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Inspection on 26/11/08 for Hesley Village and College Village Green

Also see our care home review for Hesley Village and College Village Green for more information

This inspection was carried out on 26th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service provided at Hesley Village and college (HVC) is for people with a Severe Learning Disability, autism and significantly challenging behaviour, they have needs that are very complex. There were some good opportunities for people to improve their skills and to do interesting things, such as horticulture, leisure activities, art, I.T, crafts and woodwork. People could sometimes access the community to improve their independence skill, to go shopping and staff supported some people to do things they enjoyed such as walks and swimming. People had access to health care and other professional services. For example they can see a psychologist, psychiatrist, speech therapist and a nurse, all employed by the service. This helps to monitor peoples health. People had their own flats and en suite bedrooms in their homes. There were lawns and woodland areas for people to enjoy. They made checks such as on fire and electrical equipment to make sure they kept people safe. Some staff have worked with people for a long time and those observed and spoken to appear to know people well and are able to meet their needs, however the service is short of stable and consistent staff and therefore people are at risk of not having their needs by met by the use of agency staff who do not know them. Staff are well trained to ensure the staff were adequately equipped to work in a safe way in areas such as moving and handling, fire safety and first aid. Overall people had support from committed and caring staff. Some staff had qualifications such as National Vocational Qualification (NVQ2) in care, so they understood how to provide support to people. Relatives are welcome to visit anytime, contact is maintained by a variety of means and some people had regular visits back home.

What has improved since the last inspection?

This service was not (under the previous senior management team) organised and managed in the best interests of the people using it however a new senior management team have started to make some improvements to the service. The Contracts, statement of purpose and service users guide have all been reviewed and rewritten. Some new staff have been appointed to help the service to develop further, i.e. an activities coordinator and a person centred planning mentor. When incidents occur that are considered to be practices that do not protect the peoplethat live at the service from the risk of harm the management team have started to refer these to the safeguarding adults team at Doncaster Borough Council for investigation. Staff are trained to use restrictive physical interventions to support and protect people and techniques used are now starting to be included in the guidance documents so that staff are given clear instructions on how to act. Where staff are considered to have acted inappropriately towards the people that live in the service, appropriate action is taken by the management team to remove them and ensure the people are kept safe from the risk of harm. Complaints from relatives and professionals are now being managed effectively the service now needs to consider how it can help the people that live in the service to raise concerns and complaints. Peoples views do not underpin the self monitoring systems within the service and this directly affects peoples experience of the services. A major restructure of the service is underway to ensure that sufficiently qualified and competent people are in supervisory management positions and there are enough support staff in place that are competent to meet peoples complex needs.

What the care home could do better:

All of the people that live in the service need to have a thorough assessment of all of their needs undertaken by someone competent to do so. The development of the Contracts, statement of purpose and service users guide needs to continue and all of the people need to have a copy so that they are made aware of what they are expected to receive as part of their contract and what they have to pay for as extras. This will protect peoples rights. All of the people need to have detailed care plans that adhere to person centred planning principles this will help the staff to provide care and support that is consistent and will improve peoples daily lives. All of the people need to have structured activity timetables that meet their individual needs, wants and aspirations and ensure that activities provided do not just fit in with whats provided from the educational service. This will help to make sure the person is always at the centre of everything about their lives and help people meet their goals and aspirations. There needs to be better recording of peoples behaviours that pose a risk to themselves or others so that patterns and trends can be analysed to see what works and what doesnt, so that staff are able to protect people from the risk of injury and harm. Activities and incidents that occur need to be thoroughly risk assessed and measures put in place to ensure that people are kept safe from the risk of injury and harm.People need more support and advice to ensure they are receiving a nutritious diet and staff need further training in cooking. This will better protect peoples health. Peoples health needs must be assessed and the actions need to be written in a plan so that staff can meet all of peoples health needs in a planned way and staff need to ensure that outcomes are recorded. People living in the home need to be helped to enjoy further activities and educational opportunities and access the community more so that they can reach their full potential and work towards living a more independent lifestyle. People get support from staff that have received training. However some staff are not being effectively supported or supervised by their line managers and this is resulting in poor outcomes for people. Some staff have worked with people for a long time and those observed and spoken to appear to know people well and are able to meet their needs, however the service is short of stable and consistent staff and therefore people are at risk of not having their needs by met by the use of agency staff who do not know them. The service needs to have enough staff at all times so that people needs can be met and they can be supported to attend activities of their choosing. Some peoples rights and best interests are not adequately safeguarded as policies and procedures are not being followed. There are some good health and safety systems in place but others are failing to ensure peoples safety. The organisation needs to look at how they can better protect people and their support staff during challenging incidents. Complaints from relatives and professionals are now being managed effectively, the service now needs to consider how it can help the people that live in the service to raise concerns and complaints. Peoples views do not underpin the self monitoring systems within the service and this directly affects peoples experience of the services. Areas identified as needing to be improved from the organisations QA process now need to be actioned to make sure that the service improves.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hesley Village and College Village Green Hesley Village and College Stripe Road Tickhill Doncaster DN11 9HH     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christina Bettison     Date: 0 3 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 62 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 62 Information about the care home Name of care home: Address: Hesley Village and College Village Green Stripe Road Hesley Village and College Tickhill Doncaster DN11 9HH 01302866906 01302865473 craig.hardy@hesleygroup.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Hesley Group Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 37 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 37 The maximum number of service users who can be accommodated is: 37 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 category: Learning Disability, Code LD Date of last inspection Brief description of the care home Hesley Village and College; Village Green is located 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 is one other registered service that provides care and accommodation for people with learning disabilities and other complex needs. People can access the sites college facilities; these are available for people from across Care Homes for Adults (18-65 years) Page 4 of 62 Brief description of the care home the entire site. The college facilities are within the grounds and a short walk from peoples accommodation. Hesley Village has a small shopping Mall with bakery and grocery. There is a facility for people to collect their weekly monies and cash. The Hesley group 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 restaurant. There is a medical room for people to use, to see visiting doctors and dentists. The Hesley Group manage and employ staff to run these services. The fees range from 178,810 to 249,492 pounds per year. This depends on peoples needs and level of support. Information about additional fees such as transport and other services is included in the service user guide. People who are interested in this service can get information by contacting The Hesley group. The organisation will provide a copy of the statement of purpose and service users guide, and the latest inspection reports. Care Homes for Adults (18-65 years) Page 5 of 62 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is a 0 star. This means that the people who use this service experience poor quality outcomes. This has been the case since January 2008 and despite changes in senior management and a determined effort by all to improve the service, the people that live in the service are still at risk of significant harm by not having all of their needs met, by being victims of assault by others and by not being protected from the risk if injury of self harm. There have been over 70 safeguarding adults referrals in the last 12 months and there are a number of investigations ongoing. Care Homes for Adults (18-65 years) Page 6 of 62 From the 31 January 2008 up to 1 July 2008 there had been a total of 26 safeguarding referrals made to Doncaster Local Authority. 15 of these were for allegations of physical abuse, 3 were allegations of neglect, 1 was an allegation of psychological abuse, 1 was for financial abuse and 1 was for an instance where 1 service user was alleged to have abused another. From 1 July 2008 up to the date of the inspection 46 safeguarding referrals had been made to Doncaster Local Authority. 25 of these were for allegations of physical abuse, 3 were allegations of neglect, 1 was an allegation of psychological abuse and 17 were for instances where 1 service user was alleged to have abused another. 12 of these allegations of abuse have had their investigations completed with 5 of the allegations had been proven. At the previous inspection a new senior management team had taken over. They have been working very hard to make the changes required and improve the service for the people that live there. However, they have concentrated on re structuring the service and the majority of their time has been taken up with dealing with disciplinary investigations, reviewing all of the people that live in the service, recruitment of new staff at various levels and dealing with numerous safeguarding adult referrals. Although this is evidence of good improvement it has not had sufficient impact to ensure that the service delivered to people is safe and that peoples needs are met. