About the service: Hylton View is a care home which can provide nursing or personal care to 40 older people, some of whom are living with dementia. There was no one receiving nursing care during the inspection. At the time of this inspection there were 20 people living at the service.

People’s experience of using this service: People told us they were happy with their care at Hylton View and that staff were kind and caring and the home was well managed.

At our last inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. This related to Good governance. There were shortfalls in the analysis of falls and inaccurate information in falls care plans and risk assessments. At this inspection we found improvements had been made and the service was no longer in breach of the regulations.

The environment and equipment was safe and well maintained. Arrangements were in place to protect people from risks to their safety and welfare. Staff understood how to keep people safe and used information following accidents and incidents to reduce the likelihood of future harm. Effective recruitment procedures were in place and people received care in a timely way. Arrangements were in place to protect people from the risks associated with the management of medicines and the spread of infection.

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 were supported to eat and drink enough to maintain their health and welfare. Staff received appropriate training and supervision to maintain and develop their skills and knowledge to care for people in a person-centred way. People's health was well managed and staff worked closely with other professionals to provide effective care.

Staff had developed caring relationships with people and respected their privacy and dignity. People’s independence was promoted and staff ensured people maintained links with their friends and family.

People’s care was based on detailed assessments and person-centred care plans. A range of activities were available. People felt confident raising concerns and complaints had been dealt with effectively. Staff were aware of good practice and guidance in end of life care, and respected people's religious beliefs and preferences.

A new registered manager was in post since the last inspection. Effective management systems were in place to monitor the quality of the care provided and feedback was used to make continuous improvements to the service. The registered manager worked well to lead the staff team in their roles and ensure people received a good service.

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

Rating at last inspection: Requires Improvement (report published 3 May 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

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 inspection took place on 9 and 26 January 2018. The first day of inspection was unannounced and the second day announced. When we last inspected the home we found the provider had breached the regulations relating to assessing safe care and treatment because people were left unsupervised in communal lounges for long periods and medicines were not managed safely. We also rated the home as Requires Improvement. Following this inspection we have again rated the home as Requires Improvement. This is the third consecutive time the home has received this rating.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions is the service safe, caring and well-led to at least good. We requested the provider supply the Commission with regular updates to enable close monitoring of progress. We found progress had been made and the provider was now meeting the regulation. We noted that throughout our inspection staff supervised communal lounges at all times to help keep people safe. People told us staff responded to their requests for assistance quickly. Improvements had been made so that medicines were manged appropriately. Records and our own observations confirmed people received their medicines safely.

Hylton View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hylton View accommodates up to 40 people across two separate units, each of which have separate adapted facilities. At the time of our inspection there were 35 people using the service, some of whom were living with dementia.

Since our last inspection the home had employed a new registered manager. 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, relatives and staff described the registered manager as approachable and supportive.

During this inspection we found the provider had breached the regulation relating to good governance. Quality assurance audits had not always been effective in identifying concerns, such as the lack of an in-depth falls analysis and inaccurate information in falls care plans and risk assessments.

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

Although we found improvements were required to the oversight of falls management in the home, the provider had ensured the relevant practical steps were in place to minimise the risk of individual people from falling. For example, increasing observations, providing specialist equipment and referring people to the falls team.

People, relatives and care workers told us the home was a safe place to live. People also described their care as good and said staff were kind and considerate.

Staff were knowledgeable about safeguarding and were aware of the provider’s whistle blowing procedure. Staff knew how to report concerns and confirmed they would have no hesitation in doing so if required. Previous safeguarding and whistle blowing concerns had been dealt with appropriately.

The provider completed various pre-employment checks to help ensure new care workers were suitable to care for people living in the home.

Regular health and safety checks were carried out to help keep the premises and specialist equipment safe to use. For example, checks of fire, gas and electrical safety. The provider also had policies and procedures to deal with emergency situations.

Staff told us they were well supported and received the training they needed. Supervisions, appraisals

The inspection took place on 16 and 22 December 2016 and was unannounced. We last inspected the home on 23 and 29 June 2015. During that inspection we found the provider had breached the regulations relating to infection control, person-centred care and good governance.

The home provides nursing and residential care for up to 40 older people, some of whom are living with dementia. At the time of this inspection there were 39 people living at the home.

