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, governance and staffing at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service: The service is a residential care home providing personal care to 46 older people and people living with dementia. Thirty-eight people lived in the service when we inspected.

Why we inspected: This was a scheduled inspection based on the previous rating. The overall rating has improved to good.

People’s experience of using this service: Improvements had been made since the last inspection in February 2018 around infection prevention and control. The provider was now meeting legal requirements. All areas were clean and tidy; we saw that work to improve the facilities had been completed. The rooms we looked at were nicely decorated in colours of people’s choosing. One person told us, “I love it here and my room was decorated before I came in. I think it is super.”

People told us they felt safe and well supported. The provider followed robust recruitment checks, and sufficient staff were employed to ensure people’s needs were met. People’s medicines were managed safely. People told us, “Definitely enough staff to meet people’s needs” and “Everybody is pleasant and gets you what you want.”

In the last year the provider had achieved an award from Dementia Care Matters for the development of the service. To achieve ‘Dementia Care Matters Butterfly Model of Care Quality of Life Accreditation’ the provider had remodelled the environment on the ground floor into three individual areas based on people’s dementia care needs. Staff had received training and development around management of dementia and demonstrated a good understanding of dementia care. They worked with people’s individual strengths to ensure their independence, wishes and choices were promoted. This had a positive impact on people and meant people were much more settled and at ease. Staff had time to do activities, discussions and get to know people and relatives.

Staff knew about people’s individual care needs and care plans were person-centred and detailed. People described staff as “Excellent, caring and knowledgeable.” We were told staff treated people who used the service with compassion, dignity and respect. One person said, “Well I think the atmosphere is pretty good - the way the home is divided up. Although one or two people living with dementia do walk around, the staff are there to offer help if they need it.”

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 told us the service was well managed and organised. The management team assessed and monitored the quality of care provided to people. People and staff were asked for their views and their suggestions were used to continuously improve the service.

More information is in the full report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The Hylands is a large property with accommodation and facilities spread over five floors. The service offers three communal areas (lounge/dining rooms) on the ground floor for people to spend time in. The service terms these areas as ‘houses’ called Sunflower, Primrose and Bluebell. The service is close to all local amenities. The service provides accommodation for up to 46 people who require personal care, some of whom may be living with dementia. At the time of the inspection 36 people lived in the service.

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

The service had a registered manager who was also the registered provider. 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 arrangements for assessing, reviewing and monitoring risk within the service were not robust. This applied to the environment and people’s health, safety and welfare.

The assessment of risk, and preventing and controlling the spread of infections was ineffective. Documentation for cleaning the service and recording infections was not in place.

The provider carried out recruitment checks, to employ suitable people. These were not always consistently applied, but the registered manager took immediate action to rectify these errors.

People told us they felt safe and were well cared for. There were sufficient staff employed to assist people in a timely way. Medicine management practices were being reviewed by the registered manager and action was taken to ensure medicines were given safely and as prescribed by people’s GPs.

Staff had completed relevant training. We found the care staff received regular supervision and yearly appraisals, which helped them to fulfil their roles effectively.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

The provider had used a company called Dementia Matters to utilise best practice and develop the environment to be dementia friendly. The impact on people was extremely positive with individuals interacting with each other and enjoying more activities and stimulation.

People were able to talk to health care professionals about their care and treatment. People could see a GP when they needed to and they received care and treatment when necessary from external health care professionals such as the district nursing team.

People had access to adequate food, drinks and snacks. Those who spoke with us were satisfied with the quality of the meals provided.

People were treated with respect and dignity by the staff. They said staff were caring and they were happy with the care they received and had been included in planning and agreeing the care provided.

Access was provided for people to community facilities and the range of activities in the service ensured they could engage in stimulating and interesting social activities.

A complaints procedure was in place. People and relatives knew how to make a complaint and those who spoke with us were happy with the way any issues they had raised had been dealt with.

People told us that the service was well managed and organised. People and staff were asked for their views and their suggestions were used to help improve the service.

We found there was a breach of regulation 12: Safe care and treatment in relation to risk management and infection, prevention and control measures. You can see what action we told the provider to take at the back of the full version of this report.

The service has been rated as Requires Improvement for a second time.

The service was last inspected in April 2016 and was rated requires improvement. We found the registered provider had breached three regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to lack of staff supervision, training and appraisal, lack of people’s preference recorded within their care records and a lack of formal assessment of quality and safety by the registered provider. The provider had also failed to submit statutory notifications which we dealt with separately.

We saw improvements had been made in all areas at this inspection. Following the last inspection the registered provider had enlisted various specialist consultants to support them to improve systems and process. This had included specialists in care, health and safety plus staff training. The registered provider was still working with the consultants when we inspected and improvements in some areas were still needed. The registered provider was committed to making further improvements and we were confident this would happen.

The Hylands Retirement Home is a large property which offers numerous communal lounges for people to spend time in. They have views across the bay and access to the promenade in Filey. The service is close to all local amenities. The service provides accommodation for up to 46 people who require personal care, some of whom may be living with dementia. At the time of the inspection 34 people lived in the service.

The home had a registered manager who was also the registered provider. 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.

We saw staff had received supervision on a regular basis and the registered provider had commenced annual appraisals with staff who had been in post longer than 12 months. Staff training was better organised and all training needed was booked to ensure staff received the knowledge they required to enable them to perform their role.