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Key inspection visits were previously undertaken in January, March and July 2008, which raised significant concerns about the service and identified areas, which needed to be improved. Requirements were made to improve the quality of the service, during this visit we have checked to see whether the service had complied with the requirements. This visit was announced, both registered services were inspected by two inspectors over 6 days between 26th November and 3rd December 2008. David O Connor Principal and a range of support staff, assisted us throughout the visit. During the visits we observed peoples experiences of living at Hesley village and College. We wanted to understand what it was like for people to live at this service. We spoke to managers and registered managers to gauge their views of the service. We also spoke to direct support staff. Throughout the visit we looked at the environment, and made observations on the staffs approach to, and their ability to, support people. We also checked some samples of documents that related to peoples care and safety. These included needs assessments, daily logs, care plans, risk assessments. Before the visit we received a completed Annual Quality Assurance Assessment report (AQAA). This report provides information about how the service operates. We have used some of this information within the report. Before the site visit we also looked at a range of other information we had received about the service since the last inspection. This includes information provided by local authority agencies, the homes monthly reports, adult protection referrals and complaints made about the service. People who use the service were given surveys (in picture formats) 49 of these were returned to us, we did not use peoples comments in the reports because on the whole they did not make any comments and where they did it appeared that staff had completed this for them. Staff that work at the service were given surveys and 43 were returned. Relatives were given surveys and 33 were returned. Placing social workers were given surveys and asked about their experiences and whether the service was meeting the needs of the person for whom they were responsible and 8 were returned. Comments and views have been included in relevant parts of the report. We have been working in partnership with Doncaster Borough Councils Safeguarding Adults team in order to ensure that all safeguarding concerns at the service are addressed. This is ongoing. This was a key inspection but we did not check all the key standards as they were all checked in July 2008, those there met at that time were not checked at this visit. Detailed feedback was given to Chris Mc Sharry Chief Executive Officer and David O Connor Responsible Individual and Principal on 23.12.08 and advice and guidance was also given throughout the visit. The inspectors would like to thank the people who live at the service and the staff for their co operation during our visit. The inspectors would also like to thank relatives and representatives for their comments and feedback. Care Homes for Adults (18-65 years) Page 8 of 62 What the care home does well: What has improved since the last inspection? This service was not (under the previous senior management team) organised and managed in the best interests of the people using it however a new senior management team have started to make some improvements to the service. The Contracts, statement of purpose and service users guide have all been reviewed and rewritten. Some new staff have been appointed to help the service to develop further, i.e. an activities coordinator and a person centred planning mentor. When incidents occur that are considered to be practices that do not protect the people Care Homes for Adults (18-65 years) Page 9 of 62 that live at the service from the risk of harm the management team have started to refer these to the safeguarding adults team at Doncaster Borough Council for investigation. Staff are trained to use restrictive physical interventions to support and protect people and techniques used are now starting to be included in the guidance documents so that staff are given clear instructions on how to act. Where staff are considered to have acted inappropriately towards the people that live in the service, appropriate action is taken by the management team to remove them and ensure the people are kept safe from the risk of harm. Complaints from relatives and professionals are now being managed effectively the service now needs to consider how it can help the people that live in the service to raise concerns and complaints. Peoples views do not underpin the self monitoring systems within the service and this directly affects peoples experience of the services. A major restructure of the service is underway to ensure that sufficiently qualified and competent people are in supervisory management positions and there are enough support staff in place that are competent to meet peoples complex needs. What they could do better: All of the people that live in the service need to have a thorough assessment of all of their needs undertaken by someone competent to do so. The development of the Contracts, statement of purpose and service users guide needs to continue and all of the people need to have a copy so that they are made aware of what they are expected to receive as part of their contract and what they have to pay for as extras. This will protect peoples rights. All of the people need to have detailed care plans that adhere to person centred planning principles this will help the staff to provide care and support that is consistent and will improve peoples daily lives. All of the people need to have structured activity timetables that meet their individual needs, wants and aspirations and ensure that activities provided do not just fit in with whats provided from the educational service. This will help to make sure the person is always at the centre of everything about their lives and help people meet their goals and aspirations. There needs to be better recording of peoples behaviours that pose a risk to themselves or others so that patterns and trends can be analysed to see what works and what doesnt, so that staff are able to protect people from the risk of injury and harm. Activities and incidents that occur need to be thoroughly risk assessed and measures put in place to ensure that people are kept safe from the risk of injury and harm. Care Homes for Adults (18-65 years) Page 10 of 62 People need more support and advice to ensure they are receiving a nutritious diet and staff need further training in cooking. This will better protect peoples health. Peoples health needs must be assessed and the actions need to be written in a plan so that staff can meet all of peoples health needs in a planned way and staff need to ensure that outcomes are recorded. People living in the home need to be helped to enjoy further activities and educational opportunities and access the community more so that they can reach their full potential and work towards living a more independent lifestyle. People get support from staff that have received training. However some staff are not being effectively supported or supervised by their line managers and this is resulting in poor outcomes for people. Some staff have worked with people for a long time and those observed and spoken to appear to know people well and are able to meet their needs, however the service is short of stable and consistent staff and therefore people are at risk of not having their needs by met by the use of agency staff who do not know them. The service needs to have enough staff at all times so that people needs can be met and they can be supported to attend activities of their choosing. Some peoples rights and best interests are not adequately safeguarded as policies and procedures are not being followed. There are some good health and safety systems in place but others are failing to ensure peoples safety. The organisation needs to look at how they can better protect people and their support staff during challenging incidents. Complaints from relatives and professionals are now being managed effectively, the service now needs to consider how it can help the people that live in the service to raise concerns and complaints. Peoples views do not underpin the self monitoring systems within the service and this directly affects peoples experience of the services. Areas identified as needing to be improved from the organisations QA process now need to be actioned to make sure that the service improves. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 11 of 62 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 62 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most of the people that live in the service have lived there for many years and their needs were assessed prior to admission some time ago, however the assessments were not available and peoples needs may have changed, therefore all of the staff may not be aware of what peoples needs are and may not be able to meet them. Evidence: Since the previous visit the service has changed its registration and this service is now registered for 37 people. The information that is provided to people who may wish to use the service and their relatives has been reviewed and updated since the previous visit. The AQAA completed by the service stated We provide up to date contracts which clearly identify what extras people are being charged for. The Responsible Individual told us that these had not yet been sent out to Care Homes for Adults (18-65 years) Page 13 of 62 Evidence: relatives who represent the people that live at Hesley village and college. The statement of purpose and service user guide have been updated however attention must be paid to the detail in these documents as in one persons SUG it stated that they lived somewhere else other that where they do live, in addition to this it did not specify the persons financial contribution to their service and this needs to be added. The statement of purpose states that the service provides, a multi disciplinary person centred provision that integrates education, care, behaviour and therapeutic services designed to develop each village residents individual skills and independence. This takes place in an environment which offers warmth, security and understanding and is aimed to reflect normal life experiences for the residents. As can be seen further in this report there was little evidence that this level of service provision was being delivered for all of the people that live at Hesley village and college. All of these documents must be further updated and give correct and unambiguous information for the people living in the service and their representatives. Because of previous and ongoing concerns about the quality of the service being provided at Hesley village and college, senior managers have agreed a voluntary embargo on any new placements; therefore there have been no new admissions to the service since the previous site visit, it has been agreed that this embargo on admissions will continue. At the previous visit it was noted that none of the files examined contained a full and informative assessment completed by someone competent to do so. Care files were examined at this visit and this position has not changed. We discussed this with the RI who said that some people had their original statement of special educational needs and some had an assessment completed by representatives of Hesley village and college. The information seen was basic, outdated and child orientated and it would be beneficial for all of the people currently living at Hesley village and college to have a full re assessment undertaken either by the placing local authority or a competent person from Hesley village and college. This must include an assessment of the risks that are prevalent for each individual and staffing requirements and will help to inform the development of care plans that are detailed and person centred so that staff are able to meet peoples complex needs in a consistent way. Care Homes for Adults (18-65 years) Page 14 of 62 Evidence: There have been a high number of safeguarding adult referrals made to DBC in respect of people living at Hesley village and college and as a result of some of the investigations it is apparent that there are some people currently placed at HVC whose needs cannot be met and they cannot be kept safe from the risk of significant harm whilst living in