Inspection on 16/01/08 for Hesley Village and College Village Green

This inspection was carried out on 16th January 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hesley Village and College... 01/12/09

Hesley Village and College... 28/05/09

Hesley Village and College... 26/11/08

Hesley Village and College... 03/07/08

Hesley Village and College... 29/08/06

Hesley Village and College... 20/02/06

Hesley Village and College... 21/03/05

Hesley Village and College... 07/09/04

Hesley Village and College... 03/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hesley Village and College Village Green Hesley Village and College Stripe Road Tickhill Doncaster South Yorkshire DN11 9HH Lead Inspector Mrs Sue Stephens 16 January 11:00 Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hesley Village and College Village Green Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hesley Village and College Stripe Road Tickhill Doncaster South Yorkshire DN11 9HH 01302 866906 01302 865473 craig.hardy@hesleygroup.co.uk www.hesleygroup.co.uk Hesley Lifecare Services Mr Craig Robert Hardy Care Home 20 Category(ies) of Learning disability (20) registration, with number of places Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 20 Service users aged 16-17 years should not be accommodated in any unit containing other service users over the age of 25 years. As service users grow older, the registered person must inform the registration authority, of his proposals to manage incidents of incontinence, where current laundry facilities ie washing machines x 2 are housed in the kitchens in this establishment. 29th August 2006 2 3 4 Date of last inspection Brief Description of the Service: Village Green is part of Hesley Village and College; the site is in extensive grounds in a rural setting. It is just outside the village of Tickhill and approximately 8 miles from Doncaster. Within the grounds there are 3 other registered services that provide care and accommodation for people with learning disabilities. In total the site provides a service for 72 people. Village Green provides accommodation for 20 people. The accommodation includes single flats and shared houses for groups of up to 4 people. People can access the site’s college facilities; these are available for people from across the entire site. The college facilities are within the grounds and a short walk from people’s accommodation. Hesley Village has a small shopping Mall with bakery and grocery, and clothes shop. There is a facility for people to collect their weekly monies and cash. Hesley Lifecare services operate and audit this service. People at the village call this the ‘post office’ and it is set up to look like a bank or post office building. The Village has a hairdressing and beautician salon, small cinema, and a Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 5 restaurant. There is a medical room for people to use, to see visiting doctors and dentists. Hesley Lifecare services manage and employ staff to run these services. The registered person (responsible individual) is Mrs Sue Ekins. Mrs Ekins is the organisations principle and she is a member of the executive team; she has overall responsibility for the whole site. The manager gave us information about the home’s fees and charges. The fees range from £159,888 to £375,124 per year. This depends on people’s needs and level of support. Information about additional fees such as transport and other services was not available for us to check on this inspection. People who are interested in this service can get information by contacting Hesley Lifecare services. The organisation will provide a copy of the statement of purpose and service users guide, and the latest inspection reports. Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This visit was unannounced. It took place between 11:00 am and 20:30 pm on the 16 January 2008, and 10:20 am and 17:20 pm on 21 January 2008. In the report we make reference to “us” and “we”. When we do this we are referring to the inspector and the Commission for Social Care Inspection. The registered manager, Craig Hardy, and the team, and assistant team managers, assisted us during our visit. Before this visit we have had discussions with senior managers about information we have that raises concerns about some peoples welfare at Hesley Village. We have asked the organisation to consider actions that will help safeguard people who live on the site. We have also sought advise from the Valuing People regional advisor. Valuing People is a government plan to improve the lives of people with learning disabilities. The regional advisor has agreed to work with us, and Hesley Village, to help improve services for people who live there. We did not have this information available to share with managers at Hesley Village at the time of our visit. During the visit we looked at the environment, and made observations on the staffs’ manner and attitude towards people. We checked samples of documents that relate to people’s care and safety. These include three care plans, one in detail, and a sample of policies and procedures, and health and safety records. On the first day we observed people’s experiences living at Village Green. On the second day we talked to staff and looked at the records about people’s care and support. A Commission for Social Care Inspection pharmacist, Ms Helen Jackson, looked at the services medication systems. She checked storage, records and staff working practices. This was a key inspection, where we looked at the key standards. These are set out in the National Minimum Standards, Care Homes for Adults (18 – 65). We looked at other information before visiting the service. This included evidence from the last key inspection, surveys, and the homes Annual Quality Assurance Assessment (AQAA). Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 7 An AQAA is information the commission ask service’s to provide, about once a year. This shows us how the provider thinks the home is performing. We also looked at information from safeguarding adult referrals (adult protection), the services notifications, and their own monthly visit reports. Notifications are part of care home regulation requirements. The regulations expect all care services to inform us about events that affect peoples’ safety and wellbeing in the service. Monthly visit reports are the organisations visit to the service, and a report about what they found. Five people who live at Village Green, with help from staff who support them, five relatives, and one visiting social professional responded to our surveys. We would like to thank the people who live at Village Green, the managers and staff, for their warm welcome and help during this visit. We also thank people who responded to our surveys. What the service does well: People have assessments before they choose if Village Green is the right place for them to live. People and their relatives said they got good information about Village Green, to help them decide about the service. We found good information in people’s care plans. These tell staff what they must do to help support people. There are a number of people who help review peoples care; this is good because they look at whether people are getting the right care. The manager has started to introduce person centred plans, when developed these will help give people more control over their lives. People we spoke to told us they are happy with their daily routines. Most relatives also said opportunities for people to do interesting activities are good. One person told us “I have set activities that I like doing” And a relative told us “it’s a Village atmosphere with plenty of space and activity” Someone told us they have a small job, they liked the job and Village Green give them a small payment for it. One person has support to go to Doncaster College, and other people access the community by using the sites mini bus. Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 8 Each house has a phone, so that people can keep in touch with their family and friends. People have weekly menus so that they know what meals they can have, however if they want to change these they can at any time. Staff support people who may need physical intervention or restraint to help keep them safe from harming themselves. Staff have training to teach them how to do this. And staff told us they get good support from managers and the psychology team. People’s care plans have good information about their health care needs. They have a Health Action Plan to help them keep in control of their own health care needs. People have access to a nurse who helps to monitor their health care and help them gain access to health care services. There is a good system for the accurate administration and recording of medication. This means that people are receiving their medication as prescribed, which helps to maintain their health and wellbeing. People told us they knew who they can complain to, and relatives said the service has given them information about how to complain. People said they are happy with their environment. And staff give people support to help personalise their homes. People said good things about the staff; one person said, “Staff give me lots of help”. And relatives said very positive things such as: “Lovely carers” and “Staff are friendly and caring” Nearly 50 of the staff have a National Vocational Qualification in care. This means they have had training and guidance on good care practices. Staff follow safe working practice procedures (health and safety) to help people keep safe from accidents. What has improved since the last inspection? There is a better staff structure; this gives people more consistent staff teams. Medication systems are safer. People’s records have dates on them so that people can see when staff wrote them. Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 9 Maintenance has improved; so people get repairs done quicker. Nearly 50 of staff now have a National Vocational Qualification in care. The service has a registered manager who has good experience and qualifications in managing the service. What they could do better: People need up-to-date Service User Guides and contracts so that they can know what their fees and terms and conditions are. Some people need to have better and more organised reviews. Some people need to receive better care and support that reflects the information in their care plans. Managers need to take better action when this does not happen. People need more respect and dignity. Staff need to involve people more in conversations and choices about their daily lives. The organisation needs to improve the service to avoid people having institutionalised care. People need more personalised care and the organisation needs to reduce the number of set rules it has at the service. Such as, propped open doors, locked exit gates and meal tokens. The service needs to involve people in decisions about their limitations on freedom and choice. This includes people who need physical interventions and restraint. People with dietary and nutritional needs need better care plans to meet their needs and preferences. The organisation needs to make big improvements to protect people from risk of harm and abuse. The organisation needs to improve how it shares information with us and other authorities. The organisation needs to make big improvements to their quality assurance systems to make sure people get a better and safer service. Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 10 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. People who use this service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to Village Green. People get some information about the service; and they have needs assessments to help them decide if the service is suitable to meet their needs. People do not have contracts that are up to date and provide clear information about their fees and charges. EVIDENCE: A person told us in their survey: “My Mum and Dad helped me choose Hesley Village”; “they showed me pictures of Hesley” Four of the five relatives said, in the surveys, that they always get enough information to help them make decisions, about the service. One relative responded that this ‘usually’ happened. One person said “Hesley Village are always open and welcoming, both with their attitude and information”. When people consider Hesley Village as a place to live, an assessment team from the organisation liaise with the person, their families and the funding Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 13 authority. The registered manager has some input into this, and also liaises with the team. The organisation invites the person and their families to visit and spend time on site. The team look at people’s assessments from their local authorities; and they carry out their own assessments. This gives the manager and staff team information to help put together a care plan. We looked at information about the service. We looked at their Statement of Purpose and found the information was in small print; it had few symbols and pictures to help people understand the information. A representative for the organisation told us Village Green did have a new Statement of Purpose. They had designed this in better print and a format that was easier to read. The new version was with the printers; therefore we did not check this. We looked at Village Green’s Service User Guide; it was available in the manager’s office. Some staff we spoke to were not clear about what the information was. They need to know this so that they understand what it says about the service, and what service people can expect. They need to be more aware of it so that they can help the people they support to understand the information about the service they receive. The Service User Guide was out of date by several years, and did not reflect the service. Contact numbers were also out of date. This means that people, and their families and representatives, cannot get the information they should have access to about the service. We asked to look at three people’s contracts and a breakdown of their fees and charges. Village Green staff and the sites administration department were unable to show us this information. They provided contract information that was several years old. This means that people, their families and representatives, and funding authorities cannot get easy and clear information about the service the person receives, and what extra charges they have to pay for. Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 14 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People who use this service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to Village Green. People have care plans that reflect their needs. Some of the services practices do not support people to make real decisions in their lives and daily routines. EVIDENCE: We have assessed this area as adequate because although people have good care plans we saw evidence that the service needs to improve to make sure people have real choices and better control over their lives. We looked at three peoples’ care plans, one of these in detail. The care plans have good information about people’s needs. We saw that other professionals such as a psychologist also have input to the plans. For example, when someone needs a plan to help them manage their behaviours. We noted that the plans include people’s complex needs; they describe what happens for the person and give staff instruction about how to support them. Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 15 This includes people’s behaviours, communication, and medical support, such as if someone has a seizure. We found that the plans have reviews about people’s needs and progress. Staff involved in a person’s support (for example, support staff, manager to the service, and psychologist have a core group meeting where they agree what support the person needs). They look at the plans to check that they are suitable for the person, or if they need to change anything. People’s records have dates on them; this helps to make sure the plans are up to date. Village Green staff have improved this practice since our last key inspection. We found that people’s care plans are prescriptive. By this we mean that there is a lot of information about the person and what staff must do. We understand this is necessary for people who have complex needs. However, the plans have less information about the person’s opinion or preference in each area of their care plans. This does not help people to have good choices about the way they want to live and receive support at Village Green. A visiting professional told us they had concerns about how staff at Hesley handled someone’s review. They said staff did not have the current records available in order to carry out the review. And information about the person’s complex needs and incidents was sketchy. They said information recorded about the person did not meet their personal and health care needs. They said they felt communication from the service about the persons needs was not good. The manager has started to introduce person centred plans (PCP) for some people. A person centred plan is a way of making people’s support fit their needs and aspirations better. If the manager links this in with people’s care packages it will help people to have more control over their support, and they way they want to lead their lives. More than one member of staff told us they were concerned that some staff do not follow people’s care plans, as they should. We saw records that supported their comments. However, someone had failed to follow the reporting procedure, for one of the concerns, and therefore the practice still happened. People have risk assessments in their plans. These give staff information about what the risk is, and what they need to do to help the person minimise that risk. For example, we saw risk assessments about when individuals visit the site’s ponds and boardwalk. Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 16 When we observed people going about their daily routines. We saw that some practices do not support people to make choices about their lives and daily routines. For example: • We saw that staff sometimes speak to each other about a person, but do not consult that person. We saw this happen on several occasions, and in front of the person they talked about. • One person had a storybook (information to help someone understand acceptable behaviours) however staff locked this away rather than the person having it, or a copy, as their own. • People who live on the Hesley site receive £12 per week, spending money, regardless of their needs, aspirations and choices. Helping people to be involved in decisions about their support and daily lives is important. Most people who live at Village Green are young adults who may spend a long time using care services. Some of the services practices fail to include people in real decisions about their daily lives. And because of this people are at risk of experiencing institutionalised care. Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 17 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. People who use this service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to Village Green. Some people are at risk of institutional practices becoming part of their normal daily routines. EVIDENCE: People said, in the surveys (with support from staff): “I have a college program and individual activity program” “During the day I have set activities that I like doing; when I have free time I can do what I want” Relatives said: “Its a village type atmosphere with plenty of space and activity” “They offer a range of activities” “(Persons name) has different options, such as college, walks, stay in bed, or go out on the bus” Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 18 “They need more access to outside facilities” We observed people using the sites college. People were involved in activities that included, music and drama, recycling, art and craft, and writing. We saw staff encourage people to take an interest in the local environment, such as feeding the birds and ducks and taking walks in the local woods and fields. One person told us they had chosen a job that involved checking areas of the site. Hesley village had