Hoyland Hall Residential Home

We found the following examples of good practice.

Clear arrangements were in place for visitors. Information was clearly displayed at the entrance and in the visiting areas. Relatives were kept regularly informed. Arrangements were in place for window visits and a visiting pod was in use. Relatives were encouraged and supported to safely visit people who were at the end of their life.

Staff changed into clean uniforms on arrival; a dedicated room had been provided for this. Staff put on personal protective equipment (PPE) in a separate room with appropriate handwashing facilities. Good stocks of PPE were in place and easily available for staff; this was stored safely. Staff followed social distancing rules. The registered manager frequently met with people and staff to updated them about new Covid-19 guidance and rules. Open discussions were encouraged. People were supported to understand in a way appropriate to them.

Appropriate checks were undertaken before people moved to the home. The registered manager had developed clear procedures for staff to follow, in line with up-to-date guidance.

People and staff received Covid-19 testing regularly. The registered manager ensured people and staff were supported to self-isolate if required. The home had separate zones to accommodate people who had tested positively for Covid-19, although these had not had to be used.

Extra cleaning was taking place and additional cleaning schedules had been introduced for areas such as door handles and rails. The new owners had purchased new cleaning trolleys and products as well as refurbishing areas such as laundry shelving to promote easier and more hygienic cleaning. Further refurbishment was taking place throughout the home.

The registered manager had updated policies and risk assessments to reflect the changes made as a result of the Covid-19 pandemic; these followed government guidance.

We found the following examples of good practice.

Information was clearly displayed at the entrance. Relatives were kept regularly informed. Arrangements were in place for window visits and a visiting pod was in use. Alternative arrangements for people keeping in contact with relatives were available, such as telephone calls and a laptop for virtual meetings.

Staff changed into clean uniforms on arrival; a dedicated room had been provided for this. Staff put on personal protective equipment (PPE) in a separate room with appropriate handwashing facilities. Good stocks of PPE were in place and easily available for staff; this was stored safely. Staff followed social distancing rules. The registered manager frequently met with people and staff to updated them about new COVID-19 guidance and rules. Open discussions were encouraged. People were supported to understand in a way appropriate to them.

Appropriate checks were undertaken before people moved to the home. The registered manager had developed clear procedures for staff to follow, in line with up-to-date guidance. To support people who were self-isolating additional arrangements had been made to keep people and staff safe.

People and staff received Covid-19 testing regularly. The home had separate zones to accommodate people who had tested positively for Covid-19, although these had not had to be used. A separate area had been identified to support people who were self-isolating. This was a self-contained unit.

Extra cleaning was taking place and additional cleaning schedules had been introduced for areas such as door handles and rails. Separate cleaning trolleys and products were used for each designated zone. Further refurbishment was taking place throughout the home.

The registered manager had updated policies and risk assessments to reflect the changes made as a result of the Covid-19 pandemic; these followed government guidance.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

People’s experience of using this service:

People told us they received safe, caring support at the service. At the last inspection we found four breaches of regulations associated with the safety and quality of care, however we found the registered manager had acted to put improvements in place and all regulations were now being met. People received their medicines when they needed them, and there were systems in place to ensure people were protected against the risk of abuse. The premises were kept clean and there was good infection control practice in place. There was a friendly and homely atmosphere at Hoyland Hall, and we saw people looked well cared for and relaxed.

There were sufficient staff to provide prompt care and support when people needed it. People told us, “There’s always someone at hand, they usually come quite quickly,” and “It’s well staffed, you can always find somebody.” When people needed support from healthcare professionals such as GPs, this was arranged promptly, and we saw staff followed advice they were given to ensure people’s health was maintained. Staff continued to be recruited safely and trained effectively, and they had formal and informal support from the registered manager at all times.

People’s needs were assessed and care was planned and delivered in a person-centred way, in line with legislation and guidance. Staff knew people and their needs well, and we saw caring interventions and conversations throughout our inspection. People said they enjoyed the meals they had at Hoyland Hall. Comments included, “Every meal I’ve had I’ve enjoyed,” “If you need a bit more they will offer,” and “They make a menu and if you don’t want anything just say and they don’t put it on your plate.”

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. When people were unable to make their own decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

The registered manager asked people, their relatives, staff and health professionals for feedback about the home, and conducted audits and checks to further ensure the quality of care and support provided to people. Complaints and concerns were well managed, and we found both the registered manager and provider took prompt action to address the minor concerns we had during the inspection.

Rating at last inspection: Requires Improvement (report published in March 2018). The service had improved at this inspection.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we are scheduled to return. We inspect according to a schedule based on the current rating, however may inspect sooner if we receive information of concern.