this service. This was discussed with the RI who told us that he had identified at least 5 people whose needs they cannot meet. Meetings had been held with the placing LA and it had been decided that it was at that time in peoples best interests to remain at Hesley village and college. These decisions need to be reviewed and Hesley village and college must not continue to provide a service to people whose needs they cannot meet and that they cannot keep safe from the risk of harm. The service provided at HVC is registered as a care home for younger adults however; a nurse, speech and language therapists, clinical psychologists and a psychiatrist are all employed by the Hesley group to provide clinical services to the people that live there. Consideration needs to be given as to whether the service should be registered differently. Relatives told us The whole setting is brilliant. It provides a safe, stimulating environment. There are a variety of different types of homes single or group occupancy. The input of behaviour experts, speech therapists etc is great as local services can take forever to access My son has been at Hesley for more than 8 years. I have always been more than happy with his placement Care Homes for Adults (18-65 years) Page 15 of 62 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples basic needs are generally met, however, service user plans are not detailed enough to ensure that all of peoples complex needs are identified and met. Where risks are identified measures have not been put in place to minimise the risks to people and keep them safe from the risk of harm. Evidence: It was noted at the previous visit, Care files were found to contain a lot of information however the files were untidy and disorganised and also that care plans did not cover the full range of needs for people. The AQAA stated, Each resident has an individual care plan detailing the residents needs and preferences, a behaviour support plan which integrates both proactive and reactive strategies, an individual communication plan, health needs summary, independent skills summary and individual risk assessments for all activities and Care Homes for Adults (18-65 years) Page 16 of 62 Evidence: environments. This was discussed with the RI and he told us that a proforma was in place for care plans and individual plans for everybody are in place, but some information was still in the old files and not in the new plans. Three care files were examined as part of this visit. However care files presented to us at this site visit, although very tidy and typed up, the quality of the information was very poor. There was very little information of how to meet peoples individuals complex needs and some of the information was incorrect or ambiguous. In one care file examined this person had an independence skills summary sheet that covered eating, bathing, dressing, clothes care, safety in the community, money skills, interactions style, anxiety management and favoured routines. The information was very basic. For example I need to follow my routines especially in the morning. If I don,t follow these I might become quite anxious but there was no further detail on what these routines are and I have no road safety skills and will suddenly run out into the road but there was no risk assessment completed for this. A speech and language assessment had been completed in March 2008 and a series of recommendations made into a plan for staff to follow. A review was undertaken in October this year, in this review the SALT commented, (the person) expresses her needs and wants using a mixture of signs and vocalisations. Some of (the person) signs can be difficult to understand by those who do not know her well. Any detail regarding (the person) preferred signs could not be found within the Speech and Language Tharapists (SALT) plan or the care plan therefore agency staff, new staff or unfamiliar staff would find it very difficult to understand her preferred communication methods. In the review notes it is noted by the nurse on site that the weight records were incorrect however no indication was given of what (the persons) correct weight is. It states within the notes that work is underway with the dietician to address (the person) weight issues and the independence skills summary states that (the person) is on a healthy eating plan. However records from the daily journal indicate that this is not the case and that the person regularly eats, for example, toast, sandwiches, spaghetti on toast, cheese on toast, pizza, chips, burgers and sausages. It was also noted within the journal that (the person) has a poor sleeping routine and Care Homes for Adults (18-65 years) Page 17 of 62 Evidence: that they stay in bed until late morning or on occasions until the afternoon. Sometimes rising for breakfast and then returning to bed. This was not mentioned at all in the review or in her independence skills summary therefore there is no plan for supporting the person to have a better sleeping pattern and a better quality of life. Recommendations and actions from the review were very general and none of it was followed through to a care plan. This person was the subject of 3 Safeguarding adults referrals. The first incident was when a person ran into her flat (the door was propped open) and assaulted her. On another occasion this person ran out of their flat and into another persons flat and was again assaulted and on another occasion staff had taken this person and another out for a walk together and this person was again assaulted. Risk assessments had been completed for the individual, activities and environments. This persons individual risk assessment highlighted damage to property, self injurious behaviour, habits, epilepsy and vulnerability as high risk. Robust plans were not seen to demonstrate how staff would minimise these risks and prevent the person from being harmed. Risk assessments had been completed for swimming, visits to local parks and visits to Mc Donalds that gave staff clear guidance on how to manage these events. In another care file examined this person had a basic independent skills summary that covered eating (but no mention of a healthy eating plan) bathing (staff said the person liked to be left alone in the bath, no mention of this) dressing, clothes care, safety in the community (mentions I have no road awareness and no sense of danger), interaction style (I am fully verbal and can get my needs across this directly contradicts the SALT assessment and plan), anxiety management, favoured routines (no mention of what these routines are). The SALT assessment states that (the person) can understand simple spoken sentences an use visual clues and uses 5 or 6 spoken word phrases and some of her language is echolalia that is she will repeat what has been said to her previously. This is not fully verbal and can get my needs across, this is very misleading and means that new or inexperienced staff would not know how to communicate with this person. The risk assessment overview stated that high risk areas where making people feel threatened, self injurious behaviour and mental health state however the risk management strategies to cover these areas were very basic and particularly regarding SIB did not ensure that the risk were minimised and the person protected Care Homes for Adults (18-65 years) Page 18 of 62 Evidence: from the risk of harm. Other risk assessments in the care file were for visit to the parks, swimming, eating at fast food restaurants, visits to the seaside. There were no specific risk assessments for road safety, lack of awareness of danger and bathing (alone) as identified elsewhere in the file. We looked at the behaviour Support Plan for this person and saw that they inflict self injurious behaviour by punching their head hard, biting their hand, or wrist or punching their leg hard. We saw that the person hits their head hard against objects such as the corner of walls. Although information is available for staff to distract them when they are self injuring the advice is not robust enough, records indicate that giving them PRN medication is a last resort. We saw in the incident report for October 2008 that PRN medication had been given for self injurious behaviour for 10 out of 11 incidents recorded. For November 2008 5 of the 4 self injurious incidents had been resolved with PRN medication. Staff told us that the strategies recorded in the behaviour support plan are not effective and that staff wear a baseball hat to prevent the person grabbing their hair and that when the person bangs her head against the door surrounds they place a cushion between their head and the door jam to reduce the injury. We saw that service users present high risk to themselves and others because of the complexity of their needs the activities they are involved in. We did not see robust enough risk assessments which demonstrated how staff would minimise risks and prevent service users from being harmed. Jan Slater,who completes Hesley Village and College Regulation 26 quality monitoring visits, in her report, dated 27th and 28th October 2008, stated with regard to another service user that they had been confined whilst awaiting PRN medication. Jan Slater had noted in her report that confinement had been used in the past with this resident although it is not part of written protocol for the resident. We saw in Jan Slaters regulation 26 report dated 26th September 2008 that on 08.09.09 an unplanned intervention was carried out. The person was confined but this is not an agreed intervention. She also recorded that on 20.08.08 an unplanned intervention was given from standing to lying restraint. The record stated that this was in order to bring the situation under control as the service user was in close proximity to water filled ditches. Care Homes for Adults (18-65 years) Page 19 of 62 Evidence: Jan Slater wrote in the report dated 20th August 2008 that whilst on holiday a number of unplanned interventions were carried out on another service user. The unplanned interventions include use of a seated wrap, 2 person escort, confinement on minibus. On the journey to Butlins the journey involved an unplanned stop which the person cannot cope with, this is recorded in his behaviour management plan. The report stated that the chalet was too small and the place too busy which contributed to the persons anxiety. Jan Slater in her report queries the quality of the risk assessments carried out prior to the holiday. We saw in the complaints record a complaint made by one persons parents that when their sister had visited she found had found the person alone in the flat, in a state of undress. Another persons parents made a complaint that on 30.11.08 when they visited the person was locked in their flat alone following a period of self injurious behaviour which was calmed using PRN medication. The behaviour support plan states that staff must remain with them following the administration of PRN medication. Records maintained of the severity and length of time that people self injure are very poor and are recorded in the daily journal, for example (the person) has been doing SIB for quite a while. Poor recording of behaviours, their severity and lack of accurate timescales do not enable any meaningful analysis of what techniques work and what doesnt to inform changes in practice and approach. Reviews had taken place in June and September 2008. it was discussed in the review in September that it would be beneficial for (the person) sleep patterns to be regularised and that a type of medication might help with this. This was not carried forward as an action and not implemented into a care plan or by staff. Staff told us that everyone deals with (the person) in their own way and they do not use any Restrictive Physical Interventions (RPI) with them. They acknowledged that (the person) is possibly overweight and would eat everything in the kitchen so they only go in there with staff. They also told us that (the person) is frightened of the other people that live in the village. This person was the subject of a safeguarding adults referral and it was concluded that they had suffered physical abuse by neglect. The senior management team