The home had a registered manager. 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.

During this inspection we found the provider had breached the regulation relating to safe care and treatment because the arrangements for managing medicines were not always safe. Medicines records were not always completed accurately, such as for the administration of medicines, the application of topical medicines, the application of transdermal patches and for the safe storage of medicines. We also found people were left unsupervised for prolonged periods.

The monthly medicines audits had not been effective in identifying the issues we found with medicines management. Following this inspection there had been a further two serious incidents involving medicines. We have written to the provider separately about this matter and we will closely monitor the action the provider takes to make medicines management safe.

People, relatives and care workers said the home was safe. People also told us they received good care from kind care workers.

Care workers had a good understanding of safeguarding and the provider’s whistle blowing procedure. They knew how to report concerns but said they had not previously needed to use the procedures. Care workers also said the provider and registered manager would take concerns seriously and deal with them properly.

Assessments were carried out regularly to help protect people from potential risks, such as risks associated with poor nutrition, skin damage and mobility.

Although care workers confirmed there were sufficient care workers on duty, we observed there were occasions when people were left unsupervised in communal areas. The registered manager was taking action to improve the communication between care workers to ensure people were appropriately supervised.

An effective recruitment process was in place to check new care workers were suitable to work at the home. This included carrying out a range of checks before new care workers started working at the home.

Health and safety checks were carried regularly including checks of fire safety, specialist equipment, the electrical installation, gas safety, water safety and portable appliance testing. There were also documented procedures to deal with emergency situations including personal emergency evacuation plans (PEEPs) to help keep people safe.

The provider logged, investigated and analysed incidents and accidents. Action had been taken to help prevent accidents recurring such as referrals to the ‘falls team’, replacing inappropriate footwear and increased observations.

Care workers received the support and training they needed to fulfil their caring role. Records showed supervisions, appraisals and training were up to date for most care workers.

The provider followed the requirements of the Mental Capacity Act 2005 (MCA), including the Deprivation of Liberty Safeguards (DoLS). DoLS authorisations had been approved for all relevant people. Care workers got people’s consent before providing care. Care workers used various strategies to support people with making choices and decisions.

Care workers supported people to have enough to eat and drink in line with their needs. For example, one person

In this report the names of the registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still registered managers on our register at the time.

We spoke to six people who used the service, two relatives and one visitor from another local service. We also spoke to staff members. We did speak to other people living at the home, although some found it difficult to express themselves.

We saw staff knocking on people’s doors before entering and treating people with dignity. One staff member said, in relation to a resident choosing to lock their bedroom door at times, “It may be more difficult for us to check that they are ok, but it’s their (people’s) decision at the end of the day.”

The majority of people, visitors and staff told us that they thought the home provided good quality care and treatment. We observed friendly caring conversations being exchanged between people and staff. We saw assessments of people’s needs, with corresponding care plans and risk assessments too.

People were protected from the risk of abuse because safeguarding procedures were in place and staff were able to explain them.

We found that the home had generally good practices in the management of medicines.

There were complaints procedures in place and people were given opportunities and encouraged to tell staff if they had any concerns.

We spoke with people who used the service and relatives about giving consent. One relative told us “Mom is not in a position to make certain decisions for herself and the doctors and staff here have consulted with me on her care”. The residents meeting minutes showed that the people who used the service and their relatives had been able to influence care practices in the home through their involvement in the meetings. Some of the topics discussed at previous meetings included provision for a smoking shelter, social activities, residents and family surveys.

Records we looked at showed people’s needs were assessed and care and treatment was planned and delivered in line with the individual care plan. We found a “Do Not Attempt Resuscitation Order” in one file which had been appropriately completed, signed by a doctor and also by the person’s next of kin. This meant the proper legal procedures were followed in ascertaining the wishes of the person.

People we spoke with told us they received regular medical care from their GP and from other healthcare professionals such as dentists, opticians, chiropodists and dieticians when required. This showed that people were receiving appropriate care and support from the NHS.

People we spoke with told us they felt comfortable and that they liked their bedrooms. One person told us, “It is always nice and airy in here”. Another person said, “I like my room and it is clean, nice and comfortable”.

