Hylton Grange

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This was the first rated inspection of the service. People’s needs were assessed prior to using the service and reviewed on an ongoing basis, to ensure people’s needs were met. Detailed information was collected before a person started to use the service. Passports were available with relevant information if people moved between services to help ensure people’s needs were understood and continued to be met. Care plans were developed for each identified care need and staff had guidance on how to meet those needs. Staff worked well with other health and social care professionals to ensure people’s care and treatment needs were met. Records included specialist advice and guidance, that had been obtained where people had additional support needs such as from the speech and language therapist or behavioural support team. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Assessments were carried out, around people’s mental capacity and care records contained all relevant information and were documented in line with guidance. Staff ensured that people were involved in decisions about their care. They knew what they needed to do to make sure decisions were made in people's best interests. Advocates were involved as necessary. Systems were in place to ensure people received varied and nutritious meals.

This service scored 75 (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 their care needs had been assessed and they were involved in care planning. People said staff consulted with them and knew their care and support needs. A person told us, "I have been here 6 weeks and in that time they, [staff] have done more for me than a previous place did in 6 months." A relative commented, "I wrote up for staff, things [Name] likes to do and I did one from me about what I would like to see the home do with [Name]."

There were effective systems in place to assess and monitor people’s needs. This included handover meetings between incoming and outgoing staff on shift and regular staff meetings. A staff member commented, "Communication is good. We have daily handovers that includes any changes in people's needs. We also have team meetings." Staff told us people were involved in meetings about their care plans. A staff member commented, "People and families are involved in writing the care plans." Staff knew people well and demonstrated compassion and understanding to people they supported. A staff member said, "People's care records have a section called, 'all about me’ which includes what they like and dislike."

Systems were in place to ensure people's care and support needs were met. Staff used a range of assessment tools to assess and monitor people's care needs, health and medical conditions and well-being. People’s needs were assessed prior to using the service and reviewed on an ongoing basis. They had risk assessments in areas where it was identified they may be at risk such such as their mobility, nutrition and pressure care. Care plans were developed for each identified care need and staff had guidance in care records on how to meet those needs. Care plans included specialist advice and guidance, that had been obtained where people had additional support needs.

People were supported to understand their rights and make safe decisions. People, and their relatives where appropriate, were involved in assessments, including deprivation of liberty and best interest decisions. A person and a relative confirmed this. Staff used communication tools, such as pictures and Possum (communication aid), to support people with decision making, where necessary. People’s preferences were respected, and people were involved in the development of their care plans.

Staff told us people’s care was based around what was important to them and according to their preferences. Staff knew people’s care and support needs, including their dietary preferences and nutritional needs. Staff were aware of the best practice to support people and kitchen staff took the lead from staff regarding the required level of modified diet. A member of staff told us, "There is a folder in the kitchen for the chef with specific dietary requirements for all people using the service." Staff knew how to support people to make safe choices, they could tell us what people's 'triggers' for distress were and how they reduced the likelihood of these occurring. Strategies for supporting people post-incident were also included in staff guidance. They used positive behaviour support [PBS] strategies to support people if they became distressed, using the least restrictive options. People’s 'triggers' or causes of distress were recorded to ensure they were addressed, removed or reduced. A staff member commented, "Care plans are the responsibility of the qualified nurses, they have a good level of detail for individuals."

Care records reflected people's care and support needs. The service made timely and appropriate referrals for specialist support from other professionals such as the GP, speech and language team (SALT) or the organisation's PBS team. Care plans contained information about people’s nutritional needs and if a person’s diet was modified. Records were completed to document any staff intervention with a person. For example, for monitoring a person’s nutrition and hydration. People’s weights were well-monitored for risks of malnutrition. Specific nutritional care plans were in place to ensure people were able to enjoy the meals they wanted. Systems were in place to ensure people received varied meals at regular times. Quality improvement systems were in place, which included regular audits and feedback from people and staff to ensure people received safe and effective support at all times.

People told us they were supported to access health care services. and resources to ensure there needs were met and to enjoy an improved quality of life. A person told us, "They [staff] got me a bigger bed and moved me into this room with double doors so they can get my bed out of the room and outside. I have had a special chair ordered so I can get out of bed."