have been asked to put together a protection plan. Care Homes for Adults (18-65 years) Page 20 of 62 Evidence: As previously stated a full assessment was not available for each person. One area of improvement was that the speech and language team had completed thorough assessments of peoples communication needs and developed plans and strategies to assist people in their communication needs. However it was not apparent that this had been completed for everyone and plans were not always being implemented by staff. We were told by the RI that a person centred planning mentor had been appointed and she would be involved in ensuring that care plans are person centred, however at the time of the visit she had only been in post a few weeks and had commenced with providing PCP training for all staff. Care planning and documentation still does not cover all area of peoples needs and areas that are still missing are promotion of independence skills (personal care plans dont say what people can do for themselves and what they need help in), personal preferences and routines, finance, diet and nutrition, culture and faith needs and contact and relationships with family and friends and incorporation of views and they do not give sufficient detail it all aspects of personal care. The RI told us that behaviour monitoring is being reviewed and will be changed and that behaviour support plans have improved for some people but have only been in place for 2 weeks. The ones seen did detail the use of restrictive physical interventions and what techniques can be used with individuals, however these now need to be completed for all of the people that live at Hesley village and college and include the use of confinement where this is applicable. Behaviour support plans seen were improved but did not cover self injurious behaviours and guidance on how injuries can be prevented and the risks of harm to the person. Consideration will need to be given to the assessments of individuals under the new Deprivation of Liberty safeguards. Reviews are now happening more regularly and placing LA have been attending however recommendations or changes to peoples care highlighted at reviews are still not being incorporated into the care plan (as these still need a lot of work). There were still no detailed health action plans in any of the files examined (this is covered further in the health and personal care section of this report). Assessments for people under the mental capacity act have taken place and where decisions needed to be taken about medical interventions or restrictions, best of Care Homes for Adults (18-65 years) Page 21 of 62 Evidence: interest meetings have been held, however this does not yet cover everyone and every issue and this practice must continue. Staff told us that most people dont like inconsistency with staff and when they are introducing new staff and using agency staff this can create problems and peoples negative behaviours get worse. They said that the Speech and Language therapists dont listen to staff opinion and want to do it by the book. Relatives told us We do not know of a more suitable placement as (the person) is extremely challenging (The person) is encouraged and supported by the team to be as independent as possible. Where he is incapable of certain parts of day to day needs, the staff provide excellent care We are happy with the level of care afforded to our son and from what we have seen there is a good deal of skills and experience Placing social workers told us I believe the direct care staff feel that they are acting in the best interest of the person by offering choice. Client unable to cope with choice so chooses to remain in bed all day and isolated. My client who has very complex needs is supported when ever possible to live the life he chooses. He has to be monitored as he does not have the awareness of the dangers which surround him. They need to focus on people and increasing independence. I have queried previous statements about PRN and physical restraint is known historically to not be effective and have yet to discover or receive evidence that this is in (the persons) best interest. Staff told us We provide a safe and supportive environment for people with disabilities and encourage individuals to become more independent by ways of teaching life skills and promoting self worth. Care Homes for Adults (18-65 years) Page 22 of 62 Evidence: We provide a unique service of care in this specialist area meeting different needs of young people with complex needs and communication difficulties, we provide a safe environment where our students are encouraged with independence. I think that HVC offers good education facilities for residents that choose to access the college and field study areas. The majority of accommodation is comfortable, decorated to a high standard and person centred to the individual resident living there. Staff genuinely care about the residents, health and well being and have their best interests at heart and advocate very well on residents behalf. The service does care about the service users needs and try to accommodate them in the best way possible. I believe the care service does help residents to reach their full potential due to their special needs given how difficult circumstances can be. The service provides a safe and caring environment, organised to help residents to reach their full potential. I believe we do out best to respond to the different needs of individuals. Care Homes for Adults (18-65 years) Page 23 of 62 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities are provided within the service meaning that some people have the opportunity to participate in these activities. However, inadequate planning and recording, unavailability of transport and poor management of the deployment of staff means that peoples individual needs, wants and aspirations are not met. People do not benefit from access and participation in the community. Evidence: The Hesley Group provides accommodation, care, support and additional college (type) provision. However this approach is not person centred, the activities and programmes are part of a college timetable and are not tailored to individual need, in addition to this it is provided term time only. Care Homes for Adults (18-65 years) Page 24 of 62 Evidence: The college provision is used by students who do not live at Hesley village and college. We were told by staff that most of the college courses are drop in sessions and often when they take people it is full and the person cannot attend. At the previous visit staff and relatives spoken to and surveyed all commented that access to external activities away from the village were not provided. The AQAA stated, Residents are encouraged to take part in appropriate and fulfilling activities, for example work placements, vocational activities and further education both on and off site. Three care files were examined as part of this visit. Although this may be the case for some people, the people who were case tracked as part of this visit did not appear to be provided with this level of service. When this was discussed with staff reasons given were lack of confidence for some staff, staff availability and additional staff not rotad when required, transport difficulties and the use of drop in sessions at the education facility. Activity plans are in place for some people but these do not appear to be implemented in practice. In one person care file the activity plan detailed morning routines from 9.00 to 10.00, listening to music, play with pegboard or jigsaws 4 x weekly and drop in at college or walk 3 x weekly between 10.00 to 11.30am, however the daily journal entries show that this person usually goes back to bed in the mornings. The planner daily journal does not show any time spent away from the village and out in the wider community and there was no evidence on file (assessment or care plan) to indicate why this would not be possible. In another person care file examined, their activity plan details from 8.00am morning routines, walks around the grounds, visit to the shops (on site) activities in flat, relax in flat and more of the same in the afternoon. There is one session of swimming and two sessions of trips out to local parks. However the daily journal for the month of November showed only a few trips to the shop (on site) and none of the sessions as detailed in the activity plan. Staff told us that (the persons) activity timetable was governed by their sleep patterns and they were trying to increase off site activities but the person prefers the dark. (The persons) current waking time is between 11am and 3.00pm. Care Homes for Adults (18-65 years) Page 25 of 62 Evidence: This person is 28 years old and the activity plan stops at 8.00pm for bath routine, this is not person centred. We were told that meals taken at the village restaurant are free to the people that live in the village. We were told that an audit has been undertaken of peoples eating habits and food likes and dislikes and a contract is in place with the dietician at the local PCT who is going to provide advice in diets and nutrition. However this has not seen any changes for the people who live at Hesley village and college and peoples meal provision is still dependent on staff knowledge and skills which in some cases is inadequate. Where there is a plan for healthy eating, they are not being implemented in practice for example one plan stated at present my daily diet is overseen by the care staff who ensure I have a varied and healthy diet. However records from the daily journal indicate that this is not the case and that this person regularly eats, for example, toast, sandwiches, spaghetti on toast, cheese on toast, pizza, chips, burgers and sausages. We were told that additional vehicles have been purchased to ensure access to the community can be facilitated and the recruitment drive was looking for more drivers, again this does not yet seem to be providing people with more access to the community. None of the 3 files examined adequately identified peoples individual cultural or religious needs and there was no evidence as whether people were being supported to attend religious or cultural services and events. Relatives told us We believed that frequent opportunities to make trips and visits were available although this has been questioned recently (To improve the service) more frequent opportunities to make visits and trips off site, stronger approach to a healthy diet and more attention to general life skills food preparation and cooking I would like my daughter to be able to access the outside world more often. She used to love swimming but seldom goes. This may be staffing issues Care Homes for Adults (18-65 years) Page 26 of 62 Evidence: They are trying to provide cultural food and bringing them home for visits when we ask and taking them on holidays, well done Off site activities are still inadequate Staff need more support to encourage our daughter to make good choices regarding diet, healthy lifestyle, physical activities etc Hesley have not always been able to provide activities to keep our son occupied, especially school holiday periods, we believe the situation will soon be rectified. Opportunities for off site activities has been rather limited Our son has missed out on holiday entitlement, no one knows why after meetings we are promised action or contact that doesnt happen His key worker has gone to lot of trouble to ensure (the person) has trips out and also took us all out on the mini bus during one visit (The person) would like to go to Clumber park, ice skating, swimming, bowling, looking around the market and shops in Doncaster but he NEVER does Placing social workers told us Until the last CSCI report and subsequent management changes (the person) activity programme and trips out in the community was inadequate, proposals from reviews were not followed up. This has changed significantly since the summer with dramatic changes for the better, the field centre and allotments are now open to residents more often Persistent problem with lack of transport and lack of community access. I understand this is being addressed. The service is too insular. (The person) has