This inspection was completed on 20 and 21 March 2108 and was unannounced.

Hyperion House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hyperion House accommodates 45 people in one adapted building. There were 21 people at Hyperion House at the time of the inspection.

There was no registered manager in post at the service as the previous registered manager had left their post. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager had started working at the service and had started the process of registering with the Care Quality Commission.

The previous comprehensive inspection was completed in December 2016 and the service was rated Requires Improvement overall. At that inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service had not fully ensured staff and people were protected from the spread of infection and maintenance issues had not always been addressed to ensure people’s safety. A focussed inspection of the service was completed in May 2017; we found the provider had made improvements and was meeting the requirements of the regulations. At this inspection, we found the service had maintained previous improvements and the service was rated Good overall.

People received safe care and treatment. Staff had been trained in safeguarding and had a good understanding of safeguarding policies and procedures. The administration and management of medicines was safe. There were sufficient numbers of staff working at the service. There was a robust recruitment process to ensure suitable staff were recruited. Risk assessments were updated to ensure people were supported in a safe manner and risks were minimised. Where people had suffered an accident, themes and trends had been analysed, and action had been taken to ensure people were safe and plans put in place to minimise the risk of re-occurrence.

Staff had received training appropriate to their role. People were supported to access health professionals when required. They could choose what they liked to eat and drink and were supported on a regular basis to participate in meaningful activities. People were supported in an individualised way that encouraged them to be as independent as possible. People were given information about the service in ways they wanted to and could understand.

People and their relatives were positive about the care and support they received. They told us staff were caring and kind and they felt safe living in the home. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and were able to describe what they liked to do and how they liked to be supported.

The service was responsive to people’s needs. Care plans were person centred to guide staff to provide consistent, high quality care and support. Daily records were detailed and provided evidence of person centred care. People received end of life care and support which met their individual needs and preferences.

The service was well led. People, staff and relatives spoke positively about the manager. Quality assurance checks were in place and identified actions to improve the service. The manager sought feedback from people and their relatives to continually improve the service.

We carried out an unannounced comprehensive inspection of this service on 19 and 20 December 2016 at which two breaches of legal requirements were found. This was because people were not always protected from the spread of infection through safe infection control measures and the property had not always been maintained to a safe standard. We also found the registered manager and provider had not always fully assessed risks and taken preventative action to minimise these risks.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 31 May 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Hyperion House’ on our website at www.cqc.org.uk.

Hyperion House is a care home providing accommodation for up to 45 people who require nursing or personal care. There were 36 people living at Hyperion House at the time of the inspection.

There was no registered manager at the service. 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 provider had recruited a manager who was already in place at the time of the inspection. The manager told us they had applied to CQC for their registration and we had received their registration application at the time of the inspection.

At our focused inspection on 31 May 2017 we found the provider had followed their action plan and legal requirements had been met. The provider had implemented systems to ensure the risk of the spread of infection had been minimised through safe infection control practices. Following the last comprehensive inspection, the provider had initiated a refurbishment programme throughout the home. The provider and manager had ensured systems were in place to identify, assess and address risks posed to the people living at Hyperion House.

Following our inspection, we have revised the overall rating of the service to ‘Good’.

Hyperion House is a care home providing accommodation for up to 45 people who require nursing or personal care. There were 36 people living at Hyperion House at the time of the inspection.

This inspection was unannounced and took place on 19 and 20 December 2016.

There was a registered manager in post. 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 service was not always safe. People were not always protected from the spread of infection through safe infection control measures. The property had not always been maintained to a safe standard. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment to support people. The registered manager had carried out the relevant checks to ensure they were employing suitable people at Hyperion House. Staff had a good awareness of safeguarding policies and procedures and felt confident to raise any issues of concerns with the management team.

People were receiving effective care and support. Staff received appropriate training which was relevant to their role. Staff received regular supervisions and appraisals. Where required, the service was adhering to the principles of the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLS). The environment had been adapted to meet the needs of people living at Hyperion House. People were supported to personalise their living spaces.

