Rating at last inspection: Requires improvement (published 2 May 2018).

About the service: The service is a residential care home providing personal care to 46 older people and people living with dementia. Thirty-eight people lived in the service when we inspected.

Why we inspected: This was a scheduled inspection based on the previous rating. The overall rating has improved to good.

People’s experience of using this service: Improvements had been made since the last inspection in February 2018 around infection prevention and control. The provider was now meeting legal requirements. All areas were clean and tidy; we saw that work to improve the facilities had been completed. The rooms we looked at were nicely decorated in colours of people’s choosing. One person told us, “I love it here and my room was decorated before I came in. I think it is super.”

People told us they felt safe and well supported. The provider followed robust recruitment checks, and sufficient staff were employed to ensure people’s needs were met. People’s medicines were managed safely. People told us, “Definitely enough staff to meet people’s needs” and “Everybody is pleasant and gets you what you want.”

In the last year the provider had achieved an award from Dementia Care Matters for the development of the service. To achieve ‘Dementia Care Matters Butterfly Model of Care Quality of Life Accreditation’ the provider had remodelled the environment on the ground floor into three individual areas based on people’s dementia care needs. Staff had received training and development around management of dementia and demonstrated a good understanding of dementia care. They worked with people’s individual strengths to ensure their independence, wishes and choices were promoted. This had a positive impact on people and meant people were much more settled and at ease. Staff had time to do activities, discussions and get to know people and relatives.

Staff knew about people’s individual care needs and care plans were person-centred and detailed. People described staff as “Excellent, caring and knowledgeable.” We were told staff treated people who used the service with compassion, dignity and respect. One person said, “Well I think the atmosphere is pretty good - the way the home is divided up. Although one or two people living with dementia do walk around, the staff are there to offer help if they need it.”

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 told us the service was well managed and organised. The management team assessed and monitored the quality of care provided to people. People and staff were asked for their views and their suggestions were used to continuously improve the service.

More information is in the full report.

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.

This inspection took place on 21 February and 9 March 2018 and was unannounced on day one of the inspection.

The Hylands is a large property with accommodation and facilities spread over five floors. The service offers three communal areas (lounge/dining rooms) on the ground floor for people to spend time in. The service terms these areas as ‘houses’ called Sunflower, Primrose and Bluebell. The service is close to all local amenities. The service provides accommodation for up to 46 people who require personal care, some of whom may be living with dementia. At the time of the inspection 36 people lived in the service.

The Hylands is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager who was also the registered provider. 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 arrangements for assessing, reviewing and monitoring risk within the service were not robust. This applied to the environment and people’s health, safety and welfare.

The assessment of risk, and preventing and controlling the spread of infections was ineffective. Documentation for cleaning the service and recording infections was not in place.

The provider carried out recruitment checks, to employ suitable people. These were not always consistently applied, but the registered manager took immediate action to rectify these errors.

People told us they felt safe and were well cared for. There were sufficient staff employed to assist people in a timely way. Medicine management practices were being reviewed by the registered manager and action was taken to ensure medicines were given safely and as prescribed by people’s GPs.

Staff had completed relevant training. We found the care staff received regular supervision and yearly appraisals, which helped them to fulfil their roles effectively.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

The provider had used a company called Dementia Matters to utilise best practice and develop the environment to be dementia friendly. The impact on people was extremely positive with individuals interacting with each other and enjoying more activities and stimulation.

People were able to talk to health care professionals about their care and treatment. People could see a GP when they needed to and they received care and treatment when necessary from external health care professionals such as the district nursing team.

People had access to adequate food, drinks and snacks. Those who spoke with us were satisfied with the quality of the meals provided.

People were treated with respect and dignity by the staff. They said staff were caring and they were happy with the care they received and had been included in planning and agreeing the care provided.

Access was provided for people to community facilities and the range of activities in the service ensured they could engage in stimulating and interesting social activities.

A complaints procedure was in place. People and relatives knew how to make a complaint and those who spoke with us were happy with the way any issues they had raised had been dealt with.

People told us that the service was well managed and organised. People and staff were asked for their views and their suggestions were used to help improve the service.

We found there was a breach of regulation 12: Safe care and treatment in relation to risk management and infection, prevention

We inspected The Hylands Retirement Home on 30 November and 20 December 2016. Day one of the inspection was unannounced and we told the registered provider we would be visiting on day two.

The service was last inspected in April 2016 and was rated requires improvement. We found the registered provider had breached three regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to lack of staff supervision, training and appraisal, lack of people’s preference recorded within their care records and a lack of formal assessment of quality and safety by the registered provider. The provider had also failed to submit statutory notifications which we dealt with separately.

We saw improvements had been made in all areas at this inspection. Following the last inspection the registered provider had enlisted various specialist consultants to support them to improve systems and process. This had included specialists in care, health and safety plus staff training. The registered provider was still working with the consultants when we inspected and improvements in some areas were still needed. The registered provider was committed to making further improvements and we were confident this would happen.

The Hylands Retirement Home is a large property which offers numerous communal lounges for people to spend time in. They have views across the bay and access to the promenade in Filey. The service is close to all local amenities. The service provides accommodation for up to 46 people who require personal care, some of whom may be living with dementia. At the time of the inspection 34 people lived in the service.