had two holidays in 4 years, lack of planning, the holiday issue now being addressed Very limited opportunities for community participation, the service needs to have a weekly structured timetable with stimulating and varied activities, to provide a range of off site activities and to have transport more readily available Staff told us Day staff feel lost for activities to entertain residents when college has holidays Care Homes for Adults (18-65 years) Page 27 of 62 Evidence: The service provides college facilities in the form of drop in sessions. The service promotes a non aversive multi skilled model. The majority of care staff are kind and caring and bad practice is challenged The service could provide more on site activities and more organised off site activities. The service could develop person centred planning and prepare residents better for transition We need more activities off site Provide more activities for them when the college is closed I would like to see more recreation facilities made available Care Homes for Adults (18-65 years) Page 28 of 62 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples basic health needs are generally met and the medication is managed well, however the lack of health screening, health action plans and poor recording of outcomes does not evidence that peoples health needs are met. Evidence: The AQAA states we keep clear records in care plans and health action plans about things that happen in residents lives which may affect their well being, such as when they have had a seizure or distressed behaviour. The previous visit noted that the service has an on site clinical nurse specialist and access to psychiatry support on call and a clinic one night a week. However records were not clear as to the roles and responsibilities of these professionals and who had made decisions regarding treatment and medication changes. Records seen continue to be poor. Three care files were examined as part of this visit. Health action plans were very basic and did not detail action to be taken to meet all of peoples health need and Care Homes for Adults (18-65 years) Page 29 of 62 Evidence: incorporate healthy lifestyle goals. Records of visits to GP, dentists, optician, and chiropody was patchy and non existent in some cases. This does not appear to have improved significantly. In one persons care file examined there was a very basic health action plan, it listed the people who gave support and showed these as SALT, psychiatrist, psychologist, social worker and on site nurse and there was list of medications taken, but no date and no side effects noted. It noted a list of conditions that the person has and what they have problems with but there was no detailed health screening that identified any pre disposing factors or conditions or any family histories that carers needed to be aware of and monitor. It did mention a family member that has diabetes but there was no mention of this in an action plan. Action plans relating to this person detailed the health needs as relating to the medical professional and not the health need of the person, for example I will go to the medical room once a month and have my height and weight checked by the nurse, but there is no overall plan as to why this is happening and how everyone will work together to help the person to achieve their goals. Plans are not being implemented in practice for example one plan stated at present my daily diet is overseen by the care staff who ensure I have a varied and healthy diet. However records from the daily journal indicate that this is not the case and that this person regularly eats, for example, toast, sandwiches, spaghetti on toast, cheese on toast, pizza, chips, burgers and sausages. In another care examined the health action plan is very basic and (the person) is prescribed lithium carbonate which side effects include weight gain, feeling sick, stomach cramps, shaky hands, sleepiness, slight muscle weakness, dry mouth, slight dizziness and acne or psoriasis. None of these side effects are documented in a care plan or health action plan so that staff are aware and can monitor and record any problems. The service also has psychology and speech and language clinicians in the past these professionals have worked in isolation and not supported the care staffs practice with the people that live at Hesley village and college however this is starting to improve. Staff reported that the SALT assessments and plans are helping and that the psychologists are starting to work more closely with them in developing behaviour management strategies. Care Homes for Adults (18-65 years) Page 30 of 62 Evidence: Medication records and storage were checked randomly during this visit; on the whole systems were well managed. Managers told us that the care manager or team manager completes a monthly audit of the medication systems. This includes checking stock, medication administration records, returns and expiry dates. We were told that all staff complete a one day training course and written test which they must pass and they are observed three times before they can administer any medication. We were also told that all of the people that live at HVC are reviewed at least 6 monthly by Dr Biswas (the consultant psychiatrist) and more often if required. There continues to be little information about medications prescribed and what side effects might be prevalent and PRN (medication prescribed to be used on an as and when basis) protocols are not in place for all medications used in this way. Some people are prescribed medication for pain relief and protocols need to be clear so the new or inexperienced staff will know when people are in pain (if people cannot tell you). There is no monitoring of the effects of medication and whether it is effective or not. Relatives told us We have had concerns regarding (the person) diet and medical regime Has not met (the person) needs in regards to medication for example anti epileptic drugs. Issues still ongoing Our daughter recently had a medical problem and we had concerns that the response was sometimes slow and difficult to monitor due to shift patterns. However our concerns were listened to and communication has been better Placing social workers told us They have clearly not been meeting health needs despite numerous demands and requests from myself. Recent concern re neglect was upheld. Found discrepancies regarding recording of epileptic seizures dates and times and description. Two different recording sheets in use, requested reports re dietician and weight did not receive this info. Care Homes for Adults (18-65 years) Page 31 of 62 Care Homes for Adults (18-65 years) Page 32 of 62 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a complaints system, whistle blowing policy and procedures to ensure protection of people from the risk of harm and the new management team have been investigating a number of outstanding complaints. There have been a significant number of safeguarding adults referrals currently being investigated by Doncaster Borough Council, in addition to this the inadequate care, health and behaviour management plans and poor records means that there is a continuing risk that peoples needs will not be met and they may be at risk of harm. Evidence: The AQAA states we have a clear adult protection policy which outlines what staff must do if they suspect someone is at risk of harm or abuse, there is a working relationship with Doncaster safeguarding team which facilitates strategy discussions and all incidents are now referred within appropriate timescales and according to South Yorkshire safeguarding protocols. All concerns are rigorously investigated and managed within the Hesley group policies and procedures. During the course of the visit we observed that service users who live at Hesley Village and College have complex needs which require consistent and skilled staff. All service users who live at Hesley Village require at least one to one staffing because of the complexity of their needs and the high risk of challenging behaviour. Care Homes for Adults (18-65 years) Page 33 of 62 Evidence: However there have been ongoing concerns about the service being delivered at Hesley village and college and there have been over 70 safeguarding adult incidents and referrals made to Doncaster Borough Council from across the whole site in the last 12 months. From the 31 January 2008 up to 1 July 2008 there had been a total of 26 safeguarding referrals made to Doncaster Local Authority. 15 of these were for allegations of physical abuse, 3 were allegations of neglect, 1 was an allegation of psychological abuse, 1 was for financial abuse and 1 was for an instance where 1 service user was alleged to have abused another. From 1 July 2008 up to the date of the inspection 46 safeguarding referrals had been made to Doncaster Local Authority. 25 of these were for allegations of physical abuse, 3 were allegations of neglect, 1 was an allegation of psychological abuse and 17 were for instances where 1 service user was alleged to have abused another. 12 of these allegations of abuse have had their investigations completed with 5 of the allegations had been proven. In addition to this the inadequate staffing, poor health and behaviour management plans and poor records means that service users have been at increased risk of harm. There has been some confusion by managers about what constitutes abuse and an acceptance that service user on service user assault was to be expected where service users who present challenging behaviour live together. On 28 November 2008 during a discussion between Chris Taylor, Tina Bettison, regulatory inspectors, David OConnor,Responsible Individual and Jeff Cox,they told us that they were confused about what they should refer to Doncaster Social Services as a safeguarding referral. Jeff Cox asked whether a situation which had occurred where a resident was attempting to bite a member of staff, if the member of staff held his hand up to protect himself and as a result caused injury to the service users chest would this be a safeguarding referral. Hesley village and college have policies and procedures for complaints, safeguarding adults and whistle blowing. They have a system for raising concerns (cause for concern) whereby staff raise concerns and these are looked into by senior managers and outcomes fed back to staff members. On the whole this system appears to work well and a number of safeguarding referrals have emerged from this process. Care Homes for Adults (18-65 years) Page 34 of 62 Evidence: The management team at Hesley village and college are enthusiastic and motivated to improve the service. A review of the use of Restrictive Physical Interventions used across the Hesley Group of service was commissioned and undertaken between Autumn 2007 and Spring 2008. The review undertaken by The Tizzard Centre at the University of Kent and dated September 2008 concluded Staff generally did not have high confidence levels in the ability to reproduce taught techniques in practice in particular with the standing to lying technique Environmental factors were regularly cited as the cause of difficulties in correctly implementing the supine hold The role of staff strength and gender in maintaining holds was less clear since it is thought that the successful application of techniques should not rely on these factors, this requires further consideration. The Hesley group must now take action to ensure that the staff have the skills and competencies required in the use of Restrictive Physical Interventions. The training provided must reflect current legislation and best practice, particularly in the use of supine interventions. Staff and some relatives told us that there was a much more open and responsive attitude they felt that their concerns were being listened to. Across both registered services there have been 14 complaints since the previous inspection and included Lack of staff Standard of dress and clothing Quality of diet Lack of activities and too much time spent watching TV Lack of contact with relatives Lack of attention to injury Response by managers Toileting practices Medication administration Some of these have been referred and are