Staff told us they worked well with each other and external services and were supported by management. Referrals were made to relevant specialists to obtain assessments and support for any additional care and treatment needs people may have. Staff felt communication was effective and regular multi-disciplinary meetings took place with involved professionals to discuss any additional care and treatment needs people may have. Staff followed the advice and guidance provided from the meetings, to ensure people's changing needs were met. The registered manager commented, "We liaise closely with social workers, commissioners, advocates and the community mental health team."

Positive feedback was received from professionals who were involved with the service. A professional commented, "There is a very good communication system in place and we have always had a timely response to our queries." Another professional told us, "We work together to ensure that the needs of patients are met in a timely manner."

Staff made timely referrals and worked well with other agencies to ensure people's treatment needs were met. Multi-disciplinary meetings were held with health and social care professionals to ensure people's care and treatment needs were met. Comprehensive information was available in people's care records to ensure that people's needs could be met safely and in an effective manner if they needed to move between services. For example, if a person was admitted to hospital a passport was prepared. Where people may not communicate verbally, a passport included information about their preferences, things of importance to them, as well as the necessary medical information. People were escorted by staff or relatives to appointments, so they did not attend alone. Staff handovers were completed during shift change, which included tasks completed, tasks outstanding and the well-being of people.

People were supported to ensure their health needs were met. A person commented, "I have been to an appointment to have injections to help my contracted arms and hands and the nurse comes every day to clean my hands and massage them for me. I feel like they [staff], want me to get better." A relative told us, "They [staff] keep me informed about everything and I feel they care for [Name] well medically."

Staff told us people were supported to ensure their health needs were met.

People’s healthcare needs were met appropriately. People had access to health professionals when required. Staff worked with a range of other professionals, including GPs', Occupational therapists, speech and language therapy and social workers. Care plans were in place to promote and support people's health and well-being. There was effective communication between staff and visiting professionals and staff followed guidance provided to ensure people’s needs were met. Daily notes documented what support was provided to people.

People told us the care they received was good and it made them feel comfortable and safe. A person commented, "I enjoy being here." People also told us they felt they could do what they wanted, and staff respected them as individuals. Some relative's feedback described how the care provided by staff improved people’s quality of life, general health or mood.

The registered manager and staff told us peoples outcomes were always monitored through daily observations and reviews such as care reviews and meetings. During reviews, care needs were discussed to improve outcomes. Regular audits were also carried out to monitor and improve outcomes.

Systems were in place to monitor and improve outcomes. Care plans were personalised to ensure outcomes could be met in ensuring people received safe and effective support. There was regular evaluation of risk assessments and people's care plans, to ensure they accurately reflected people's needs, with appropriate guidance for staff about the support people needed. Reviews took place to ensure peoples support and outcomes were monitored. Audits were carried out, with an action plan in place, to ensure people received personalised care according to their needs to ensure there was a system of improvement and improving outcomes for people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People told us they were asked for their choices and staff respected their decisions. A person commented, "There are always lots of choices." Another person said, "I am happy with the food, if there is something you don’t like you can have something different."

Staff knew how to support people in a way which respected their decisions and supported them to make choices. They knew what they needed to do to make sure decisions were made in people's best interests. The registered manager and staff were aware of the principles of the Mental Capacity Act (MCA) and the need to ask for consent. Staff empowered people to make their own decisions about how their day to day care and support was provided. They understood people’s capacity to make decisions through verbal or non-verbal means. We observed positive interactions between staff and people. Staff involved people in everyday decisions and acted in people's best interests. Staff explained what they were doing and asked people's permission before providing support. A staff member told us, "Care plans include information on the preferences of individuals."

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Staff supported people in least restrictive ways. Records around people’s capacity contained all relevant information and were completed in line with national guidance. [DoLS] authorisations were monitored by the management team. Records showed mental capacity assessments had been completed with people and their representatives. People’s capacity and ability to consent was taken into account, and people and their representatives had been involved in planning their care and support. Where people could not make decisions and consent to their care, there were processes in place to make sure any decisions would be made in their best interests. People had the involvement of an advocate when family or friends, were not available.