provided them with suitable clothes and staff support to do this. They told us they enjoyed the job very much. Hesley Village gave the person a small payment for this. The person said they liked this because they could save up and go out and enjoy a “leisure day”. The site has a cinema, hairdressers and beautician salon. One person invited us to sit with them while they had an aromatherapy session. They said they enjoyed these very much. Hesley Village makes a charge to people who use the salon for aromatherapy. During the session a member of staff opened the door to the salon, although the person was dressed it left them in sight of people passing in the square. The staff spoke to staff, while holding the door open, in the salon but not to the person. They did not excuse themselves or apologise for the interruption. The discussion between the staff was of a social nature. The incident did not take into account the persons dignity and respect. This was very poor practice. Following this we noted that staff discussed an aspect of the persons care needs, and carried this out, without allowing the person to make a real decision about it. Staff told us that the people they support could access the community. For example, if it was appropriate for a person, they could attend Doncaster College. They also told us that they take people out for meals and to pubs; but this happened more in the summer. Staff told us that for some people it is possible to use public transport. However, most of the time they relied on the sites minibus, and they had to book this or check the availability. Staff told us that people could phone their relatives and friends. Each house had a phone in the entrance hall for people to use. We noted that one care plan told staff when and how the person needed support to contact his parents. This is good practice because most people who live at Village Green live along way from their family and friends. However, one relative told us they ask staff for regular contact, by phone, with their family member, and this does not always happen. Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 19 We saw some practices that do not respect people’s rights. They place people under the same restrictions; and don’t follow a person centred approach. This includes staff talking about people, and making decisions for them, rather than with them; we have some examples of this under standard 7 of this report. When we visited people in their homes and flats we noted that most people had their front doors propped open. For one person, staff used a beanbag to do this, for other people they had fire alarm sensitive doorstoppers. It is not clear from peoples’ care plans whether this is because a person has specifically requested that their door is propped open, whether it is necessary for the person’s wellbeing, or whether it is a convenient staff practice The amount of people who have propped open doors is unusual. The service needs to look at this carefully, because the practice affects peoples’ choices, dignity and privacy. The Hesley Village has locked gates and a small perimeter wall around the site. People who live at the village, and visitors, cannot get in or out without a member of staff with a pass. We looked to see if Village Green assess, review, and inform people about this. We did this to check if the service keeps people involved in decisions about restrictions on their freedom and choices. We found no evidence that Village Green consult and review this limitation on their freedom. Staff told us the gates were important to “Keep people out”, such as “burglars and intruders”. However this does not explain why all people who live at Hesley Village have no free access out of the village. Because there is poor evidence to show how Hesley Village consider people’s rights, such as the locked gates and propped open doors, people are at risk of experiencing institutionalised care. These practices could put people’s rights under the Mental Capacity Act, 2005 at risk. Staff told us people have a budget of £26.50 per week for food. They do their shopping at local supermarkets, and can use Hesley Village shop to stock up on milk and bread. In addition to this, each person receives a weekly meal voucher to use at Hesley Village’s restaurant. People receive the same food budget regardless of their health and diet needs. If people want to purchase food from the restaurant, over and above their meal voucher, they use their own spending money. Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 20 We found no assessments or reviews about how this fits in with peoples’ individual choices and needs. For example, someone may need a higher budget if they have special dietary needs. And it may be a person’s choice to use a local community restaurant rather than Hesley Village’s. This practice does not promote people’s individual needs and choices; it is not a person centred approach. Staff told us that they have a weekly menu to follow, and that people could make alternative choices if they wanted. We looked at a care plan drawn up for a person who needs to follow a healthy diet. The care plan was misleading; it gave wrong information about what staff should do to support the person to eat healthily. The plan did not reflect the person’s person centred plan; and did not include the person’s choice and preferences in the decision. The plan did not include professional input such as a dietician, G.P or government healthy eating guidelines. We told a manager about this straight away because the plan has the potential to affect the person’s healthy diet. A visiting professional told us they had concerns that the person they monitor does not get enough support from staff to follow a healthy diet. They said they had looked at the persons diet records and these showed the person had an inadequate diet. Hesley Village and College Village Green DS0000046970.V344898.R01.S.doc Version 5.2 Page 21 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use this service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to Village Green. People receive good personal and health care from staff at the home. However, the service needs to improve how it manages people’s physical interventions. EVIDENCE: Some people who live at Village Green need physical interventions, if the person becomes upset or distressed. This can include physical prompts or restraint to help keep the person and others safe. People’s care plans include what staff must do to avoid the person getting distressed, and if necessary, how to carry out a physical restraint for that person. Staff told us they had training to do this. They told us they had good support from managers and the psychology team. One staff told us Village Green has changed it’s policy so that staff must have a debrief following every incident. We found no evidence in people’s plans that staff or psychologists consult people as to why they need physical intervention. This does not protect peoples, rights, consent and dignity. Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 22 We would expect to see storybooks, pictures and symbols or accounts of how staff try to inform and involve people. There are some good practice guidelines on the Department of Health website about this. A professional, not employed by Hesley, but involved in someone’s care, told us they have concerns about their client’s restraint and the records. They told us they have ongoing issues about this with the service. People’s care plans record when things have happened in people’s lives that affected their wellbeing; for example, if they had a seizure or distressed behaviour. The staff record this and the records show that they have information to feedback to other professionals, such as the psychologist, psychiatrist and G.P. This is good practice that helps people get the correct medical support. People have Health Action Plan’s. Health Action plans are a national initiative designed to encourage people to take more control and have a better understanding about their health care needs. Hesley Village employ a registered nurse to help monitor people’s health care needs and to help them gain access to health care services. The CSCI Pharmacist Inspector made the following report about her findings on people’s medication: A list of staff authorised to administer medication is kept. This means it is possible to identify who was involved in administration if a problem or query occurred. There are no dividers between each person’s MAR charts. The use of a divider reduces the risk of medication being given to the wrong person. Forms and records of covert administration are kept with the MAR charts. The forms require a 6 monthly review of the need to covertly administer. This is done and recorded on the form. There is a statement on the forms that the student should be encouraged to take medication without mixing with food. The use of these forms and the review is an example of good practice for covert administration of medicines. A person’s needs may vary and a review will help identify such changes. Where possible medication should be given without hiding or crushing into food as a person should be able to know what medication they are being given and when. Seizure protocols are kept with the MAR charts for people receiving treatment for epilepsy. These are written and reviewed by the epilepsy specialist nurse. This means staff have access to up to date information on how to help and support someone during a seizure and helps to reduce the risk of that person coming to harm during a seizure. Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 23 One person had their epilepsy medication increased by the specialist team in August who asked for a review to be done in two months. This had not been done. It is important that a review is followed up when requested to check if any changes to medication has had any harmful affects on the person. There were very few gaps on the MAR chart. This means there is an accurate record of the medication administered to people. Some medicines that are still in use had a handwritten entry rather than a printed chart. Staff need to inform the pharmacist of medication still in use but not supplied. This helps to reduce the need to handwrite MAR entries and makes sure the charts contain accurate information. There was inconsistency in the accurate recording of handwritten entries. The date of entry and the quantity supplied were missing from some entries. To make sure there is an accurate record this information should be included, with a witness signature where possible. A check of medication administered against medication in stock showed that medicines are being given as prescribed. This means that a person is receiving their medication correctly. The dates of opening are not always written on medication. For example a tub of cream was found that had a pharmacy label dated 11/01/05. The date of opening had not been recorded so it was difficult to know how long the cream had been in use. Tubs of cream may become contaminated when in use so a date of opening helps staff know how long it has been used for and if it needs to be destroyed. A system to record opening dates helps to make sure that medicines are safe to use. The system for monthly prescriptions should be improved. Currently prescriptions are not checked before being sent to the pharmacy. The checking of prescriptions makes sure that any changes from the previous month are on the new prescriptions, to see if any items are missing and to inform the pharmacy of items that were not requested. The checking of prescriptions is an important part of the management of medication. The medication practices have improved since our last inspection. Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 24 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use this service experience poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to Village Green. People can raise concerns and complaints. However, the organisations adult safeguarding systems do not protect people enough from harm and abuse. EVIDENCE: People told us in their surveys that they could tell staff if they wanted to complain, or they were worried about something. One person said they could tell the psychologist, and another said they have a “student complaint guide”. Relatives told us in the surveys they know how to make a complaint. We saw a complaint procedure with symbols and pictures to help people understand how to make a complaint. A staff member said people have these in their bedrooms. The member of staff told us that for some people, who cannot communicate well, staff monitor their moods and characters and this helps them to recognise if the person is unhappy. We checked Village Green’s complaints book, over a year they have had one complaint, from a family member. The records showed us that the manager had dealt with the complaint in satisfactory way. Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 25 Staff told us all new staff have an induction when they start work at Village Green. Included in the induction staff have safeguarding adults training. (Adult Protection Training). Staff have a handbook that tells them what they must do if they suspect some one might be at risk of harm or abuse. This was also available in one of the services offices. It has good clear information and gives names and numbers of people to contact for advice and support. We found that although staff have good organisational information about how to report if they suspect abuse or harm, they have little awareness about policies and procedures outside of the Hesley complex. For example, they did not know about the National ‘No Secrets’ Guidance and the South Yorkshire local authority procedures. This means staff may not understand how the action they take fits in with national and local guidance. This puts people at risk of isolated care, and inconsistent approaches to help keep them safe. Since our last inspection we have had discussions with senior managers at Hesley Village as a whole about a number of concerns. We have also shared this information with Doncaster Local Authority, and their adult safeguarding team. These include: • • • • Senior managers have failed to notify us on some events that have affected people’s safety or welfare. These include injuries or threats from other people who live at the village and some staff practices. The number of incidents where staff resort to using physical intervention and restraint; and the outcome to these, such as the number of staff involved in the restraint, and injuries following a restraint. The number of safeguarding adult referrals for the Hesley site as a whole. The information we receive following, verification or investigation of an incident. Since our last key inspection in August 2006 Village Green have had six safeguarding adult referrals. All the allegations involved staff practices. The safeguarding adult procedures or Hesley investigation procedures have not yet concluded the outcome of some of the allegations. Often local authorities will ask services to verify the information about an allegation, or they will ask the organisation to carry out their own investigation. This has happened with some referrals made at Village Green. Some of the information in the referrals suggests people could be at risk from institutional abuse (repeated incidents of poor practice) or situational abuse (pressures arising from difficult or challenging behaviour). Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 26 ‘No Secrets’ is a Department of Health national guidance for organisations to help protect vulnerable adults from abuse. The number and nature of allegations at Village Green, and senior managers response to the allegations tell us that they have not implemented the guidance enough. For example, the guidance refers to specialist training for investigators, and the features of what is institutional abuse and situational abuse. We checked whether managers and senior managers had attended the Local Authorities safeguarding adult training (The training is an introduction in how to implement the new South Yorkshires safeguarding adult procedures) we found that none of the managers who deal with safeguarding adult referrals had attended the training. The Government National Guidance ‘No Secrets’ offers services guidance about the level of training staff need. For example, training managers to undertake investigations. We found that the organisation has not put these systems in place enough to safeguard people from the risk of abuse. Since we met with senior managers about our concerns (September 2007) we have continued to have concerns about further information, and the organisations failure to provide information, when people have been involved in incidents that affect their safety and welfare. On this visit we issued an immediate requirement for the organisation to comply with regulation and notify us about the relevant events. We have also noted a delay in the service notifying us about an allegation of abuse. Evidence from this visit has shown us that the organisation has not done enough to reduce bad practices in the service, such as dignity and respect. We found the service does not do enough to protect people’s human and capacity rights. (See standard 7 and 16). And although the manager has started to document person centred approaches, the services systems do not promote people’s welfare in a ‘person centred way’. The organisations awareness of external safeguarding adult procedures is not enough to make sure people receive a service that can follow up allegations in a timely and robust manner. Information from other agencies, such as people’s placing authorities have told us some relationships and links with the organisation are weak. (See standard 6). Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 27 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30. People who use this service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to Village Green. People live in comfortable surroundings that suit their needs. EVIDENCE: One person told us in their survey that their home was “always” clean and tidy “but sometimes a bit messy”. We visited some people’s homes and flats. They told us they were comfortable and they liked their surroundings. Staff told us the maintenance system had improved, and this meant that people could get repairs done to their property quickly. Some people had their own dining and living rooms, while others shared with up to two other people. One person told us he had been out shopping with his carer and chose pictures and ornaments for his flat. This shows that people have support to personalise their own homes. Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 28 Some people’s homes had adoptions to meet their needs and keep them safe. And staff told us that the maintenance department had a rolling program to decorate people’s homes, but they could ask for this sooner if someone needed a room redecorating quickly. Staff told us that they had seen people’s lives improve since they had moved into Village Green, and their own accommodation. A member of staff said one person they supported was much more relaxed and had less agitated episodes. On the whole we found people’s homes clean and personalised. However, we saw some practices that did not respect people’s dignity, for example handwritten labels (not placed in neat or dignified order) on someone’s furniture. We pointed this out to staff during our visit and suggested alternative ways that would respect the person’s dignity better. On our last inspection we found staff had propped open a fire door. one fire door propped open with a bean bag. We saw Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 29 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. People who use this service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to Village Green. People receive care from a staff team who are kind and have good intentions. The staff need more support and guidance to help make sure people get support that respects their welfare, rights and dignity . EVIDENCE: One person told us about the staff: “Staff give me lots of help” Relatives gave us a lot of positive comments about the staff team, these included: “Lovely carers, carefully chosen to meet my sons needs” “(Name)’s