or have been investigated by DBC under the safeguarding adult procedures. Procedures need to be available in an accessible format so that the people who live at the service are helped to understand them and use them. Care Homes for Adults (18-65 years) Page 35 of 62 Evidence: At the previous visit it was noted that behaviour support plans did not follow best practice guidance and did not detail specific RPI that can be used for individuals. These had not been agreed by placing LA and families, therefore there were numerous occasions when staff had to use unplanned RPI. There has been some improvement in this. The RI told us that behaviour monitoring is being reviewed and will be changed and that behaviour support plans have improved for some people but have only been in place for 2 weeks. The ones seen did detail the use of restrictive physical interventions and what techniques can be used with individuals, however these now need to be completed for all of the people that live at Hesley village and college and include the use of confinement where this is applicable. Behaviour support plans seen were improved but did not cover self injurious behaviours and guidance on how injuries can be prevented and the risks of harm to the person. Consideration will need to be given to the assessments of individuals under the new Deprivation of Liberty safeguards. Staff told us of an incident where one service user was being abused by another and action was only taken after the service user was injured. Staff said they had kept reporting the incident and were told to monitor the situation. After a best of interest meeting the victim had had to move house rather than the perpetrator and staff did not think this was the correct outcome. Staff were not consulted about the intended outcome and not asked to offer an opinion. Relatives told us We were concerned that when our son had a problem with a housemate it took a serious incident before a remedial move was made. The situation was allowed to go on for approx 3 months and the serious incident with our son getting a badly burnt arm could and should have been avoided Placing social workers told us (The person) assessed needs as highlighted in his behaviour support plans and Hesley villages care plan are being met. However the current number of safeguarding referrals indicate his need for safety is being compromised doors have been propped open as staffing levels have been reduced but service users have had direct access to each others living environments Care Homes for Adults (18-65 years) Page 36 of 62 Care Homes for Adults (18-65 years) Page 37 of 62 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment provides people with safe, comfortable and homely surroundings in which to live that meet their individual needs and lifestyles. Evidence: None of this outcome area was assessed at this visit, there were no requirements made at the previous visit and the outcome area was rated as good. Care Homes for Adults (18-65 years) Page 38 of 62 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a staff team that in general are trained, caring and well meaning however the current staff shortages, use of agency staff and lack of adequate care plans and guidance mean that peoples needs may not always be met. Evidence: The AQAA states, We have a rigorous recruitment policy which ensures that all potential employees are treated fairly and equally. All required checks are carried out e.g. CRB and written references.The new staff rota provides staff with staff development days which can be devised to provide support in the delivery of formal and informal training. Hesley village & College have an ongoing recruitment campaign that is rigorous and robust and staffing difficulties and shortfalls have been given serious consideration and action taken. Despite this, a number of safeguarding adults investigations, internal investigations, capability procedures and ongoing complaints investigations has meant that a number of staff have been suspended pending disciplinary investigations and a number of staff have left the organisation. Care Homes for Adults (18-65 years) Page 39 of 62 Evidence: This has left the service with significant staffing difficulties and shortfalls within the rota. Staff are working additional hours to cover the rota and two agency contracts have been set up for the provision of agency staff. There has been a robust recruitment drive undertaken and this is ongoing. In addition to this there has been a major restructure of the service, the service has been re registered with CSCI into 2 registered services from 4. 2 registered managers (1 for each registered service) incorporating 9 residential areas. 9 care managers (there are 3 vacancies at this level) 9 deputy care managers (new posts) These post will all be supernumerary to enable them to undertake the full range of management and supervisory functions. 27 care supervisors (new posts) There is an intention to increase the numbers of direct care staff There is a new staffing rota in place, which incorporates 9 paid staff development days for training, both formal and informal. On the whole direct care staff met and observed throughout the course of the inspection were seen to treat the people that live at Hesley village and college with respect and dignity and some staff were observed to have good relationships and interact well with the people they were working with. Recruitment documentation, induction records and training records were not examined during this visit as they were examined at the previous visit in July and found to be in good order. However the RI told us that there is a training plan for supervision skills in place and new supervision documentation is in place. Audits are now taking place but there are still gaps in supervision due to staffing vacancies and use of agency staff. We were also told that 155 staff out of a total of 254 across both registered services have got NVQ level 2 or equivalent and further 36 are currently going through the assessment process. New staff spoken to through the course of the visit commented that the induction Care Homes for Adults (18-65 years) Page 40 of 62 Evidence: programme was good, very informative and the shadowing part of the induction gave them confidence for when they would be working on their own. We were told that the induction course is comprehensive and specifically includes communication with people who have autism. It includes two video exercises, group exercises and role play exercises in the first week, then the subject is re visited during the second week as part the LDQ underpinning knowledge. PCP training is now being provided, however a number of staff, relatives and social workers commented that the direct care staff would benefit from some Autism specific training. Staff told us that staffing numbers are low, one staff member told us that last week they only had 3 permanent staff to 6 service user the remaining staff made up of agency staff. We were told there is a high turnover of staff and no opportunities to take a break. One staff member also told us that they had recently done some autism training, which was a real eye opener. Relatives told us (The person) core carers do have the skills and experience but again due to staff shortages and the training of new staff this may not always be the case (The person) has a good bond with his care team, we are extremely appreciative and grateful for the tremendous hard work and kindness from the care staff We are very impressed with (the person) key worker and colleagues who provide care, inevitable while staff are being trained and while they are gaining experience there will be occasional difficulties Some staff are more pro active than others, some have limited initiative and I wonder how Dependant they are on management and organisation Care staff need more autism specific training and they also need support form behavioural specialist, clinical psychologist, SALT. Apparently this is beginning to happen Some staff lack training to deal with autistic and epileptic residents needs Care Homes for Adults (18-65 years) Page 41 of 62 Evidence: (The person) has built up a relationship with his key worker which has enabled him to thrive recently (The person) has a 1 to 1 carer he needs this otherwise he is lost. In that sense the home Hesley does provide the support but there are often staff shortages and (the person) doesnt cope well with continual changes in staff and sharing staff. We have phoned when (the person) has been left alone (dont know how long for) and the carer has had to go and look after someone else They need more staff to go out on trips, I was told I would have to pay for extra staff The staff are second to none, the whole service provides excellent care and support to (the person). We have always had an excellent care team Placing social workers told us Staff need more training re learning disability, complex care, autism and more direct support and monitoring of care staff The staff who work closely with my client have the necessary skills and expertise to support with both social and health care needs Staff, team leader and local managers work well to support my client to ensure that his needs are met and this reducing incidents, staff work closely with my clients family and ensure regular communication Prior to 2008 reviews and concerns of parents not acted upon, the last review in October much more positive and for the first time care staff much more involved The service gives structure and works to keep boundaries set with (the person) which helps minimise the risk of behaviours . The service appears to be developing (the person) skills in a way appropriate to his needs Some care for (the person) is excellent and direct care care staff are very person centred Staff do not appear to be trained in Autism, direct care workers at times lack an understanding of needs. The nurse at Hesley lacks experience in care plan writing Excellent key worker however I have not been impressed at level above. I have been requesting information for 6 weeks but still not received this, communication is not Care Homes for Adults (18-65 years) Page 42 of 62 Evidence: good, phone lines all seem to be engaged, left messages on answer phone, never got a reply Concerned about staffing issues and use of agency staff Staff told us We have been very short of staff for several months, the organisation should have more consideration for the staff who are the backbone of the establishment. The majority of whom are very caring I think everyone should do epilepsy awareness and administration of stesilid and medazolam while on induction and how to cope with aggression directed at you by residents We are always short staffed and have to work 2 staff to 3 students regularly even though they are funded 1 to 1 When some of the residents are going through anxious times or distress leading to aggressive behaviours, then there is rarely spare staff to support, there have been a number of injuries caused to staff because they are put onto residents who should only have experienced staff Regular training is provided and senior managers are available to discuss concerns Since the changing of the rota and having two days off, I have found it much better and not as stressful We need better pay for support staff and more staff Always seem to be short staffed, need more regular staff instead of agency staff being used People believe better wages would bring more staff Some wonderful individual carers who work beyond the call of duty on occasions, training and development is always high in the agenda, great facilities and environment We are a company with a large staff turnover and 1 to 1 staffing which we have never manage to maintain over a long period Care Homes for Adults (18-65 years) Page 43 of 62 Evidence: Pay people a decent salary for some of the most stressful and challenging work in the care industry and provide free meals for staff that work unsociable hours Often short staffed, we need more staff to cover holidays and sickness Hesley offers an excellent staff individual ratio. Staff have access to comprehensive training packages. Hesley provides the individuals with a high standard of care and