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Inspection on 28/05/09 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 28th May 2009.

CQC found this care home to be providing an Adequate 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 6 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) Village Green is for people with a Severe Learning Disability, autism and significantly challenging behaviour, they have needs that are very complex. People are provided with contracts, statement of purpose and service users guide which tell them what they can expect from the service (however see comments under what they can do better) 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 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 healthcare co ordinator, all employed by the service. This helps to monitor people`s 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 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. 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. More than 50% of staff had qualifications such as National Vocational Qualification (NVQ2) in care, so they understood how to provide support to people. 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, this is helping to make sure that people are kept safe from the risk of harm. Relatives are welcome to visit anytime, contact is maintained by a variety of means and some people had regular visits back home. Complaints from relatives and professionals are managed effectively, the service now needs to consider how it can help the people that live in the service to raise concerns and complaints. People`s views do not yet underpin the self monitoring systems within the service and this directly affects people`s experience of the service.

What has improved since the last inspection?

This service is starting to be organised and managed in the best interests of the people using it and improvements to the service are now evident. The major restructure of the service is complete which means that sufficiently qualified and competent people are in supervisory management positions and there are enough support staff in place that are competent to meet people`s complex needs. Additional staff have been appointed to help the service to develop further, i.e. clinical staff, IT staff, an activities coordinator and a person centred planning mentor. Staff are trained to use restrictive physical interventions to support and protect people and techniques used are now included in the guidance documents so that staff are given clear instructions on how to act. Some additional information has been included within the care plans but these still need further development to ensure they cover all of peoples complex needs. Managers and staff are now taking practical steps to make sure that people are kept safe however, there are still a number of incidents where people are not being protected and this still needs to improve. There is 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 doesn`t. This will make sure that staff are able to protect people from the risk of injury and /or harm. Staff are now getting more support and advice to ensure they can provide a nutritious diet and they are getting training in cooking.

What the care home could do better:

The development of the Contracts, statement of purpose and service users guide needs to continue and include fees and what people have to pay for as "extras". This will protect people`s rights. Some of the people that live in the service may need to have an assessment of their mental health needs. The development of the care plans needs to continue and they must adhere to person centred planning principles, this will help the staff to provide care and support that is consistent and will improve people`s daily lives. The development of the activity timetables needs to continue and should meet peoples individual needs, wants and aspirations and ensure that activities provided do not just fit in with what`s provided from the vocational 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. 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 or harm. People`s health needs must be assessed and the actions need to be written in a plan so that staff can meet all of people`s health needs in a planned way. Staff need to ensure that outcomes are recorded. There are some good health and safety systems in place but others are failing to ensure people`s safety. The organisation needs to look at how they can better protect people and their support staff during and after challenging incidents. The service now needs to consider how it can help the people that live in the service to raise concerns and complaints. People`s views do not underpin the self monitoring systems within the service and this directly affects people`s experience of the services. When incidents occur that are considered to be practices that do not protect the people that live at the service from the risk of harm the management team have improved how they refer these to the safeguarding adults team at Doncaster Metropolitan Borough Council for investigation. However there have still been some occasions when this has not happened and this still needs to improve.