The home had a registered manager who was also the registered provider. 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.

We saw staff had received supervision on a regular basis and the registered provider had commenced annual appraisals with staff who had been in post longer than 12 months. Staff training was better organised and all training needed was booked to ensure staff received the knowledge they required to enable them to perform their role.

We have recommended the provider review good practice surrounding the environment, activities and staff support for people living with dementia to ensure they deliver the best care they can for people.

A new dependency tool had been used to determine the staffing levels required to meet people’s needs. This had led to the registered provider increasing staffing in the service to safe levels. We found recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. The full work history of applicants had not been documented which may mean that the provider would be unaware of important information. The registered provider told us they would improve the system following the inspection.

People’s care plans were person centred and written in a way which described their care needs. We saw evidence to demonstrate people were involved in all aspects of their care plans. Individual risks to people’s safety had been assessed by staff. Recognised assessment tools to aid staff understanding in key topics such as pressure area care and nutrition were not used. On day two the registered provider had started to use these. Key information from the outcomes of such assessments and risk needed to be better linked to care plan descriptions to ensure staff had all the information they needed.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. A recent health and safety audit completed by external professionals had led to an action plan to improve safet

This inspection took place on 21 and 22 April 2016 and was unannounced. The last inspection took place in August 2013 and the standards inspected at that time were met.

The Hylands Retirement Home offers accommodation and personal care for up to 46 older people. At the time of the inspection there were 40 residents living at the service.

There is a registered manager in place. 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 felt safe and were confident they could raise concerns with the staff team. However, there were no robust systems in place to assess quality and safety. The registered provider had not adequately monitored the service to ensure it was consistently safe.

The service did not have effective systems in place for identifying trends in risk to individuals. Accidents and incidents were recorded in people’s individual files, but there was no analysis of these or an overview to monitor them to identify how risks of re-occurrence could be reduced.

We have made a recommendation about recording of risk assessments and clear guidance for staff.

Staff had been recruited safely and all relevant checks had been carried out before they delivered care and support to people. People told us that staff were attentive and available in sufficient numbers to meet their needs.

Staff were trained in their roles and we saw that additional training was being sourced from a local provider to meet the training needs of new staff. This meant that staff had the appropriate knowledge to support people.

We found that staff were communicating with each other, their senior care workers and registered manager. However, supervision and appraisal were not offered consistently or used to develop and motivate staff and review their practice or behaviours. Staff training or good practice needs were not identified through supervision. There were no opportunities for staff to have regular private discussion with their registered manager to raise concerns or review their personal development.

Staff encouraged people to be as independent as they wanted to be. People told us they felt they were treated with respect and kindness. People also told us the staff approach was caring and they made positive comments about the care they received.

The care plans we saw did not all contain a full assessment of people’s needs and were lacking in information. People were not consistently consulted about their own care needs, nor were they involved in planning, reviewing, or making suggestions regarding improvements they wanted to make. The registered manager had not made sure that people received person-centred care that met their needs and reflected their personal preferences.

People who used the service and their relatives told us they felt confident about talking to the registered manager to raise any issues.

However, the service had not encouraged more formal feedback from the people who used the service. There was no robust process in place to allow the service to adequately monitor and assess whether people had received a quality service. For example, by using surveys or questionnaires.

Leadership within the service was inconsistent. Assurance and auditing systems were not in place to monitor and drive improvement in the quality of the service. The views of people, regarding their experience of the service were not being gathered to ensure that issues were identified and standards of practice were not continually evaluated to ensure they were maintained. Staff were not adequately supervised to encourage motivation and development of the staff team. Records relating to each person were not detailed or complete and the registered manager and provider had no

We carried out this inspection because at our previous visit on the 10 April 2013 we had issued compliance actions as the provider was not compliant with the regulations.

At this visit we saw that the care plans were robust and contained a personal evacuation plan and a hospital passport. The plans were reviewed on a regular basis and where possible had been signed by the person they were about.

We saw that the recruitment policy and procedure had been renewed and this ensured that people provided appropriate information as part of their application. This meant the provider could make a decision about a person's suitability to work with vulnerable people.

We spoke with three people who lived at the service and two relatives who were visiting at the time of the inspection visit. People told us they were consulted about their care. One relative told us 'The staff take time to listen to (our relative). They make an effort to include her in things and help her with the routines she is used to.' All the people we spoke with told us that they were well cared for and that staff understood their care needs. They felt safe at the home and thought that staff were well trained because 'They know what they're doing.' One person told us 'They are wonderful. Very kind and understanding.'

Three out of the three people we spoke with who lived at the home were satisfied with the care they received. We spoke with two relatives of people at the home who raised concerns about care, particularly in relation to moving and handling.

People who use the service told us that staff always treat them with respect and dignity. They also said that they enjoy some activities especially skittles. Several people said that staff had helped them to maintain contact with the their relatives through e-mail. People told us they can follow their own routines during the day.

Staff told us that they have access to training and supervision and the providers are very supportive of them. They also said that people work together as a team and one oft he advantages is that staff have worked there a long time.