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

Hoyland Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hoyland Hall has two floors with living accommodation on both floors which is accessible by lift. The premises had undergone some refurbishment and included large accessible wet rooms on each floor. There were 28 people living in the home on the days we inspected.

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.

People and their relatives told us they felt safe and happy in Hoyland Hall. Staff knew how to report safeguarding concerns and we saw appropriate follow up action was taken.

Risk assessments did not always reflect current need or provide staff with the necessary guidance to support people safely. Risks were not always mitigated based on individual need. Personal emergency evacuation plans had incorrect information and some staff were not aware of how to use fire safety equipment. Fire drills were not conducted regularly enough.

We observed poor moving and handling practice which did not mirror people’s assessed need, and records did not show how people’s needs had changed over time. We saw all equipment had been checked in line with Lifting Operations and Lifting Equipment Regulations 1998 and other premises safety checks had been completed as necessary. However, there was no other evidence of any equipment checks taking place on the hoist or slings.

There was a mixed view of staffing levels as some people felt their needs were met promptly but others did not. We observed staff were continuously busy with specific tasks and this meant peoples sometimes had to wait.

Medicines were administered, stored and recorded safely and infection control practices were robust. The home was clean and odour free.

All staff had received an induction, supervision and training although this needed further consideration due to staff’s lack of dementia awareness.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice. The registered manager did not have current information about people’s Deprivation of Liberty Safeguards or their relevant conditions.

We did not observe positive mealtime experiences for people as they were waiting too long for food to be served, were not offered a choice of meal or beverage, records did not always show people’s current dietary requirements and people who needed support did not receive this effectively.

We found people accessed health and social care services as needed.

The lounges were not conducive to social interaction and the premises were very cold on the first day, which had been remedied by the second day of the inspection.

Staff were considerate and caring towards people and respected people’s privacy and dignity.

Care records were person-centred in style but had not been updated since 2015 in many cases. Although they were reviewed on a monthly basis this evaluation did not incorporate people’s changed needs.

There was limited social interaction, partly due to the layout and because staff did not have time to provide extra support. We saw the registered manager had tried different options but people were reluctant to engage.

People and staff told they enjoyed living and working at Hoyland Hall. However, we found there was not a clear vision for the home and there was a lack of quality assurance measures in place from which to assess the effectiveness of care delivery. The provider visited regularly but their visits did not evidence robust scrutiny of documentation but focused on people’s experiences and the atmosphere in the home which was very welcoming.

We found breaches of regulations in regards to person-centred care, the need for consent, safe care and treatment and a further breach of good governance. We have made a recommendation about the review of staffing levels.

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

The inspection took place on 30 September 2016 and was unannounced. At the last inspection on the 21 May 2014, the registered provider was compliant with the regulations we assessed.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission [CQC] to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a 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 was present throughout the inspection.

During this inspection we identified concerns about the management of the service. The registered provider had regularly completed a range of audits to maintain people’s safety and welfare, this had impacted on monitoring the quality of the service. Audits had failed to recognise some carpets and décor were in need attention and repair.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance). You can see what action we told the provider to take at the back of the full version of the report.

We found some areas of the home’s environment required attention and improvement to make sure they were clean and hygienic. Equipment; furniture and the two sluices in the building were found to be dirty. There was a lack of hand washing facilities available in nineteen of the thirty occupied rooms in the en suite facilities; this was commented on by visiting professionals.

This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Premises and Equipment). You can see what action we told the provider to take at the back of the full version of the report.

Once identified the provider took prompt action to ensure the sluices were stripped for refurbishment , hand washing gels, paper towels and pedal bins were put in place and updates of infection control training arranged for all staff.

Staff received training related to their role and were knowledgeable about their responsibilities. Staff had the skills, knowledge and experience to support people with their care and support needs.

We found the staff recruitment and selection procedures were robust and helped to ensure people were cared for by staff who were suitable to work in the caring profession.

Staff had received training to identify abuse and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the mental capacity Act 2005 [MCA] and Deprivation of liberty safeguards [DoLS].

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. People told us they were happy with the variety and choice of meals available to them. During the inspection, we saw regular snacks and drinks were provided between meals.

Care plans were organised and identified the care and support people required. Staff had maintained detailed supplementary records to monitor people’s fluid and food intake and repositioning support. Care plans had been kept under review and updated when necessary.

We saw arrangements were in place that made sure people’s health needs were met. People had access to healthcare professionals and their healthcare needs were met. We saw the management team had responded quickly when people had experienced health problems. People received their medicines as prescribed and medicines were held securely.