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:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Christina Bettison     Date: 0 1 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 47 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 47 Information about the care home Name of care home: Address: Hesley Village and College Village Green Hesley Village and College Stripe Road Tickhill Doncaster DN11 9HH 01302866906 01302865473 craig.hardy@hesleygroup.co.uk www.hesleygroup.co.uk The Hesley Group Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Jeffrey David Cox Type of registration: Number of places registered: care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 43 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. Care Homes for Adults (18-65 years) Page 4 of 47 Over 65 0 43 0 3 1 2 2 0 0 8 Brief description of the care home People can access the sites college facilities; these are available for people from across 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 47 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: one star adequate 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 1 star. This means that the people who use this service experience adequate quality outcomes. Key inspection visits were previously undertaken in January, March, July and November 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. 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. Care Homes for Adults (18-65 years) Page 6 of 47 A number of improvements were noted at this visit which are detailed within the report however some new requirements have been made to ensure that the service continues the improvements. Since January 2008 there have been a number of safeguarding adult referrals and investigations. Some of these have related to service users hurting each other. However the numbers of these incidents has reduced. For the Village Green registration Doncaster Metropolitan Borough Council told us that there have been 36 referrals made to them from 3.12.08 to 26.4.09. Of these at the time of writing 11 had been investigated and 9 substantiated and 2 were unsubstantiated. It was decided not to accept 1 as a safeguarding referral.The others are in the process of being investigated. This visit was unannounced and was completed over 3 days between 28th May and 1st June 2009. The visit was undertaken by the Lead Inspector for the service, Tina Bettison assisted by Chris Taylor Inspector from the Regional Enforcement Team, Nicholas Smith Healthcare Assessor and Alan Bevan Mental Health Act Commissioner and findings from the team of inspectors are included within this report. Doncaster Metropolitan Borough Council Environmental Health Department were requested to investigate the numbers of assaults on staff and their findings are included within this report. Jeff Cox Registered Manager for Village Green 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, clinical support staff and direct support staff to gauge their views of the service. 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 documents that related to peoples care and safety. These included needs assessments, daily logs, care and health plans and risk assessments. 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. We did not ask relatives to complete surveys for us at this visit as they had been asked several times before. Relatives and social workers of the people whose care files we looked at were contacted by telephone to obtain their views. Not all could be contacted. Those who could be contacted, their comments and views have been included in relevant parts of the report. Care Homes for Adults (18-65 years) Page 7 of 47 We asked the registered manager to give surveys to all of the staff who work at Village Green whilst we were at the service and their comments are included in this report. We have been working in partnership with Doncaster Metropolitan Borough Councils Safeguarding Adults team in order to ensure that all safeguarding concerns at the service are addressed. This is ongoing. Managers at Village Green have been working much more with DMBC to ensure safeguarding matters are addressed. This is detailed further in the complaints and protection section of this report. This was a key inspection but we did not check all the key standards as they were all checked in July 2008. Those that were met at that time were not checked at this visit. The inspectors would like to thank the people who live at the service and the staff for their cooperation during our visit. Staff told us;We provide support and promote independence We care for residents and give then support on their way to an independent life, but we need better solutions for storing food, bigger fridge and freezer We provide a good level of skills in and outside of the residents environment We give high quality care for students and cater for all their needs, but we need to plan more outings for students We give 100 care to students but we need more outdoor activities The recent changes that have taken place have made the quality of life of our residents so much better. They all have activity plans that are geared around them (and not the staff). Their homes are much more personalised and staff are being encouraged in this. This is my tenth year here and for a couple of years i have not enjoyed my work. I now enjoy coming to work again and feel that we are now much more able to do for our residents what we should be doing The organisation supports staff better now and in turn this enables people to support the residents more positively. Residents have a better quality of life. the care plans have really improved, are more person centred, relevant and detailed. The home could bring all of the staff training up to a higher level by providing NVQ level 3 and 4 and relevant management qualifications for managers. I have worked in this establishment for 4 years and since the new management team took over I now feel supported and appreciated in my role. I feel as though I am listened to and this better support enables me to to support residents more positively and positively influence a team to do the a same They care and support both residents and staff We meet the needs of service users but we need to personalise the homes of the service users Care Homes for Adults (18-65 years) Page 8 of 47 We provide a good living environment where they all live happily in a shared house We provide a good standard of care and offer plenty of activities on and off site, but they need to communicate with staff more and let staff know what is happening with the group In recent months the place I work has improved, in training and all aspects of the work environment, this has