We inspected this service on 5 January 2018 and the inspection was unannounced and undertaken by one inspector. At our previous inspection in December 2015, the service was meeting the regulations that we checked and received an overall rating of Good. At this inspection we found the service remained Good.

Jason Hylton Court is registered to accommodate 40 people in one building that has been adapted to meet people's needs. At the time of our inspection 33 people were using the service. Bedrooms are provided over three floors with three lounge areas and a dining area on the ground floor. An enclosed patio area is available that people can access.

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 registered manager oversaw the running of the home and was supported by a deputy manager, senior support workers and support workers.

People continued to receive safe support. Sufficient staff were available to support people who understood their role in protecting people from the risk of harm. Risks to people were identified and minimised to maintain their safety. Assistive technology was in place to support people to keep safe. People were supported to take medicines and records were kept which demonstrated this was done safely. The recruitment procedures in place ensured the required checks were undertaken before staff commenced employment, to ensure they were suitable to work with people. People were protected by the systems in place for the prevention and control of infection.

People continued to receive effective support. Staff had the skills to support people because they received support and training. People were supported to have maximum choice and control of their lives and staff understood the importance of gaining people’s consent regarding the support they received and supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were involved in the assessment and reviews of their care; which enabled them make decisions about how they wanted to receive support in their preferred way. People were encouraged to eat a balanced diet that met their preferences and assessed needs and were supported to access healthcare services. People received coordinated support that met their needs and preferences because the registered manager worked with other organisations and healthcare professionals to achieve this.

People continued to receive caring support. There was a good relationship between people and the staff who knew them well and promoted their independence and autonomy. People’s privacy and dignity was respected and upheld by the staff team and people were supported to maintain relationships with those who were important to them.

People continued to receive responsive support. People were supported to develop and maintain interests and be part of the local community. The registered manager actively sought and included people and their representatives in the planning of care. There were processes in place for people to raise any complaints and express their views and opinions about the service provided.

People continued to receive well led support. A positive culture was in place that promoted good outcomes for people. People and their representatives were involved in developing the service; which promoted an open and inclusive culture. Staff understood their roles and responsibilities and were encouraged by registered manager to develop their skills. The registered manager and provider understood their legal responsibilities and kept up to date with relevant changes. There were systems in place to monitor the quality of the servic

We inspected this service on 10 December 2015. The inspection was unannounced. At our previous inspection in January 2015 the provider was not meeting all the regulations relating to the Health and Social Care Act 2008. There were breaches in meeting the legal requirements regarding cleanliness and infection control and in assessing and monitoring the quality of

service provision. The provider sent us a report in April 2015 explaining the actions they would take to improve. At this inspection, we found improvements had been made since our visit in January 2015.

Jason Hylton Court provides accommodation and nursing care for up to 37 people with health conditions and physical needs. On the day of our visit there were 32 people living at the home. Accommodation is arranged over three floors and there is a lift to assist people to get to the upper floors.

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 registered manager determined the staffing levels through an assessment of people’s needs. People told us and we saw there were sufficient staff available to support them. Staff were knowledgeable about people’s care and support needs to enable support to be provided in a safe way. Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. Systems were in place and followed so that medicines were managed safely and people were given their medicine as and when needed. The provider had undertaken thorough recruitment checks to ensure the staff employed were suitable to support people.

Staff received training to meet the needs of people. Staff received supervision, to support and develop their skills. The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity in certain areas, capacity assessments had been completed to show how people were supported to make those decisions. Applications had been made for DoLS in line with legislation. People received food and drink that met their nutritional needs and were referred to healthcare professionals to maintain their health and wellbeing.

Staff were caring in their approach and had a good understanding of people’s likes, dislikes and preferences. Staff respected people’s privacy and supported them to maintain their dignity. People were supported to maintain and develop their social interests. People felt confident that they could raise any concerns with the registered manager. There were processes in place for people to express their views and opinions about the service provided and raise complaints. There were systems in place to monitor the quality of the service to enable the registered manager and provider to drive improvement.

This was a short, focused visit, to check that the compliance actions left at our visit in May 2013 had been met.

At our visit in May 2013 systems in place did not ensure that the service was monitored effectively. For example housekeeping practices were not sufficient to ensure the home was maintained to a good standard.

At this visit we found that practices had improved. For example audits were being undertaken to monitor the services people received such as environmental audits, laundry audits and kitchen audits. The home had been awarded a four star rating by the environmental health officer in July 2013.

At our visit in May 2013 one person and their relative told us about a concern they had raised and said they had received no feedback regarding this. The registered manager told us that this person had received verbal feedback regarding the investigation. Following our inspection in May the registered manager sent us a copy of the letter sent to this person and their relative informing them of the outcome of the investigation.

At our visit in May 2013 we were unable to look at how complaints had been investigated as the registered manager advised us that the complaints log had been mislaid.

At this visit a complaints log was in place to demonstrate that complaints were recorded and responded to appropriately.

We spoke to nine people that were using the service, six people visiting their relatives and friends and one visiting professional.

