Hylton Grange

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

This was the first rated inspection of the service. The culture of the service was open as people and staff were listened to, and had the opportunity to give feedback. Systems were in place to ensure people were kept safe and protected from the risk of harm and abuse. Incidents and accidents were reported, investigated and lessons learned to reduce risk of re-occurrence. People were supported to understand and manage risk. Care plans were clear and provided detailed guidance to staff to keep people safe. Improvements were required to medicines management and medicines record keeping. Detailed information was collected before people moved to the service and was available to take with them if they moved to another service. There were appropriate staffing levels and skill mix to make sure people received consistently safe care that was person-centred. Staff received training that was relevant to their roles and responsibilities. The environment was clean, well-maintained, safe and comfortable with a good standard of hygiene, to ensure people’s safety and comfort. There was robust recruitment of new staff. People received visitors.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt safe and staff responded immediately if they needed support. A person commented, "The nurse visits me every day to spend time with me and I feel quite safe here." A relative told us, "Staff are always popping in to see that [Name] is okay."

Staff told us communication was effective. Any incidents about people's safety was discussed with staff in a timely way, with action taken to mitigate further risks. A staff member told us, “Communication is good, handover is helpful at the start of the shift. We get all the details of what is needed, what has gone well and if anything is wrong." Staff members told us they reported any incidents. A staff member commented, "Learning is shared after an incident. The nurse in charge and managers will let staff know."

People received safe care because staff learned from safety alerts and incidents. Staff recognised incidents and reported them appropriately, and the management team investigated them, and shared lessons learned. The registered manager analysed incidents and near misses on a regular basis so that any trends could be identified, and appropriate action taken to minimise any future risk.

Information was available about people if they moved between services to ensure their safety and continuity of care.

Staff were aware of when people had health or social care professional input. They said they felt confident working with other agencies. Recommendations from health professionals or other professionals had been implemented.

We received positive feedback from professionals involved with the service. A professional commented, "We have recently placed a client with complex needs at Hylton Grange and I have found the home manager very helpful and proactive. They also, appeared very supportive and flexible during the client’s transition."

Systems were in place for staff to work with people and partners to establish and maintain safe systems of care, in which safety was managed, monitored and assured. People received a continuity of care when they started using or were discharged from the service. Pre-admission assessments helped ensure people’s health and social care needs could be met by staff and that the service was right for the person, as well as the person being right for the service. People, their relatives, health and social care professionals were involved in the planning.

People told us they felt safe being supported by staff. They knew how to raise any concerns they might have. A person commented, "I am quite safe here. I have no concerns and if I did I would speak to the nurse in charge."

Staff said they were trained in safeguarding and understood how to safeguard people from the risk of abuse. They said they would raise any concerns and were confident the registered manager would respond appropriately. A staff member commented, "Management are very accessible if you need them, I would feel safe and confident raising any concerns."

People appeared to be happy, comfortable, and safe in their surroundings. They told us they felt safe, they would speak with staff if they were worried, and they always felt listened to.

Processes were in place to protect people from abuse. Staff had received training on identifying and reporting abuse and knew what action to take if they identified abuse. Concerns were reported to the local authority as appropriate. Safeguarding incidents were investigated and showed evidence of action taken and effective lessons learned, where needed. Safe staff recruitment helped ensure people were protected from staff unsuitable to work in the care sector.

People and relatives were involved in identifying, assessing and mitigating known and new risks.

Conversations with staff confirmed they were aware of the risks associated with people’s care and the action they needed to take to keep people safe. Staff understood where people required support to reduce the risk of avoidable harm. Staff knew the risks to people well and told us they were kept up to date if there had been any changes to people's risk assessments. A staff member told us, "We have the information needed with guidance on the best way to give care to that person e.g. there is a resident with a choking risk, so all the information is there for staff to follow."

Staff supported people safely and appropriate equipment was available if people needed assistance. People told us staff knew how to support them. A relative told us, "Staff are available to support people as soon as they need support."

Systems were in place to ensure any risks to people's health, safety and well-being were mitigated. Risks to people had been assessed and risk assessments had been put in place to help mitigate risks as far as possible. These risks included areas such as supporting people with mobility, risk of choking, skin integrity, personal care or distressed behaviour. Identified risk was transferred to care plans. Care plans contained information of the measures for staff to follow to keep people safe, including how to respond when people became distressed.This included guidance for staff about how to de-escalate and reassure a person if they became upset. Risk assessments were regularly reviewed to reflect people's changing needs. Staff had the knowledge and skills to protect people's safety. Staff received health and safety training and training about safe working practices. They understood their responsibilities for reporting accidents, incidents, or concerns.