benefited everyone who works here We provide excellent care and facilities for service users, but induction training needs to look at all aspects of what support workers may face during a working day. Need to recognise the support staff when out and about with residents, support staff often feel invisible, this would go along way in maintaining good staff morale We need more free choice and less mandatory activities, more buses for service users, own living space and not shared living. Support staff when in need and not ignoring them and belittling them. some managers at hesley dont seem to understand what support workers go through and what they have to deal with Relatives told us;The care here is superb, its nice to see him as a happy and relaxed young man, problems and complaints are always resolved and the new management structure has enabled managers and staff to attend to detail, we are involved in the development of plans and are happy with approaches used We are quite happy with the service and (the person) likes it here The facilities and accommodation is very good, we are satisfied with the way the person is looked after, we have seen some improvements. HVC are trying to make lots of improvements (the person) is getting out a lot more If i had spoken to you 1 year ago it would have been a very different story, but it is much improved. We get lots of contact and are kept up to date. I think they grew too quickly, the new senior management team are very approachable and will respond quickly and effectively to letters and concerns My son has been there for 4 years and we are very happy with the service Placing social workers told us;They are trying very hard to improve and they are under lot of scrutiny which makes it harder but there are lot of incidents, there was an incident last week when (the person) was bitten, I have to question why this is allowed to happen when she has 1;1 staffing Care Homes for Adults (18-65 years) Page 9 of 47 What the care home does well: What has improved since the last inspection? This service is starting to be organised and managed in the best interests of the people using it and improvements to the service are now evident. Care Homes for Adults (18-65 years) Page 10 of 47 The major restructure of the service is complete which means 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. Additional staff have been appointed to help the service to develop further, i.e. clinical staff, IT staff, an activities coordinator and a person centred planning mentor. Staff are trained to use restrictive physical interventions to support and protect people and techniques used are now included in the guidance documents so that staff are given clear instructions on how to act. Some additional information has been included within the care plans but these still need further development to ensure they cover all of peoples complex needs. Managers and staff are now taking practical steps to make sure that people are kept safe however, there are still a number of incidents where people are not being protected and this still needs to improve. There is 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. This will make sure that staff are able to protect people from the risk of injury and /or harm. Staff are now getting more support and advice to ensure they can provide a nutritious diet and they are getting training in cooking. What they could do better: The development of the Contracts, statement of purpose and service users guide needs to continue and include fees and what people have to pay for as extras. This will protect peoples rights. Some of the people that live in the service may need to have an assessment of their mental health needs. The development of the care plans needs to continue and they must 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. The development of the activity timetables needs to continue and should meet peoples individual needs, wants and aspirations and ensure that activities provided do not just fit in with whats provided from the vocational 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. 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 or harm. 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. Staff need to ensure Care Homes for Adults (18-65 years) Page 11 of 47 that outcomes are recorded. 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 and after challenging incidents. 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. When incidents occur that are considered to be practices that do not protect the people that live at the service from the risk of harm the management team have improved how they refer these to the safeguarding adults team at Doncaster Metropolitan Borough Council for investigation. However there have still been some occasions when this has not happened and this still needs to improve. 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 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 12 of 47 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 13 of 47 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 adequate 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, recent assessments completed contain more detail and are helping to develop more detailed care plans, however, some people may need further assessment. Evidence: Village Green is registered for 37 people and currently has 28 people living there. The service consists of Areas 1 to 5 Village Green. 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. We were told that the Principal has been trying to obtain information from the placing local authorities about how much the service users financial contribution to their placement is, so that this can be included within the contracts and service user guide. Care Homes for Adults (18-65 years) Page 14 of 47 Evidence: 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. At the previous visit it was noted that none of the files examined contained a full and informative assessment completed by someone qualified to do so. Since the previous visit some agency social workers had been recruited to complete re assessments of all the people that live in Village Green. Assessments seen during the course of the visit did not have all of the areas completed. We were told that the information had been gathered from staff and existing documentation. In addition to this people who may be at risk of self harm and or harm to others have not had a thorough assessment of their mental health needs. This may lead to peoples needs not being properly identified and therefore not met and people not being protected from the risk of harm. In addition the healthcare assessor noted, confinement and isolation as described