People were generally positive about the support provided by the staff team. Some people using the service and their visitors felt that there were occasions when there was not enough staff available in the communal areas of the home. On the day of our visit we observed periods of time when staff were not available within communal areas, such as following the lunch time meal.

Most people we spoke to told us that they were happy with the quality and variety of the meals provided, although some people told us they thought meals could be better. One relative told us, “the food here is delicious, I can’t fault it.” Another visitor said they would not like to eat with their relatives when visiting as, “the food is not good.” Satisfaction surveys had been sent out to people using the service, their family and friends in January 2013. The audit of these satisfaction surveys confirmed that in general people were happy with the meals available.

Although general care practices were satisfactory, the systems in place were not effective in ensuring that the service was monitored effectively. For example housekeeping practices were not sufficient to ensure the home was maintained to a good standard, information regarding a complaint and how this had been addressed was not recorded, to demonstrate that the correct actions had been taken.

This was the second follow up visit to check if the compliance action made at our previous follow up visit in July 2012 had been addressed.

We spoke with one person at this visit, as the compliance action left was regarding the support they received. This person confirmed that they were happy with the support and services provided to them.

This was a focused visit to check if the compliance and improvement actions made following our previous visit in April 2012 had been addressed.

We spoke with some of the people using the service regarding the meals provided. Everyone told us they enjoyed their meals and felt they were good quality.

We only spoke with one person using the service, in relation to the improvements that had been made in supporting them with a specific need.

People that we spoke with at our visit in April 2012 confirmed that they were happy with the support and services provided to them.

We spoke to five people that were using the services and four relatives.

People using the service and relatives spoken with said they were very happy with the support they received from the staff team.

People told us they liked the staff and felt that they did a good job. They told us that the staff were friendly and were able to meet their needs. One person told us “They look after me very well.” Another person said “They’re very nice to us, always got a smile and a friendly word, I’m very happy here”.

One person told us that when staff were busy attending to other people they could be waiting up to half an hour at night time before their nurse call bell was answered.

One visitor confirmed that although they did not have any specific issues with their mother’s care they had observed occasions when there had been no staff in the communal areas for up to half an hour.

People told us they felt safe, and able to report any concerns they may have to staff or the person in charge. Relatives also told us that they felt able to report any concerns to staff.

People using the service and visitors that were spoken with were positive about the home and the services provided.

One visitor told us, “We are very happy with the care mum gets. Staff communicate well with us and keep us informed of any changes.” Another visitor said “the care here is very good, the staff are friendly and have been very supportive to me”.

One person using the service told us, “it’s very nice here, the staff are helpful, the food is good quality I enjoy it”

People spoken with told us that they were able to follow their preferred routines.

People confirmed that their support needs were met by the staff team and that they were involved in the development and reviews of their support package.

Comments included, “they’re all nice and there’s always enough staff around if you need them.” And “I don’t have any concerns, there staff are around if you need them and very friendly”.

The inspection took place on 7 and 8 January 2015 and was unannounced.

At the last inspection on 16 August 2013 the provider was meeting all of the regulations.

Jason Hylton Court provides accommodation and nursing care for up to 37 people with health conditions and physical needs. On the day of our visit there were 34 people living at the home. Accommodation is arranged over three floors and there is a passenger lift to assist people to get to the upper floors.

The service 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.

People who we spoke with were happy with the care and support they were receiving. They told us that staff did respond to their needs but they frequently had to wait for assistance. People were provided with choices about their care and support and how they spent their time. Staff felt well supported in their roles.

We found that the environment at the service varied considerably on different floors of the service. The ground floor was quite lively and busy during the daytime whilst the first and second floors were very quiet. Although this suited some people, we had concerns about the deployment of staff throughout the floors of the building, as some people were unable to summons assistance when they needed it.

Staff recruitment procedures were robust and ensured that appropriate checks were carried out before staff started work. Staff received an induction and on-going training to ensure they had up to date knowledge and skills to provide the right support for people. However their knowledge relating to individual’s care needs varied and was inconsistent.

We spoke with staff about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This is legislation that protects people who lack mental capacity to make decisions about their care and support, and protects them from unlawful restrictions of their freedom and liberty. Staff’s knowledge and understanding of MCA and DoLS varied but we saw that the legislation had been used appropriately. We spoke with the manager in relation about the recent case law relating to DoLS. The manager advised us that they had been in touch with the local authority following the case law and that they were going to start to reviewing people’s needs.

People were involved in decisions about what they had to eat and drink. People were supported to access relevant health professionals as they required. Mental Capacity Assessments had been completed appropriately and where best interest decisions had been made they were appropriately documented. Where people had the capacity to consent to their care and treatment there was evidence that their consent had been obtained.

People told us that staff were caring, however, we observed that staff did not always communicate with people in a caring way. People had care plans in place but these contained very little information about people’s personal preferences and had not always been updated when changes had taken place. Changes had not always been communicated effectively with the staff team which led to inconsistencies in people’s understanding.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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