educational opportunities HVC have very dedicated staff the majority of whom do a first class job in the care and welfare of the residents they support. The staff are pro active in their approach and the majority very experienced in managing challenging behaviour only using physical intervention as a very last resort At present we are working towards a more person centred approach. Changes have stared to be made within the service and training for all staff will be provided soon Staff must be supervised and monitored appropriately, this is now starting to happen although due to staffing levels at times this has been difficult. When the new management structure comes in there should no longer be a problem and managers can be made more accountable It has been a very difficult period with staff shortages during the summer period, this is now being addressed and gradually improving Most of the time we are well staffed although every area suffers from sickness etc I think in some cases things are not being passed down quickly enough about the resident to the carer Support is always on hand from managers and other staff who have more experience of working with certain users of the service Recently there has been some short staffing issues but generally spaces are covered by staff working overtime, agency staff or managers working direct care I think once adequate staffing levels are in place residents will be able to do more activities off site Due to low staffing levels I am working hands on and it is increasingly difficult to meet Care Homes for Adults (18-65 years) Page 44 of 62 Evidence: for supervision with my manager or supervisees Staffing levels are at times very low, resulting in the quality of 1 to 1 staffing support. Also certain staff are working many overtime shifts which in turn is effecting performance i.e. tiredness, stress We have a lot of dedicated and good staff who work hard to provide the best standards of care to each individual resident. It provides good training for all staff and support is available at all times for staff and residents Employ more staff who are as dedicated as current employees Currently there appears to be a shortage of staff We have lot of residents with complex needs and new starters (staff) are sometimes put in a vulnerable position not having the experience to cope with some of the residents Some students are left with no staff to work with them which shows when other shift staff got to support them, they withdraw into themselves and have behaviours which could be avoided if they could have regular staff Most days on my unit we are 4 staff short unless we have overtime, the introduction of agency staff has eased this but can also be a hindrance as they are new and have never supported any of our residents We need better activities for residents, more autism and learning disability specific training and improve staffing levels The service does encourage residents to make their own choices and interests, staffing levels at the moment make it very difficult for staff to support residents to pursue their interests all of the time but there is a big recruitment campaign It provides an excellent environment, it provides comprehensive training, it respects requests for improvement, it employs excellent hard working staff. The staff cope under at times very stressful and difficult situations sometimes suffering injury We need more specialised training on the understanding of autism and how to communicate with people with a learning disability I feel that staff try their best under difficult circumstances and that with more Care Homes for Adults (18-65 years) Page 45 of 62 Evidence: involvement from behaviour specialists, speech and language therapists and carers together has helped to improve the opportunities for our students to live the life they deserve In some of the houses that are divided into flats and you are working one staff to two residents you can be in one flat with a resident and the other resident could get up and you dont know because you havent heard them. I feel this could put the resident at risk Care Homes for Adults (18-65 years) Page 46 of 62 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service is being managed by a skilled and motivated group of managers who are working hard to make the improvements needed. However the focus of their work up to now has been on restructuring the service and dealing with high number of complaints and disciplinary investigations. This means that other areas have not improve yet. The service still has staffing shortages, inadequate care plans/health plans and lack of risk assessments and behaviour management guidelines for staff meaning that people may be placed at risk of not having their needs met and not being kept safe from the risk of harm. Evidence: The AQAA states The registered managers ensure compliance to the Hesley group policies and the NMS and manage the service to meet the interests of the residents who live at HVC. There is a clear vision and plan for HVC which had been framed through the improvement plan determined by requirements from CSCI inspections Care Homes for Adults (18-65 years) Page 47 of 62 Evidence: The service provided is for people with Severe Learning Disability, autism and significantly challenging behaviour, they have needs that are very complex. The senior management team consists of David O,Connor principal and RI, Jeff Cox deputy principal and RM and David Little deputy principal and RM. At the previous inspection visit a meeting was held with the senior managers and we were told that A consultant had been asked to undertake a full QA audit of the services, and has developed a detailed action plan to ensure improvements are made within reasonable timescales. A new QA manager has been appointed to take these improvements forward however at the time of this visit she had only been in post few weeks. There is going to be a major re configuration and staffing re structure commencing with the new management team and a new rota to be introduced in September 2008. This has commenced see the staffing section of this report. A dietician from the PCT has been asked to undertake a review of the food and meal provisions and make some recommendations. This has commenced however at the time of this visit the report had not been received. There is an intention to ensure that different departments within the Hesley group work more closely together i.e. operations and care, maintenance and servicing, HR, and psychology and speech and language therapy. This has started to happen however the people that live at Hesley village and college have yet to benefit from improved outcomes. They intend to bring about changes in practice and attitude, i.e. unlocking the locked gates, consultation with staff, service users and relatives, responding to complaints, listening to staff and being open and transparent about incidents and safeguarding adults issues. This has started to happen and in general staff and relatives comment that the management team listen and are more responsive to ideas, suggestions and resolve Care Homes for Adults (18-65 years) Page 48 of 62 Evidence: issues quicker. They intend to close the house in the middle of the grounds (Ivy Cottage) service users to be relocated across the site (following assessment and consultation) and the house utilised as a staff facility for meetings, training, supervision etc. This has commenced and people are being re located across the site. The senior management group confirmed that they are well aware of the failings and are working closely with Doncaster Borough council and CSCI to implement the change, the improvement plan is being updated on a monthly basis and sent to CSCI however the change will take time. This is happening however the scale of the task was huge and as yet the improvements are not affecting more positive outcomes for the people that live at Hesley village and college. This service still has a long way to go to ensure that the people that live there are given the high quality of service that they deserve. The independent person who currently undertakes the regulation 26 visits to the service told us The important thing is not only to address individual issues but to look at those issues and see if there are any wider lessons to be learnt which require a more strategic approach. Changing the culture takes longer than just changing systems or documentation. They have made real start but have to be realistic abut time scales and to have project management approach to ensure milestones are set and met and if not to look at why etc This service helps people to live reasonably independent lives in spacious, pleasant, and quiet surroundings however this is severely compromised by the previously poor management arrangements, configuration of the service and the way in which care has been delivered. Poor quality paperwork, inadequate behaviour management guidelines, poor attention to the provision of structured, stimulating and meaningful activities and current staffing difficulties mean that this service does not currently meet the needs of the people living there and people are not being protected from the risk of harm. Relatives told us Care Homes for Adults (18-65 years) Page 49 of 62 Evidence: We are generally satisfied with the Hesley group. We have every confidence that the new senior management team will bring the service up to speed Its pleasing to see that we are now receiving a lot more information regarding our son and the college in general Senior management take an active interest and are approachable The few things we have agreed and have not taken place despite being discussed in several meetings Better communication between senior management and hands on care staff When (the person) equipment breaks down it takes far too long to be replaced. His wheelchair once broke and I had to make very forceful phone call to sort out an alternative as they waited for over 3 months and (the person) had increased his self harming because he couldnt go out The college used to be a bit like a prison with a lot of locked gates which made it difficult for us to move around. We have enjoyed visits more now that the grounds are easily accessible and (the person) enjoys going in and out of his flat now that the door is left unlocked We have some issues but we have seen a lot of improvement which is heartening I often feel I dont know what is available outside of HVC that he can tap into The new management team have made a big impact on both students and staff Placing social workers told us On the surface they promise positive improvements but unable to deliver these consistently it is an expensive service and until recent months (the person) was not getting the quality of service that one would expect I have professionally had significant concerns re the service delivery since 2007, I was reassured that all CSCI themes in the inspection report upheld all of my concerns. This service is not qualitative and is very expensive Care Homes for Adults (18-65 years) Page 50 of 62 Evidence: In the past requests have been made for full reports regarding my client, full details have not been received Hesley have kept me updated with concerns and any incidents. The reviews are thorough, I have been involved for the past 18 months Some of the records were muddly but there are plan to streamline and make information more accessible. I feel confident that this will be completed and I have no other concerns Communication has improved recently since the change in management. Responses and co working has been effective and timely. The service is taking very seriously POVA issues and dealing efficiently with these. Staff told us: The new managers are trying to sort things out and make the place better, thats what it needs and it can only get better. They are a lot better than previous managers, more honest and we see them out and about, early mornings and late at night and they are approachable The company has expanded greatly in the time I have been employed by them. When I joined it appeared to be innovative and at the forefront of provision for those with autism. They appear to have not changed their practices to encompass legislation and newer