in some plans and on incident forms whereby an individual is prevented from leaving a room or building by staff holding the door shut or shutting people outside. The checks and balances afforded by detention under the Mental Health Act when patients are secluded are not in place for this group of people, people who are not always able to consent to these interventions or have insight into their actions however the people who are caring for them are implementing strategies that are denying them access and egress from areas and free association. The Mental Health Act Code of practice defines seclusion as, 15.43 Seclusion is the supervised confinement of a patient in a room, which may be locked. Its sole aim is to contain severely disturbed behaviour which is likely to cause harm to others. Clearly the holding of a door shut meets the definition of seclusion, and as all of the individuals are informal the need to consider formal detention will come in to play. The Mental Health Act Code of practice goes on to state 15.46 Seclusion of an informal patient should be taken as an indication of the need to consider formal detention. Care Homes for Adults (18-65 years) Page 15 of 47 Evidence: For individuals who are restricted by being shut or locked into their home the use of formal detention should be considered and recorded. And further 15.49 The decision to use seclusion can be made in the first instance by a doctor, a suitably qualified approved clinician or the professional in charge of the ward. It is clear that the episode of being shut or locked into their home is not made by a doctor or a suitably qualified clinician. Some of the people that live in Village Green may need an assessment of their mental health needs, especially for people where confinement or seclusion is used and for those people who present a risk of harm to themselves or others. Consideration will need to be given to requesting assessments for people under the Mental Health Act to ensure that people receive the necessary safeguards and protection they deserve. There have been a number of safeguarding adult referrals made to Doncaster Metropolitan Borough Council in respect of people living at Hesley Village & College and as a result of some of the investigations it was apparent that there were some people placed there whose needs could not be met and they could not be kept safe from the risk of significant harm whilst living in this service. Since the previous visit a number of people whose needs could not be met have been given notice and moved on into more appropriate placements. The service provided at Village Green is registered as a care home for younger adults and a healthcare co ordinator, 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. Care Homes for Adults (18-65 years) Page 16 of 47 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 adequate 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 and service user plans are more detailed however they still need further development to ensure that all of peoples complex needs are identified and met. Where risks are identified some measures have been put in place to minimise the risks to people and to try and keep them safe from the risk of harm. However there are still a number of incidents where people are suffering harm from self injury or assaults from others and risk assessment documentation needs to adhere to best practice guidance. Evidence: Four care files were examined as part of this visit. Care files presented to us were tidy and typed up and had improved slightly with the introduction on some further detail. Since the previous visit some agency social workers had been recruited to complete reassessments of all the people that live in Village Green. Examples of these Care Homes for Adults (18-65 years) Page 17 of 47 Evidence: assessments seen during the course of the visit were of a reasonable standard. The Hesley Groups own pre-admission assessment documentation had been used which is not sufficiently robust. We were told that the information had been gathered from staff and existing documentation. 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. Care plans are beginning to be more person centred and the person centred planning co ordinator has been providing training for all staff and we saw some evidence that reviews were being facilitated via DVD and included a visual demonstration of peoples lives. Assessments, care and health plans, risk assessments and other supporting documentation although much improved still does not cover all areas of peoples needs and still requires further development. Care files consist of an assessment, independence skills summary (ISS), Individual daily living programme (IDLP), Risk assessments (RA), mental capacity act best of interest assessment (MCA) and a behaviour support plan (BSP), a second file is the medical file and contains a health action plan (HAP) and records, in addition the these a daily journal (DJ) is used for recording day to day events. Individual daily living programmes seen were more detailed and gave staff good guidance in how the person likes to be supported. Some of these include promotion of independence skills, what people can do for themselves and what they need help in, and include some personal preferences and routines, but do not always cover all areas of need. For all care files examined there was a very detailed communication plan completed by the Speech and Language Therapists and in some detailed risk assessment documents. However, a number of the actions within the Risk Assessments are not transferred into care plans. In one care file examined, there was an IDLP that gave good information about the persons preferred routines and choices including morning and night routines and personal care preferences. It indicated what the person could do for themselves and what they needed help with. Care Homes for Adults (18-65 years) Page 18 of 47 Evidence: There was detail of what the person likes to eat and drink and an indication that they are on a healthy eating programme, this was supported by evidence that there had been a visit from the dietician and recommendations incorporated into the plans. The ISS covered clothes care, safety in the community, money skills, interaction style, anxiety management, eating, bathing, dressing and favoured routines. There was a document entitled risk assessment and management plan that covered some risk areas but was not a detailed risk assessment, it also covered some areas that should have been in the support/care plan or medical plan and some management of behaviours that is covered in the behaviour support plan. It is not clear what the purpose of this document