People and relatives were involved in identifying, assessing and mitigating known and new risks.

Staff told us they had received training in safe working practices and they felt safe working at the service. They said they had appropriate equipment to move people safely and had received training on how to use it. They felt supported when management were not on duty as an on-call system was available to provide support and guidance, in an emergency.

The service demonstrated people were cared for in a safe environment that was designed to meet their needs. The premises and equipment were well-maintained which helped support staff to deliver safe and effective care. The provider employed a member of staff to carry out maintenance, there were effective arrangements to safely maintain the building.

Regular checks of the environment took place to ensure it was safe and well maintained. Detailed records were kept of all servicing and checks. This included certificates and audits for example, for fire systems, water checks for legionnella, gas, electric and health and safety audits. Emergency plans were detailed and covered topics such as risk assessments in the event of fire. Environmental risks were assessed, with measures put in place to remove or reduce the risks. Regular health and safety checks were completed, this included of the general environment and equipment. Staff completed health and safety, including fire safety checks of the environment to help ensure risks were mitigated as far as possible.

People told us they felt safe with staff support and thought they there were sufficient staff. A person commented, "I have this buzzer I can work with my head and the staff come straight away to see what I want." A relative said, "There are always plenty of staff and if I want to take [Name] out I can have a member of staff go with me."

The registered manager told us a dependency tool was used to calculate the number of staff required. Staff verified there were sufficient staff on duty to support people. They told us about the training they received as part of their job roles and were knowledgeable about the training they received. Their comments included, "I have received Positive Behaviour Support [PBS] and de-escalation training, it was good. We get specific training for new residents if needed, we get it before they arrive", and " I think training has provided me with the skills and knowledge required to do the job."

There were sufficient staff to support people safely and in a person-centred way. People were attended to in a timely way and did not have to wait a length of time for assistance. Care was person-centred and staff were observed to spend time with people, not just when they provided care and support.

Staffing levels were sufficient so people received care in a timely and person-centred way. Systems and processes were in place to ensure staff were recruited in a safe way. Staff files demonstrated that safe recruitment practices were in place to make sure that all staff were suitably experienced, competent and able to carry out their role. New staff had appropriate pre-employment checks in place which included photo identification, work history, references and a Disclosure and Barring Service (DBS) check in place. DBS checks provide information including details about convictions and cautions held. Staff received training to give them insight into people’s care and support needs. A system of supervision and appraisal was in place to help support staff members. The staff training matrix and staff records showed staff received a variety of training courses supervision, observations and checks of competency to carry out their role safely and effectively.

There were effective infection prevention and control systems in place. These included regular cleaning and systems to prevent people and visitors from catching and spreading infections. People told us they thought their home was kept clean. A professional commented, "The facilities and environment are very clean and fresh."

Staff told us personal protective equipment (PPE) and all cleaning materials needed were available. They confirmed they had received infection control training

The building was clean, well-decorated and well-maintained. People's rooms were well-personalised, appropriately furnished, warm and comfortable.

Regular checks of the premises were carried out to ensure the environment and equipment was kept clean and free from malodours. Staff received training in infection control practices and used personal protective equipment (PPE) effectively and safely. The management team accessed support and advice on infection control and training and maintaining a safe environment.

Improvements were needed to medicines management and record keeping. There was no robust process for creams applied by care staff as part of personal care. There was no clear guidance and records were not accurately completed. Some people were prescribed medicines to be taken on a ‘when required’ basis or with a variable dose. Guidance for how these medicines should be administered was not person-centred. There was no information when a variable dose was prescribed in line with the provider’s policy. A process for ensuring people received time sensitive medicines at the right time was in place. However, one person on medicines for Parkinson's disease did always not get their medicines at the prescribed time. People’s preferences about how they wanted their medicines were not always documented, up to date or clear. People were not harmed as a result of the improvements needed to record keeping and medicines management.

Staff told us they had completed medicines training and had been recently assessed. Managers told us about the variety of medicines audits, these had identified some of the issues found.

Records of regular medicines followed national guidance including recording people’s allergies. However, we checked medicine stock against medicine administration records (MAR) and found that stock for 2 people didn’t balance showing that the records were not correct. Medicine for 1 person was recorded as been given at an incorrect dose on several occasions this was not escalated for investigation. Care plans for medicines were available however these were not up to date or had conflicting information. The medication list in the care plan did not match the MAR. There was conflicting information for two people prescribed insulin. The registered manager took immediate action to make the identified improvements, including updating the care plans, following our site visit. Comprehensive policies and procedures were in place to support the administration of medicines. Medicines were stored securely and safely including controlled drugs.