staff consistently care for and meet her needs” “At the moment the best staff team (name) has had” “Generally we are pleased with the staff, but we feel they need more training to deal with autism” “The staff are friendly and caring, and when you visit it feels like your Childs home and family” Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 30 Staff told us they had a good staff team, and managers gave them good support. When we spent time observing staff practices, we saw that people had good relationships with their carers. We saw people who were happy and relaxed spending time with their carers. And we saw that staff were, in the main, kind and caring towards people. We have identified in other areas of this report where staff practices, although not intended to be unkind, need to improve to enable people to live a more dignified and person centred life. The manager told us 45 of the staff team have a National Vocational Qualification in care at level 2 or above. And a further 22 of the staff team were working towards these qualifications. National Vocational Qualifications give staff a framework for good care practices, and this helps people receive safe and up to date support. The service has improved this since our last inspection. Staff told us they have good access to in-house training. And this included: Levels of physical interventions Positive behaviour approaches Awareness of abuse Medication and risk assessments When we spoke to staff they said very few people had training outside of the Hesley organisation. For example, training events put on by local authority and leading organisations. It is good practice to encourage staff to access some external training to help avoid isolated knowledge and care practices. This will help people receive better person centred care. We found staff had access to regular training. However, because of some of the practices we have seen (see standards 7 and 16) Hesley Village need to look at the standard and content of the training and evaluate how this can have a better impact on people’s daily lives. Staff told us the organisation had restructured the staff teams and this works well. They said it has improved things for people because they now have more consistent staff and managers. Staff also told us they had a good on call system, and someone was always available for advice and support if they needed it. We looked at three staff recruitment files. These showed that the organisation follow the right procedures to help make sure they employ suitable staff to support people. This includes face-to-face interviews, references and criminal record bureau checks. Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 31 We looked at people’s supervision files to check the support managers give to staff. We found that some staff had expressed concerns about people’s care, but managers had not followed this through well enough to safeguard people’s dignity and welfare. Where staff had raised a concern about someone’s inappropriate behaviour in a persons home, managers had taken action to support members of staff but not the individual who’s home it is. This is not acceptable, it does not promote people’s dignity, welfare and rights, and it does not follow person centred approaches to people’s care. We fed this back to managers during our visit, and a senior manager shortly after our visit. Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 32 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People who use this service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to Village Green. People receive care and support from a service that needs to improve their self monitoring to make sure it improves the quality of peoples care and support. EVIDENCE: Since our last inspection the manager has registered with us. This means he has demonstrated that he has the right qualifications, training, and skills to manage the service well. The manager told us he had good experience at managing services. And he has worked at Hesley village in less senior roles and understood the organisations systems well. He told us he gets good support from senior managers and has a good staff team. Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 33 Hesley Village Green has some excellent policies and procedures (as part of the whole site). The organisation has a nominated person who visits the site on a regular basis and makes a report, about once a month, on their findings. This includes an overview of physical intervention records and other records that relate to peoples care. The organisation also has some very thorough and in-depth recording tools. These are examples of good quality assurance practices. However, when we asked staff about how the managers assess standards at the service they told us that their immediate managers were always around, so could see day-to-day practices. But, more senior managers did not visit. When we asked, staff told us the responsible individual, Sue Ekins, “Never visits” and “We never see her in (people’s homes)”. A staff confirmed that the responsible individual was based on the Hesley Village site but did not come down to speak to people who live on the complex or staff. This means that the senior managers are missing opportunities to hear peoples and staff’s views about the service, and how it is run. We have also found, from information before and during our visit, that the organisations quality assurance monitoring does not impact enough on people’s safety, rights and dignity. And that people do not always receive care approaches that follow the organisations policies and procedures. We have detailed these under the related standards in this report. We have had discussions with senior managers about our concerns, we have explained the importance of reducing bad practice, and we have asked the organisation to consider actions that will help safeguard people who live on the site. (See standard 23 for more information). We found that Village Green has good safe working practice procedures (health and safety), staff attend regular safety training and there is good maintenance to make sure equipment, buildings and fittings are safe. Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 2 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 2 X 3 X 1 X X 3 X Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 5 12.2 Requirement To make sure people, their families and representatives have clear and accurate information about the services at Hesley Village Green the organisation must: Make sure people, their families and representatives, have upto-date Service User Guides The information in the Service User Guide must reflect the service people receive The Service User Guide must include the correct contact details of the Commission for Social care Inspection 2 YA5 5 The organisation must provide people with an up-to-date contract that gives them clear information about their terms and conditions This must include clear information about the organisations fees and additional charges Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 36 Timescale for action 30/06/08 30/06/08 This will help protect people’s rights 3 YA6 12.2 The organisation must examine and improve the way it carries out people’s reviews and how they involve external professionals (such as people’s social workers) The organisation must make sure that information about people’s complex needs and incidents is clear and accurate This will help external professionals and people’s families and representatives support people to make the right decisions about their care at Village Green And it will help protect people’s rights and give people support to make decisions about the care they receive 4 YA6 12.1 The organisation must make sure people receive the support and care as agreed and set out in their care plans When staff report that people have not had care, in line with their agreed plans, managers must take action to investigate and address this This will make sure people receive consistent and agreed care approaches 5 YA7 12.2 The organisation must make sure that staff involve people in day-to-day choices and include them in conversations and decisions. DS0000046970.V344898.R01.S.doc 30/09/08 30/09/08 30/09/08 Beeches (The) (Seven Kings) Version 5.2 Page 37 The organisation must improve the support they give people to help people have a better say in their care, routines and preferences 6 YA16 12.1 12.2 The organisation must review practices that can lead to institutionalised care. They must improve these to give people more personalised care They must make sure their services meet people’s individual needs and aspirations and avoid ‘set rules’ that do not take into account people’s needs, preferences and aspirations (For example people’s front doors propped open, locked exit gates, and meal tokens) 7 YA16 12.1 12.2 12.4(a) The organisation must assess, record and keep under review people’s imposed limitations on freedom and choice They must include the person it involves and their representatives in this process This will help protect peoples rights under the mental capacity Act 2005 8 YA17 12.2 16.2(i) Care plans about people’s dietary needs must reflect the individuals needs and choices Staff must be aware of how to draw up safe and healthy care plans about dietary needs 9 YA17 16.2(i) The organisation must make DS0000046970.V344898.R01.S.doc 30/09/08 30/09/08 30/06/08 30/06/08 Page 38 Beeches (The) (Seven Kings) Version 5.2 sure the diet staff offer people reflects individuals dietary and nutritional needs They must keep clear information about this to show how the service has monitored the individuals diet and preferences and personal choices 10 YA18 12.2 The organisation must improve how they involve people in decisions and reviews about using physical interventions and restraint on them This will help protect peoples rights under the mental capacity Act 2005 11 YA23 13.6 18.1(c)(i) The organisation must improve staff awareness of safeguarding adult procedures that exist outside of the Hesley complex For example National ‘No secrets’ guidance and South Yorkshire local authority procedures The organisation can do this by giving staff access to Doncaster Local Authority safeguarding adult training This will help to prevent people from the risk of experiencing isolated, abusive and inconsistent care approaches 12 YA23 13.6 The organisation must improve managers and senior managers awareness of safeguarding adult procedures that exist outside of the Hesley complex For example Local Authority Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 39 30/06/08 30/09/08 30/09/08 training and new policies and National Government ‘No Secrets’ guidance on policies and training 13 YA23 37 Immediate requirement The organisation must submit a notification to the Commission for Social care Inspection when people have experienced an event that affects their safety and wellbeing 14 YA23 13.6 The organisation must improve the service they provide to people, and identify, and take action, to reduce incidents where people are at risk of institutional and situational abuse The organisation must look at the standard and content of staff training and improve how this impacts on people’s dignity, respect and rights Where staff raise concerns about care practices and people’s welfare the organisation must make sure they take appropriate action to protect peoples welfare, dignity and rights The organisation must improve how their quality assurance systems impact on the services people receive 30/09/08 21/01/08 15 YA35 12.4(a) 18.1(c)(i) 30/09/08 16 YA36 12.4(a) 30/09/08 17 YA39 24 30/09/08 Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 40 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The organisation should make sure that staff understand what information is in people’s service user guides This will help staff to give people accurate and up-to-date information about the service and accommodation 2 YA6 To help people have more say in their care and support care plans should have better information, about people’s opinions, choices, and preferences, under each section of their plans Village green should continue to introduce person centred plans. However, these need to reflect people’s real experiences and their care packages The organisation must assess people’s dietary needs and make sure the budget they provide is suitable for people’s individual dietary needs and choices The organisation should review the meal token system because it may not be the most appropriate option for all individuals Plans that affect people’s health and welfare (for example nutritional care plans) should include professional input and good practice guidelines For accurate information on MAR charts all handwritten entries must have detailed information and a witness signature where possible. A divider should be used to separate each person’s MAR charts. This helps to reduce the risk of medication being given to the wrong person. Monthly prescriptions should be checked before they are sent to the pharmacist. This will reduce the risk of errors. A system to check the length of time medication supplied in tubs has been in use should be developed. This will help Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 41 3 YA6 4 5 YA17 YA17 6 YA17 7 YA20 to make sure the medicine is safe to use. Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beeches (The) (Seven Kings) DS0000046970.V344898.R01.S.doc Version 5.2 Page 43 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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