is. For example it included;- (the persons) skin can become dry and uncomfortable and the action was prescribed medication to be used regularly. This is also included in the medical file. Also (the Persons) underarms are shaved by staff and the action judge (the persons) mood before undertaking this task this is a care plan need not a risk area. The behaviour support plan for this person was seen to be much more detailed, including all behaviours likely to be presented (including self injurious behaviour) and interventions to be used by staff and also detail of best interest decisions made. The contributors to this plan included;- key worker, care workers and managers, clinical psychologist and educational tutor. In another file examined again the IDLP gave much more detailed information about the persons support needs. In a review held on 8/1/09 it was suggested by the support staff that this person might benefit from the use of a daily journal to help them to feedback about their day. This was introduced on 28/2/09 and was seen in use. It contained pictures and symbols to indicate what the person has done throughout the day and they use this to help to explain to their parents what they have being doing. The behaviour support plan for this person was very detailed and included aggressive behaviour towards others, self injurious behaviours and socially inappropriate behaviours and strategies and interventions to be used by staff to manage the behaviours and keep the person and others safe. In addition to this there was an emergency crisis management plan for the use of confinement. Care Homes for Adults (18-65 years) Page 19 of 47 Evidence: A request had been made to the supervising Local Authority for an authorisation under the Deprivation of Liberty safeguards for this person. In another care file examined there was an ISS and an IDLP giving detail of how the person prefers to be supported in relation to bathing and morning and night routines. There was also a night care plan. The behaviour support plan for this person had been updated and reviewed in April 2009 and was more detailed. In the fourth care file examined there was an ISS and an IDLP that gave good detail on the persons morning and evening routines, dressing and use of the toilet, eating and drinking and a night care plan. The behaviour support plan detailed all behaviours that were likely to be presented and gave staff good guidance on how to manage the behaviours and prevent people from suffering harm. Again the document entitled risk assessment and management plan appeared to be a mix of care plan needs and areas that may pose a risk, if this is to be used as a care plan it needs to be more detailed and if used a a risk assessment document it is not sufficiently robust enough to minimise risks. More attention needs to be given to assessments, care and health plans and individual daily living programmes to ensure they are developed further to include more detail on finance, culture and faith needs and contact and relationships with family and friends and incorporation of views. They must cover all of peoples support needs and give sufficient detail it all aspects of personal care. The healthcare assessor noted, The risk assessments were not in a recognised format that identified risk and then developed management plans to reduce the risks to acceptable levels. The tool in use did not focus on the risk but concentrated on the activity where the risk may occur so there were several risk plans for the same risk interventions. For example, if the risk was verbal aggression to parties unknown, you would expect to see a risk plan in place for ensuring that the opportunities were reduced and there was a strategy to avoid or remove the individual when the risk was being acted out. What was seen was a series of plans that were the same for each activity undertaken these may include shopping, work, swimming, leisure activities etcetera. Care Homes for Adults (18-65 years) Page 20 of 47 Evidence: It was not clear if individuals had been involved in the assessment and planning of risk management plans For all care files examined there was a very detailed communication plan completed by the Speech and Language Therapists and in some detailed risk assessment documents however a number of the actions within the risk assessments are not transferred into care plans. Weekly Management meetings have been introduced which bring together staff, care managers and clinical staff and is intended to discuss the individual and what is working well and what is not working and suggest changes to plans and practice. We saw evidence in notes that these meetings have taken place and were told that changes in practice are implemented. However, there was little evidence that this is transferred to the service users plans and risk assessments. In some cases where monitoring is said to be taking place we saw no written evidence that this was happening. It is vital that all levels of staff at Village Green both direct care staff and clinical staff can contribute the planning process and that care is co ordinated. Daily Journals are used to record day to day events and is a primary source of information,the quality of the recording in the journals was variable depending on who had completed them. In some there were good and informative records, in some there were gaps, in some they were written in the first person, as if the service user themselves had written it, and in some the information was very basic. The quality of the service provided is judged by the information in the DJ amongst other things, and helps staff to provide consistent care across shifts and it is vital that this information is accurate and not misleading. We were told that this is being addressed through training. Behaviour monitoring has been reviewed and changed and behaviour support plans have improved for people. The ones seen did detail the use of restrictive physical interventions and what techniques can be used with individuals, and cover self injurious behaviours and guidance on how injuries can be prevented and the risks of harm to the person. However, we still have concerns about the use of confinement and supine interventions, although the Registered Manager told us that the use of these techniques had reduced. Reviews are now happening more regularly and are being held as a celebration review Care Homes for Adults (18-65 years) Page 21 of 47 Evidence: and include a DVD showing a visual representation of how people are spending their time. 