practices and have fallen behind many of their competitors and the expectations of CSCI and funding authorities. I am hopeful that the new management team will take the company forward and it will be regarded as a high quality service to very vulnerable people who challenge services We have a strong confident senior management team who are determined to make changes and improvements to the service Sometimes it can be a long time before action is taken or decisions made Over the past 6 months great improvements have been made to improve our service, this has included new care plans, medicines files, communication between managers and staff, the introduction of a person centred planning coordinator and activities coordinator With the new management structure in place I now feel valued and am happy in my Care Homes for Adults (18-65 years) Page 51 of 62 Evidence: job role, I can see how staff and service users quality of life will improve even more in the future as this something that is starting to happen Since the introduction of the new senior management team I have seen vast improvement that can only benefit the residents in future. The planning side is excellent and is disseminated to staff to action. The improvements to behaviour support and speech language departments and the introduction of person centred planning all bodes well for the future Since the new senior management team has been in place communication has improved tremendously. The training has been a lot more organised and meaningful At this moment in time due to a new management regime in place claiming to put things right, it is a very anxious time for all staff. Changes to staff rotas, redundancy, changes in titles and responsibilities are all part of the present climate, most of the genuine care staff are supporting this and hope things will improve in time. However, I have seen very little activity in the area of supporting staff moral or concerns. At the moment it tends to be if you dont like it then leave. Hesley have on the whole a fantastic and genuine group of people who conduct themselves in a professional and responsible attitude to their work and are longing to see some kind of recognition and incentive in what can be a very stressful and demanding job We need to formulate plans and targets to improve health and safety in areas where there is a high probability of injury to employees or residents Care Homes for Adults (18-65 years) Page 52 of 62 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 2 14 (1 a and b) The organisation must 31/10/2008 ensure that all of the people have an up to date assessment of their needs undertaken by someone qualified to do so, this will help staff to understand their needs better and be able to meet them The organisation must 31/10/2008 ensure that plans are developed that identify the full range of needs of people so that staff know what all of their needs are and are able to meet them. The organisation must 31/10/2008 ensure that that where staff are acting in peoples best interests and making decisions on behalf of people who lack capacity that this is clearly documented and consulted upon. The organisation must assess, record and keep under review peoples imposed limitations on freedom and choice. This will help to protect peoples rights under the Mental Capacity Act 2005. 2 6 15 3 7 14 Care Homes for Adults (18-65 years) Page 53 of 62 4 9 13 (4) and 14 The organisation must 31/10/2008 ensure that risk assessments are completed for all areas that pose a risk to people and action taken in a timely manner to minimise those risks and keep people safe from the risk of harm. 16 (2 m and n) The organisation must 31/10/2008 ensure that people are able to have a job, continue their education and/or take part in fulfilling activities. The organisation must 31/10/2008 ensure that people are able to become part of and participate in the local community in accordance with assessed needs and the individual plans. The organisation must ensure that people have access to and choose from a range of appropriate leisure activities. The organisation must ensure that the service has an effective staff team with sufficient numbers and skills to support peoples assessed needs at all times. 31/10/2008 5 12 6 13 16 (2 m and n) 7 14 16 (2 m and n) 8 33 18 31/10/2008 Care Homes for Adults (18-65 years) Page 54 of 62 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 12 The organisation must not retain people within the service whose needs they cannot meet and who they cannot keep safe from the risk of harm. 31/03/2009 2 3 12 The organisation must review its registration category and take action to ensure that it has the necessary registration for the level of service that it is providing. 31/03/2009 3 6 15 The organisation must 31/03/2009 ensure that care reviews are effective and that issues for action that are raised in reviews as peoples needs change are incorporated into their service users plan so that all of their needs are met. The organisation must ensure that information Care Homes for Adults (18-65 years) Page 55 of 62 about people complex needs and incidents is clear and accurate. 4 7 13 The organisation must 31/03/2009 ensure that where people display behaviours that are difficult to manage or the use of restrictive physical interventions are used to prevent self harm or abuse or harm to others that this is agreed by a multi agency meeting and documented appropriately. Behaviour management guidelines must detail specific techniques to be used with each individual to protect people from the risk of harm. Action must be taken to ensure that any restrictions placed on peoples freedom of movement and choices have only been taken to meet their individual needs. This information must then be recorded on people;s individuals files. This will better protect peoples rights. This requirement has not been met and remains outstanding. 5 17 16 The organisation must ensure that care plans include peoples dietary needs and they must reflect the individuals needs and choices and nutritional needs. Peoples nutritional 31/03/2009 Care Homes for Adults (18-65 years) Page 56 of 62 needs must be reviewed to ensure that people are offered a nutritious diet. Any exceptions to this must be clearly recorded and reviewed regularly to protect peoples health needs.They must keep clear information about this to show how the service has monitored the individuals diet and preferences and personal choices. This requirement has not been met and remains outstanding. 6 18 13 The organisation must take 31/03/2009 action to ensure that the staff have the skills and competencies required in the use of Restrictive Physical Interventions.The training provided must reflect current legislation and best practice, particularly in the use of supine interventions.Records maintained must be Clear, concise and individualised Who was involved How long did the intervention last What form did the intervention take Where there any injuries Was there any impact on other people using the service Have the relevant people been informed that the intervention took place Records need to be used for Care Homes for Adults (18-65 years) Page 57 of 62 learning about What did not work well What did worked well What could have been done differently Are there any training needs identified for staff Discussing the event with the person or their representatives Does the care plan, BSP need updating Are risk assessments still valid This will help the service to learn from experiences and to improve the service delivered to the people who live there. 7 19 13 The organisation must 31/03/2009 ensure that peoples health needs are met by the identification, planning and meeting of health needs and preparation of health action plans and access to relevant professionals secured.This requirement has not been met and remains outstanding. This requirement has not been met and remains outstanding. 8 23 13 The organisation must improve the service they provide to people and identify and take action to reduce incidents where people are at risk of abuse and physical harm. 31/03/2009 Care Homes for Adults (18-65 years) Page 58 of 62 This requirement has not been met and remains outstanding. 9 23 13 The organisation must 31/03/2009 ensure that all staff receive regular training updates in safeguarding adults provided both in house and externally. This will prevent people from the risk of experiencing isolated, abusive and inconsistent care practices. 10 35 18 The organisation must ensure that staff are provided with Autism training and this is regularly refreshed and updated so that staff have the skills to support the people that live in the service. 11 37 12 The organisation must ensure that the management of the service continues to improve the service prioritising areas that will improve the outcomes for the people at Hesley village and college. This will ensure that people are kept safe from the risk of harm. 12 41 17 The organisation must ensure that records are maintained of how staff are meeting peoples complex needs and that these are maintained by all levels of staff. This will ensure that 31/03/2009 31/03/2009 31/03/2009 Care Homes for Adults (18-65 years) Page 59 of 62 records reflect the care delivery and decisions made. This will ensure that records reflect the care delivery and decisions made. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The organisation should ensure that the statement of purpose is up to date and accurately reflects the service to be provided. The organisation should ensure that people, their families and representatives have clear and accurate information about the service at Hesley village & college within the service user guide and contract and this should include the fees, payable by whom and the local authority and representatives should be consulted. The organisation should ensure that service user plans follow person centred planning principles. These need to reflect peoples real experiences, their needs, wants and aspirations. To help people have more say in their care and support service user plans should have better information, about peoples routines and preferences. The organisation should ensure that people are given the opportunity of a 7 day annual holiday outside of the home which they and or their representative help choose and plan. This should be part of their contract price. The organisation should review practices that can lead to institutionalised care. They must make sure their services meet peoples individual needs and aspirations and avoid set rules that do not take into account peoples needs, preferences and aspirations. Plans that affect peoples health and welfare for example nutritional care plans should include professional input and good practice guidelines. The organisation must ensure that where medications are administered PRN that guidelines for administration are written up and followed by staff. The organisation should review and monitor the Page 60 of 62 2 5 3 6 4 14 5 16 6 17 7 20 8 23 Care Homes for Adults (18-65 years) effectiveness of training in the use of RPI with staff taking into account the findings of the Tizard report. 9 35 The organisation should continue to implement the training programme and assess staffs competence to meet peoples complex and changing needs. The organisation should consider providing staff with more training outside of the Hesley organisation. This will help to avoid institutional practices and encourage staff to bring in fresh and compared good practices ideas. The organisation should ensure that quality and quantity of supervision is adequate so that staff have the support and guidance they need to be able to meet peoples needs. The organisation should ensure that sufficient transport and drivers are made available to ensure that all of the people that live at Hesley village and college have the opportunity to participate in the community. The organisation should ensure that areas for improvement identified within the QA audit are implemented and steps taken to improve the service. 10 35 11 36 12 37 13 39 Care Homes for Adults (18-65 years) Page 61 of 62 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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