The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which maintained peoples dignity. People had end of life care plans which reflected their wishes and preferences.

The service was responsive to people’s needs. Care plans were person centred and contained sufficient detail to provide consistent, high quality care and support. People were supported to engage in a range of activities based on their preferences and interests. There was a complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

The service was not always well-led. The registered manager and provider had not always fully assessed risks and taken preventative action to minimise these risks. Quality checks were in place and the registered manager was planning to ensure these were better used to improve the service provided. People, relatives and staff spoke positively about management. Staff morale was good and staff told us this was due to good leadership from the management team.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The inspection took place on 20 and 21 April 2016. This was an unannounced inspection. The service was last inspected in July 2015. There were a number of breaches of regulations. At the time of the inspection, there was evidence that these had not been met.

Hyperion House is a care home providing accommodation for up to 45 people who require nursing or personal care. There were 41 people at Hyperion House at the time of the inspection.

There was a registered manager in post. They told us they had been working as manager in the home for 14 years. 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 did not receive a service that was safe. Risk assessments were implemented but these did not always contain enough detail to reflect current level of risk. This meant there were no clear guidelines for staff to follow to minimise risk to people. The registered manager informed us they did not use a dependency tool to determine staffing levels although one was available through the care records computer system being used by the home. We recommend the registered manager uses this as this will ensure there are always sufficient staff numbers on shift to meet people’s needs.

People were not receiving effective care and support. Although staff had received training, staff understanding of training courses was not always assessed. Not all staff were receiving regular supervisions. The service was not adhering to the principles of the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty

Safeguards (DoLS).

The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which maintained peoples dignity. The service was providing end of life care but we did not see any evidence on end of life planning.

The service was not always responsive. Care plans were not person centred and did not provide sufficient detail to provide safe, high quality care to people. Care plans were not reviewed or updated following accidents or incidents.

Where complaints had been made, there was evidence that these had been dealt with effectively.

The service was not always well-led. Although quality assurance checks and audits were completed these were not always robust nor did they cover all aspects of the service. The audits did not always identify actions required to improve the service. Staff spoke positively about the registered manager.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This inspection took place on 15 July 2015 and was unannounced. Hyperion House provides accommodation for 45 people who require nursing and personal care. 39 people were living in the home at the time of our inspection. Some of the people living in the home had been diagnosed with a type of dementia and others had limited mobility. This service was last inspected in May 2014 when it met all the legal requirements associated with the Health and Social Care Act 2008.

Hyperion House is mainly set over two floors which are accessible by stairs or a lift. The home has a main lounge with an adjoining large conservatory and a dining room. People had access to a private secure back garden.

A registered manager was in place as required by their conditions of 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 2014 and associated regulations about how the service is run.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People and their relatives gave us mixed comments about the quality of care at Hyperion House. People told us they were bored and staff did not have time to spend any social time with them. Limited activities were available but they were not planned around people’s individual interests and preferences. People’s needs and risks had not been thoroughly assessed and documented. Their preferences and consent to care had not always been recorded. Home cooked food was provided but people were not always provided with adequate support to ensure they had sufficient food and drinks. Risks assessments for people who had been identified as being at risk were not always completed thoroughly. People’s care records did not give staff adequate guidance and support to ensure people’s needs were fully met. People’s medicines were not managed effectively. There was no comprehensive system to manage people’s medicinal creams and pain relief.

People were at risk of cross contamination as good infection control practices and management were not in place. The home’s environment did not support people with dementia and help to orientate them to overcome their lack of memory. We have made a recommendation about creating a home environment which supports people living with dementia.

Formal support and training for staff was not effectively managed and monitored to ensure people were being cared for by staff with the appropriate skills. Staff were knowledgeable about recognising the signs of abuse. They knew people well enough to understand their preferences; however they were not all familiar with the Mental Capacity Act 2005 and their legal responsibility on how to support people who lacked capacity. Some people’s mental capacity to make day to day or significant decisions had been assessed or recorded but the records were not clear.