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 interest meetings have been held. Care Homes for Adults (18-65 years) Page 22 of 47 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 adequate 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 and local community meaning that some people have the opportunity to participate in these activities. However, interests, hobbies, likes and dislikes have not been assessed properly meaning that plans do not reflect peoples individual needs, wants and aspirations and they may not always be met. Evidence: The Hesley Group provides accommodation,care, support and additional college type provision. Staff spoken to said that the provision of activities has improved, there are now more vehicles available and staff qualified to drive the vehicles. In addition to this staffing is Care Homes for Adults (18-65 years) Page 23 of 47 Evidence: much more stable with majority of vacancies having been filled. However the activities and programmes that are part of a college timetable are still not tailored to individual need and is provided term time only. The college provision is used by students who do not live at Hesley Village and College. Four care files were examined as part of this visit, activity plans have been developed for people, however the assessments completed and reported on in the Choice of Home section of this report, did not assess peoples needs in relation to hobbies, interests, like and dislikes. It must have been difficult for staff to prepare activity plans that are person centred and meaningful. In addition to this there is an expectation that people will attend the college provision available. In one care file examined the persons activity plan detailed attendance at various on site college classes e.g. IT, horticulture, sculpture and willow weaving, in addition to this it included swimming, shopping, pub visits and trips to the park all in the local community and watching TV and listening to music at home. Daily journal entries evidenced that on the whole this plan is followed. In another care file examined the persons activity plan detailed attendance at various on site college classes e.g. IT, crafts, pottery, horticulture and sculpture, in addition it included games and puzzles, housework, excercise to music and bowling, pub trips, and swimming off site. This person also has jobs on site as a cinema club assistant and recycling. Daily journal entries evidenced that on the whole this plan is followed. The third care file examined the persons activity plan detailed attendance at various on site college classes i.e woodcraft, dance, horticulture, art, sculpture and moulding,in addition it included swimming at the dome, listening to music, walks, letter writing, household chores and this person has a job at the cinema as an usherette, selling tickets and refreshments. Staff support this person to go for regular visits home. In the fourth care file examined the activity plan detailed attendance at various on site college classes e.g horticulture, paper making, field study centered and off site activities i.e. shopping, tickhill church, meals out at the pub,walks, visits with friends and listening to music and watching TV in the flat. Care Homes for Adults (18-65 years) Page 24 of 47 Evidence: The records indicated that on the whole this plan is followed however a lot of activities appeared to take place on site. Activity plans are in place for people, staff are starting to implement these however, person centred plans need to be continually developed. 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. Evidence of this audit was not made available during the course of the visit however, some basic information was available in the assessment of peoples needs and there was a basic list of likes and dislikes in some care plans and evidence that the dietician was involved and providing advice and guidance to staff. We did see evidence that some staff have completed training from external providers in housekeeping, cleaning and how to prevent cross contamination and reduce the likelihood of infection, nutrition and healthy eating, food safety at level 2 and also safe food training packages. In addition to this training, three DVDs have been purchased;- ban the bugs for care home kitchens and in the home and for people with learning disabilities. None of the files examined adequately identified peoples individual cultural or religious needs and there was little evidence on files as whether people were being supported to attend religious or cultural services and events. As part of the visit we looked around the services and observed a handover.We saw evidence on an office planner of some people attending religious services, and staff said this was getting better. Care Homes for Adults (18-65 years) Page 25 of 47 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medication is managed well and peoples basic health needs are generally met but this is reactive to illness and circumstances. The lack of health screening, health action plans and poor recording of outcomes does not evidence that all of peoples complex health needs are identified, planned for and ultimately met and that preventative work is being carried out to ensure people are enabled to live healthy lifestyles. Evidence: The service has an on site healthcare coordinator who undertakes tasks such as taking blood samples and blood pressure under the direction of the GP. Health records seen continue to be poor, there was some minimal evidence on file of the psychiatrist involvement and decisions taken and some evidence of the health coordinators input, however, these records were very basic and in most cases either the health co ordinator or care managers had completed the psychiatrists notes. Care Homes for Adults (18-65 years) Page 26 of 47 Evidence: Four care files were examined as part of this visit. Health action plans remain very basic and have not improved since previous visits. They do not detail action to be taken to meet all of peoples health needs and do not incorporate healthy lifestyle goals. Records of visits to GP, dentists, optician, and chiropody had improved. In one persons care file the health needs summary covered dentists, seizures, optician, blood pressure/weight, continence, hearing, skin/hair, diet, sleep, menstruation and exercise and actions being;- to visit the dentist, optician and GP regularly and to get weighed every month. These are not health actions to help someone live a healthy lifestyle and for their health needs to be met, these are a list of professionals to visit, i.e. getting weighed every month is not an action to maintaining a healthy weight. In the plans it indicated that the person had specific health needs that reqiuired monitoring in relation to their pain by the GP. There were no records to evidence that this