Staff respected people’s privacy and dignity. We received positive comments from people who used the service and their relatives about the staff team and the approach they used when supporting people.

There were systems in place to manage complaints and people who used the service and their relatives told us they felt able to raise concerns and complaints. The registered manager had consulted with people who used the service, their relatives and professionals for input on how the service could continually improve.

At the time of our inspection, 30 people were living at Hoyland Hall residential home. We spoke with eight people who used the service, one relative, one professional visitor, the registered manager, three care staff and the cook. We also reviewed records relating to the management of the home which included three care plans, audits, staff rotas, medication records and other relevant documentation.

Below is a summary of what we found. The summary describes what people we spoke with told us, what we observed and the records we looked at.

Is the service safe?

There were risk assessments in place where required for people using the service in relation to their support and care provision. These were reviewed and amended as necessary to ensure that risks were mitigated, whilst still allowing independence, to ensure people's safety in relation to their care and support.

There were suitable arrangements in place to manage medicines. People got their required medication when they needed it which was administered safely by trained staff.

There was a sufficient amount of staff on duty to meet people's needs. Some people at the home observed staff were busy and said the number of staff had reduced. However, people told us they always received assistance from staff when they requested it. One person said 'they come when I use my buzzer, I'm not waiting long, I sometimes have to use it a lot if [my health condition] is playing up'.

Systems were in place to make sure the manager and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. Policies and procedures were in place to make sure unsafe practice was identified and people were protected. This reduced the risk to people and helped the service to continually improve.

The home had policies in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), and staff received training in this. No one at the home had a DoLS in place but the manager understood how to make an application and in what circumstances. This demonstrated safeguards were in place to protect people's welfare in line with relevant legislation

Is the service effective?

People at the home were happy with the care they received and felt this was suitable for their needs. It was evident from speaking with staff they know people well and recognised what support people needed. People at the home told us, 'everything's perfect, we're looked after', 'they do their best, I'm alright here' and 'I'm getting the best of treatment here'. No one expressed any concerns with their care.

People received a varied, well balanced diet and measures were in place to ensure people received adequate nutrition and hydration. Everyone we spoke with was complimentary about the food and told us that any dietary requirements they had were taken into account by staff. One person said, 'I'm on a soft diet and they make sure they follow that, they're aware of [my health condition]'.

Is the service caring?

During our visit we saw care workers interacted positively and gave encouragement whilst supporting people. People said, 'I've got to speak up for the staff here, they're great' and 'everything's perfect, we're looked after'. A relative we spoke with said, 'no complaints at all, they've been very good and they do look after people'. One health professional who attended the home on the day of our inspection said, 'I love this home, it's the best care, people get looked after here, it's really good, brilliant. I've got no concerns at all'.

Is the service responsive?

People's needs had been assessed before they moved into the home. Each person was allocated a key worker who worked with them to identify any needs they may have.

Care plans were in place for each individual covering a number of areas including mobility, falls, skin, continence and memory and cognition. Information was reviewed monthly and in response to any changes in needs. Updates and amendments were made where required. We saw contact with, and referrals to, other professionals had been made where necessary. One person said, 'they're pretty good at getting in touch quickly with the doctor and other people you need to see'.

No activities took place on the day of our inspection but people spoke about various entertainment that occurred within the home. This included monthly 'chairobics' and occasional coffee mornings. Some people were sat outside in the sun throughout the day. Two people expressed that they would like more to do and we observed that, although staff were caring with people, interaction was only when a task was being completed. This meant some people experienced a lack of social and mental stimulation.

Is the service well-led?

The home worked with other agencies and services to make sure people received their care in a co-ordinated way.

The home had a quality assurance system and records seen by us showed that identified shortfalls were addressed. This meant that actions to improve continuously were in place.

Questionnaires were available for people in the home and visitors to provide feedback about the service. Feedback was also sought by way of daily discussions and relatives and residents meetings.

Discussions on best practice, improved ways of working and incidents reviews were common throughout formal team meetings and informal discussions.

We talked with five people who used the service. The people who used the service told us they were happy living at the home, happy with the care they received, liked the staff that looked after them, and enjoyed their food. People explained that they had been able to see a doctor when this was needed. Some comments captured included, 'very caring [staff]' and 'everybody is very friendly here'. During our inspection we found people looked clean, tidy and we saw their personal care needs had been met.

During our inspection we conducted a tour of the premises and found it was clean, tidy and free of any unpleasant odours. There were systems in place to reduce the risk and spread of infection.

We found there were effective recruitment and retention processes in place.

We found there was a complaints process in place.