This inspection took place on 23 June 2015 and was unannounced. At the last inspection on 18 October 2013 we found the service was meeting the regulations we looked at.
Hylton House is a small care home which provides personal care, support and accommodation for a maximum of six adults. People using the service have learning disabilities, physical disabilities and/or sensory impairment. There were five people living at the home at the time of our inspection. The service also provided a respite service, to a sixth person who uses the service some weekends.
The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
Relatives, visitors and health and social care professionals all told us people were safe at Hylton House. Staff knew how to protect people if they suspected they were at risk of abuse or harm. They had received training in safeguarding adults at risk and knew how and when to report their concerns if they suspected someone was at risk of abuse. The provider had a formal procedure in place for staff to follow to ensure concerns were reported to the appropriate person.
There were appropriate plans in place to ensure identified risks to people were minimised. Staff had access to appropriate guidance and knew how to minimise identified risks in order to keep people safe from injury or harm in the home and community. Managers ensured regular maintenance and service checks were carried out at the home to ensure the environment and equipment was safe. Staff kept the home free of obstacles so that people could move freely and safely around.
There were enough suitable staff to care for and support people. Managers continuously reviewed and planned staffing levels to ensure there were enough staff to meet the needs of people using the service. They carried out appropriate checks on staff to ensure they were suitable and fit to work at the home. Staff received relevant training to help them in their roles. Staff felt very well supported by managers and were provided with many opportunities to share their views and ideas about how people’s experiences could be improved. Staff were motivated, enthusiastic and told us they enjoyed working at the home.
People experienced outstanding care. People's feedback about the service universally praised the care and kindness shown by staff towards not only people living in the home but to their relatives and others that visited the home. We observed many instances of warm, kind and gentle interactions between people and staff in which people’s needs, wishes and choices were always respected. Staff’s priorities were clearly focussed on ensuring that people's care and support needs were met and they had an excellent understanding and awareness of how to do this. This included ‘going the extra mile’ as one visitor to the home described to us. The way staff supported people during the inspection was always kind, thoughtful and caring.
Staff treated people with great respect. Staff spoke with people in a warm and respectful way and ensured information they wanted to communicate to people was done in a way that people could understand. Staff knew how to ensure that people received care and support in a dignified way and which maintained their privacy at all times. Staff also positively supported people, where appropriate, to retain as much control and independence as possible, when carrying out activities and tasks.
People were supported to keep healthy and well. Staff ensured people were able to access other healthcare services quickly when this was needed. Staff worked proactively with healthcare professionals to ensure people got the care and support they needed. Medicines were stored safely, and people received their medicines as prescribed. People were encouraged to drink and eat sufficient amounts to reduce the risk to them of malnutrition and dehydration.
Support plans had been developed for each person using the service which reflected their specific needs and preferences for how they were cared for and supported. Support plans gave guidance and instructions to staff on how people’s needs should be met. Staff ensured that people, their relatives, advocate and other relevant healthcare professionals were all actively involved in making decisions about their care and support needs. These were discussed and reviewed with people regularly.
People told us the home was always open and welcoming to visitors and relatives. People were encouraged to maintain relationships that were important to them. People were also supported to undertake activities and outings of their choosing. Relatives and visitors said they would feel comfortable raising any issues or concerns directly with staff. There were arrangements in place to deal with people's complaints, appropriately.
Managers demonstrated good leadership. All of the people we spoke with commonly referred to managers as 'excellent’, 'approachable' and 'supportive' and that this was the reason why people experienced good quality care. They proactively sought the views of people, relatives, visitors, staff and other healthcare professionals about how the care and support people received could be improved. They ensured staff were clear about their duties and responsibilities to the people they cared for and accountable for how they were meeting their needs.
The provider and managers carried out regular checks of key aspects of the service to monitor and assess the safety and quality of the service that people experienced. Managers took appropriate action to make changes and improvements when this was needed. Managers used learning from incidents and inspections to identify how the service could be improved. They worked proactively with healthcare professionals to share and learn best practice so that the quality of care and support people experienced was continuously improved.
Managers had sufficient training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) to understand when an application should be made and in how to submit one. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.