was being monitored. However, some records had improved slightly and indicated that this person was attending appointments more regularly. They had seen the dentist in November 2008, the optician in February 2009 and the GP in March 2009 for another health condition. A detailed epilepsy management plan was in place, seizures were being monitored and there was evidence of regular liaison with the epilepsy nurse. There was evidence of medication to be taken and what side effects might be prevalent and guidance for what staff need to look out for. In another care file examined the health needs summary covered dentists, seizures, breast checks, optician, blood pressure/weight, continence, hearing, skin/hair, diet, menstruation, exercise and medication and actions being;- to clean their teeth, staff to provide support when getting eyes checked, continue use of facial scrub, to follow the menu provided by the dietician and continue to eat healthy diet and many more. These are better health actions to help someone live a healthy lifestyle and for their health needs to be met. There was good evidence of the side effects of medication written down so that staff are guided in what to look out for and lots of evidence of blood tests completed to check lithium levels and thyroid levels and good monitoring of other areas of concern. Record keeping is much improved and there was evidence of visits to dentist, GP, Care Homes for Adults (18-65 years) Page 27 of 47 Evidence: optician, epilepsy clinic and neurology department at the local hospital. There were records of visits with the consultant psychiatrist completed as a clinic summary by the care manager. There is a risk of information being misrepresented by someone other than the psychiatrist completing the clinic notes for the file. In the third care file examined the health needs summary covered first aid/minor ailments general health, dentists, optician, epilepsy, health promotion and well being, diet and nutrition, mental health and foot care actions being;- to ensure falls are dealt with and to manage headaches, monitor blood pressure, to ensure teeth and gums remain healthy, to ensure eyesight is checked regularly, to ensure hearing is good, to monitor boils and ensure an effective treatment plan is in place,to ensure a healthy weight and balanced diet, to monitor sleep patterns, weight fluctuations and observation of mood for changes in mental health status, to ensure feet and toe nails are healthy. These are better health actions to help someone live a healthy lifestyle and for their health needs to be met. Records evidenced that on the whole these needs were being met, however, an action point from the review held on 12/3/09 indicated that a referral should be made for physiotherapy services and there was no evidence that this had happened. In the fourth care file examined there was a health needs summary and a health plan that covered first aid and minor ailments, general health, teeth, eyes,hearing, mental health, diet and nutrition and health promotion and well being with actions being;- to manage falls and headaches and pain during menstruation, ensure teeth and gums are healthy, ensure eyesight is checked regularly, ensure person can hear, monitor sleep patterns, weight fluctuations and observe mood for changes in mental health status and to ensure the person is as healthy as possible and all known conditions are monitored. There were record to indicate that the person had seen the GP on 24/2/09, dentist in 2008, regular appointments with the consultant psychiatrist and letters from the psychiatrist to evidence this. This person has managed to lose some weight since last year so the healthy eating programme seems to be working. 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 continuing to improve. Staff reported that the Speech and Language Therapy assessments and plans are helping and that the psychologists are starting to work more closely with Care Homes for Adults (18-65 years) Page 28 of 47 Evidence: them in developing behaviour management strategies. Medication records and storage were not checked during this visit as they have been examined at previous visits by pharmacy inspectors and on the whole are well managed. However, the healthcare assessor and mental health act commissioner recommended that a BNF be made available in each area for staff and that details of side effects of medication be more explicitly detailed within health files so that staff are aware of what to look out for. There was more information held on files about medications prescribed and what side effects might be prevalent for staff to look out for but there is no monitoring of the effects of medication and whether it is effective or not. We were also told that all of the people that live at Village Green are reviewed at least 6 monthly by the consultant psychiatrist and more often if required, however, again this practice does not support the staff who are working directly with service users and there is little evidence of decisions taken and why. The organisation must review the role and practice of contracting in Psychiatry services. People on large quantities of medication including neuroleptic medications must be reviewed more frequently and side effects and contra indications taken into consideration. Arrangements must be put in place to ensure services are available locally in the event of a psychiatric emergency. Notes from psychology and behavioural analysts interventions must be kept on the persons file. Care Homes for Adults (18-65 years) Page 29 of 47 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 adequate 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 robust and well managed complaints system and whistle blowing policy and procedures to ensure protection of people from the risk of harm and complaints are investigated and resolved. There continues to be a number of safeguarding adults referrals being investigated by Doncaster Metropolitan Borough Council. The outcomes of some are still unknown but the outcomes of others demonstrate that the service may still be unable to keep all of the people safe from the risk of harm. Evidence: The people who live in Village Green have complex needs, which require consistent and skilled staff. All of the people require at least one to one staffing because of the complexity of their needs and the high risk of challenging behaviour. They are at risk of hurting themselves and/or others and this needs to be well managed. This has not always been the case and although there has been some improvements to keep people safer, there has still been a number of referrals made to Doncaster Metropolitan Borough Council for investigation, some of these have been substantiated, some unsubstantiated and some undetermined. However, evidence from records and referrals made shows that some people have suffered harm. Although a number of improvements have been made (see the report for detail), the Care Homes for Adults (18-65 years) Page 30 of 47 Evidence: key areas i.e. care plans, risk assessments and health plans have not improved enough to ensure that staff have the necessary guidance and that the service can keep people safe. Policies and procedures are available 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. There have been 5 formal complaints received for Village Green registration since the previous inspection. Issues raised were; 1. Inappropriate use of language from a member of staff when talking to a service user. 2. Diet and activities. 