There were sufficient numbers of staff to meet people needs although people and relatives felt staff levels needed to increase as they were not always available immediately or able to spend time with people socially.

The registered manager had an ‘open door’ policy but they had not actively sought feedback from people and their relatives about their experiences of living in Hyperion House. Some quality assurance audits were carried out by the registered manager; however there were no quality audits carried out by the provider. Although the provider had an action plan in place to make improvements to the home.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with five people who used the service, the registered manager and three members of staff. We reviewed records relating to the management of the service which included five care plans. Below is a summary of what we found. The summary describes what people who used the service and staff told us, what we observed and the records we looked at.

Is the service safe?

The service was safe because the registered manager ensured that equipment was safely installed, maintained and serviced. Equipment was suitable for its purpose. Staff demonstrated that they understood their roles and responsibilities in relation to infection control. The home was clean and hygienic and there arrangements in place to protect people against the risk of acquiring healthcare associated infections. The registered manager understood the requirements to protect people under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were aware of their responsibility to report any suspicions or allegations of harm or abuse.

Is the service effective?

The service was effective as people's needs and choices had been identified and delivered in line with their care plan. One person said “I am very happy living here”. People told us that the staff were kind and caring. Visitors told us the care was very good and that they were always welcomed by staff. People had appropriate equipment and support to meet their needs. Care plans reflected people’s current care and support needs.

Is the service caring?

The service was caring because people were treated with kindness and compassion and their dignity was respected. We saw that relationships between staff and people who used the service were friendly and warm. Appropriate health care professionals were involved in planning and managing people’s care and support. Relatives told us that their loved ones were cared for and staff were supportive and friendly. One relative said "Everyone is like family to me here".

Is the service responsive?

The service was responsive as people’s individual needs were regularly assessed and reviewed. Staff responded to people’s changing needs which were reflected in people's care records. Emotional support was available to people and their families. Concerns and complaints were dealt with in an efficient manner. People had access to general activities but these were not always focused around individual preferences or interests.

Is the service well-led?

This service was well led as there were effective arrangements in place to continually review care practices in the home. The management understood the principles of quality assurance to improve the service and quality of life for people who lived in the home. Staff were motivated and caring. One member of staff said "we don't always receive formal support from the manager but we can always speak to her if there is a problem". The registered manager was clear about their role and responsibilities within the home and had systems in place to monitor and improve the service.

The Registered manager, one registered nurse and seven care staff were available throughout the day and were very knowledgeable about people in their care, the policies, procedures and systems in place to ensure the continued smooth running of the home.

People shared with us their experiences about living in the home and we spoke with three people. Everyone expressed positive comments. People told us “This is a lovely home”, “The care offered is marvellous” and “Staff here are dedicated and caring”.

We spent time in various parts of the home, including communal areas such as the lounge and both dining areas so that we could observe the direct care, attention and support that people who lived at the home received. There was a constant interaction between staff and people in the home. People were relaxed, happy and comfortable in each other's company and staff cared for people with empathy.

At the time of our inspection there were 37 people living at Hyperion House. We spoke with five people living in the home, four members of staff, the registered manager and three relatives that were visiting the home.

Not all people were able to verbally tell us about the care they received and if they were happy. Therefore we observed how staff interacted and supported people, to enable us to make a judgement on how their needs were being met.

We observed some people being supported and examined their care plan documentation. This was to ascertain if an appropriate level of care was being provided, in line with their assessed needs.

Overall comments were positive from people living in the home. Comments included; “it’s ok here”, “they ask what I might want”, “I play ball games I like that”.

Relatives we spoke with told us they were happy with the care that was delivered. One relative told us “they were fantastic we could not have wished for better care throughout our relative’s last days”. Another relative told us “they keep us updated with any changes that might occur. The manager is approachable”.

The members of staff we spoke with told us they felt they delivered a high standard of care to people living in the home. They also stated they were well supported by the management team.

We did not speak to people directly about their medicines