People told us that they were well looked after and that care they received was good. Some of the comments from the people we spoke with included, “I am happy here. I get everything I need”; “The staff are very caring and I am happy with them”; “I am glad I chose this home”.

People also told us that the food was good and they have always enjoyed their meals. One person told us, “There is always plenty to eat and drink”. Another person said, “if you don’t like what is available they will give you something else that you fancy, but within limits, of course”.

Hylton View is a purpose built care home which provides nursing and personal care for older people, some of whom may be living with dementia. It is registered to provide up to 40 places. All of the bedrooms are for single occupancy and are en-suite. At the time of this visit there were 37 people living at the home.

The last inspection of this home was carried out on 3 January 2014. The service met the regulations we inspected against at that time.

This inspection took place over two days. The first visit on 23 June 2015 was unannounced which meant the provider and staff did not know we were coming. Another visit was made on 29 June 2015.

The previous registered manager had left the service in April 2015. A new manager commenced work at the home in May 2015 but had not yet applied for registration. 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.

During this inspection we found the provider had breached a regulation relating to the prevention and control of infection. This was because some areas of the premises could not be kept fully clean, especially in bathrooms and toilets, because they had surfaces that were not sealed. Several armchairs that people sat on only had foam pads which were not covered so could not be kept clean. This compromised the control of infection as well as the dignity of the people who lived there.

The provider had also breached a regulation relating to personalised care because people’s individual care records were not always complete or up to date. This meant that it was not always possible to be clear if a person was appropriately cared for and supported in the right way.

The provider had also breached a regulation relating to quality assurance. This was because its quality assurance system had not been followed as there had been no visits to monitor the service since December 2014. Internal audits had not identified shortfalls, for example to care records and infection control, so they had not been effective in addressing areas that needed improvement.

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

The accommodation was not specifically adapted for people living with dementia, even though the home purported to provide a dementia care service. We have made a recommendation about this.

People said they felt safe and comfortable at the home. For example one person told us, “I’m safe as houses here.” Staff knew how to recognise and report any suspicions of abuse. Staff told us they were confident that any concerns would be listened to and investigated to make sure people were protected. Potential risks to people’s safety were assessed and managed. People’s medicines were managed although plans about ‘as and when’ medicines could be more specific.

People told us there were enough staff to meet their care needs. Care professionals told us it was a better service when agency staff were not used as they did not know people’s individual needs. People felt staff came “quickly” or “quite quickly” when they asked for assistance. The manager was going to look into how staff were deployed at mealtimes as several people needed support at those times. Staff were recruited in a safe way so that only suitable staff were employed.

The manager understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision and deprivation of liberty safeguards to make sure they were not restricted unnecessarily. Staff were to receive additional training in this area so that they understood people rights to an independent lifestyle, unless it was in their best interests to be safeguarded. People told us staff always asked for their consent before carrying out care tasks. They told us they made their own choices over their own daily lifestyle.

The people we spoke with felt staff were competent in their roles and they supported them in the right way. Staff had training in health and safety as well as care. The manager was arranging further training to make sure staff were fully up to date with the latest standards in care.

People were supported to eat and drink enough to meet their nutrition and hydration needs, although records about this needed to be more meaningful. The menus were repetitive, and did not include many options for vegetables, salads or fruit but people told us they could ask the cooks for alternative meals if they did not fancy the two main dishes. Dietetic and speech and language professionals told us they had no concerns at this time with the way people were supported with their nutrition.

People and relatives made many positive comments about the “caring” attitude of staff. One person told us, “The staff are smashing.” Another person commented, “Staff are lovely. When I’m feeling down they come in and help put a smile on my face.”

Relatives said there was a good atmosphere in the home and staff were friendly. One relative commented, “You are always made to feel very welcome here and staff are very obliging.” Staff were helpful and encouraging when assisting people.

People had opportunities to go out on local trips from time to time. There were also daily in-house activities and occasional entertainment. People had information about how to make a complaint or comment and these were acted upon.

People and relatives said the new manager was approachable. They felt they were asked for their views and opinions and there were regular residents’ meetings. Staff told us they felt the manager was approachable and open to their views. There were regular staff meetings for staff to be kept informed of the standards of care and expected practices.