We have recommended the provider review good practice surrounding the environment, activities and staff support for people living with dementia to ensure they deliver the best care they can for people.

A new dependency tool had been used to determine the staffing levels required to meet people’s needs. This had led to the registered provider increasing staffing in the service to safe levels. We found recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. The full work history of applicants had not been documented which may mean that the provider would be unaware of important information. The registered provider told us they would improve the system following the inspection.

People’s care plans were person centred and written in a way which described their care needs. We saw evidence to demonstrate people were involved in all aspects of their care plans. Individual risks to people’s safety had been assessed by staff. Recognised assessment tools to aid staff understanding in key topics such as pressure area care and nutrition were not used. On day two the registered provider had started to use these. Key information from the outcomes of such assessments and risk needed to be better linked to care plan descriptions to ensure staff had all the information they needed.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. A recent health and safety audit completed by external professionals had led to an action plan to improve safety systems and process. The registered provider was using this to improve the service.

Staff understood the requirements of the Mental Capacity Act (2005) and worked to ensure they supported people to make their own decisions. The required documentation to evidence assessment of capacity and best interest decisions was not fully understood or always in place. Staff were due to attend a training session to improve their knowledge in this area.

Systems in place for the management of medicines required reviewing so that people received their medicines safely. We have made a recommendation about the management of medicines.

The registered provider had a system in place for responding to people’s concerns and complaints. People said they would talk to the registered provider or staff if they were unhappy or had any concerns. The minor day to day concerns were not captured to analyse patterns and trends.

Systems in place to monitor and improve the quality of the service provided had been improved since our last inspection. These were not yet fully implemented or embedded. We saw the views of people were gathered and formal meetings for residents and relatives were due to recommence early 2017.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Observation of the staff showed they knew the people very well and could anticipate their needs. People told us they were happy and felt very well cared for.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. Where people required monitoring for their nutrition and hydration this was in place. People had been referred to see health professionals where required. People were supported to maintain good health.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. People enjoyed the activities on offer but had asked that more be available. The registered provider had started to implement new initiatives to support this. Staff encouraged and supported people to access activities within the community.

Overall we saw significant changes and initiatives at this inspection where the commitment and hard work of the providers and their team to drive improvement were very apparent.

The Hylands Retirement Home offers accommodation and personal care for up to 46 older people. At the time of the inspection there were 40 residents living at the service.

There is a registered manager in place. 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 felt safe and were confident they could raise concerns with the staff team. However, there were no robust systems in place to assess quality and safety. The registered provider had not adequately monitored the service to ensure it was consistently safe.

The service did not have effective systems in place for identifying trends in risk to individuals. Accidents and incidents were recorded in people’s individual files, but there was no analysis of these or an overview to monitor them to identify how risks of re-occurrence could be reduced.

We have made a recommendation about recording of risk assessments and clear guidance for staff.

Staff had been recruited safely and all relevant checks had been carried out before they delivered care and support to people. People told us that staff were attentive and available in sufficient numbers to meet their needs.

Staff were trained in their roles and we saw that additional training was being sourced from a local provider to meet the training needs of new staff. This meant that staff had the appropriate knowledge to support people.

We found that staff were communicating with each other, their senior care workers and registered manager. However, supervision and appraisal were not offered consistently or used to develop and motivate staff and review their practice or behaviours. Staff training or good practice needs were not identified through supervision. There were no opportunities for staff to have regular private discussion with their registered manager to raise concerns or review their personal development.

Staff encouraged people to be as independent as they wanted to be. People told us they felt they were treated with respect and kindness. People also told us the staff approach was caring and they made positive comments about the care they received.

The care plans we saw did not all contain a full assessment of people’s needs and were lacking in information. People were not consistently consulted about their own care needs, nor were they involved in planning, reviewing, or making suggestions regarding improvements they wanted to make. The registered manager had not made sure that people received person-centred care that met their needs and reflected their personal preferences.

People who used the service and their relatives told us they felt confident about talking to the registered manager to raise any issues.

However, the service had not encouraged more formal feedback from the people who used the service. There was no robust process in place to allow the service to adequately monitor and assess whether people had received a quality service. For example, by using surveys or questionnaires.

Leadership within the service was inconsistent. Assurance and auditing systems were not in place to monitor and drive improvement in the quality of the service. The views of people, regarding their experience of the service were not being gathered to ensure that issues were identified and standards of practice were not continually evaluated to ensure they were maintained. Staff were not adequately supervised to encourage motivation and development of the staff team. Records relating to each person were not detailed or complete and the registered manager and provider had not understood what matters must be notified to CQC and had not made notifications requested by law.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care, staffing and governance. You can see what action we have taken at the back of this report.

We found two breaches of the Care Quality Commission Registration Regulations 2009. This related to the notification of deaths and of other incidents. This is being followed up and we will report on any action once it is complete.

Where a service is rated as ‘inadequate’ in any key question but is rated as ‘requires improvement’ overall, special measures re-inspection timescales apply. This means that this service will be re-inspected within six months, not 12 months.

If the service remains inadequate in any key question after the re-inspection, the service will become subject to the special measures framework.

At this visit we saw that the care plans were robust and contained a personal evacuation plan and a hospital passport. The plans were reviewed on a regular basis and where possible had been signed by the person they were about.

We saw that the recruitment policy and procedure had been renewed and this ensured that people provided appropriate information as part of their application. This meant the provider could make a decision about a person's suitability to work with vulnerable people.