3. Lack of communication from senior management, non attendance at swimming and concerns re lack of access to the community. 4. Concerns about quality of personal care, property repairs not attended to and ability levels of staff. 5. Poor communication with staff and managers and difficulty in arranging home visits. Complaints documentation examined during the inspection provided evidence that their procedures are robust and that they take all complaints very seriously and respond appropriately. Contact is maintained with the complainant during the investigation and outcome. All complaints were from parents of service users. None of the complaints were made by service users. A picture/easy read version of the complaints procedure was seen at various points around the village. There has been some improvement in the quality of the behaviour support plans. The ones seen did detail the use of restrictive physical interventions and what techniques can be used with individuals. Care Homes for Adults (18-65 years) Page 31 of 47 Evidence: On the whole managers in this registration are referring incidents to Doncaster Metroplitan Borough Council for safeguarding investigations. The Hesley Group have appointed two social workers to act as safeguarding co ordinators and a safeguarding forum has been established with two independent persons and an independent chairperson demonstrating some commitment on the part of the Hesley group to protect people and promote good practice in safeguarding adults. However, recently an incident had occurred with a person who lives in the Village Green registration whereby a small child had their hair pulled by the service user whilst out in the community. This was notified to the Care Quality Commission and the inspector discussed this with Doncaster Metropolitan Borough Council safeguarding manager. It was agreed that this should have been sent as safeguarding referral as the person had not been managed well enough thereby a child had been injured as a result of this. Any incident that affects the safety and well being of people and that places them at the risk of significant harm must be referred to the DMBC safeguarding team for a decision on how to proceed. Until this happens on every occasion CQC cannot be satisfied that the Hesley Group are following the multi agency policies and procedures for the protection of vulnerable adults, that they are being open and transparent and aiming to keep people safe. Care Homes for Adults (18-65 years) Page 32 of 47 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: Previous visits have all noted the environment as good, inspectors noted at this visit that peoples living accommodation continues to meet peoples individual needs and they are involved in making choices about redecorating and renewal of fixtures and fittings where this is appropriate. In response to some of safeguarding adults investigations changes have been made to the key pad locking system on peoples front doors to ensure that their own accommodation can be kept private and a risk assessment for the security of the site has been carried out and measures put in place to ensure access and egress in and out of the site but also to maintain peoples safety. There were no requirements made at previous visits and the outcome area remains good. Care Homes for Adults (18-65 years) Page 33 of 47 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 good 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. Evidence: The Hesley Group have an ongoing recruitment campaign that is rigorous and robust and staffing difficulties and shortfalls have been given serious consideration and action taken. There were concerns at the previous visit that there were significant shortfalls in staffing numbers and deployment. However, since the previous visit there has been considerable improvement in this area. The restructure of the service is complete Village Green currently has, 1 manager with responsibility for 5 residential areas. 3 care managers, one for each area and a care services manager covering the two Care Homes for Adults (18-65 years) Page 34 of 47 Evidence: vacant care manager posts until these are filled. 5 deputy care managers Direct support staff that work 1 to 1 or 2 to 1 with service users. Staff told us that staffing numbers have improved and the manager for Village Green told us that they did not have any vacancies. Direct care staff, met and observed throughout the course of the inspection were seen to treat the people that live in Village Green with respect and dignity, and most staff were observed to have good relationships and interact well with the people they were working with. Recruitment documentation was examined for four newly recruited members of staff all had completed application forms, attended for interview, references had been received and Criminal Records Bureau checks completed prior to starting work. Some members of staff had been through the disciplinary procedures since the previous inspection. Documents held demonstrated that good practice guidance had been followed for suspending and investigating allegations of misconduct. We were given some information about the numbers of staff that have completed NVQ training, as follows, Village Green Area 1 50 of staff are qualified and 13 are registered. Village Green Area 2 61 of staff are qualified and 8 are registered. Village Green Area 3 47 of staff are qualified and 24 are registered. Village Green Area 4 60 of staff are qualified and 7 are registered. Village Green Area 5 56 of staff are qualified and 24 are registered. Induction training and processes were all examined at the previous visit in November 2008 and were found to be good therefore they were not examined during this visit. When competence or capability issues are raised this is dealt with rigorously using the supervision, conduct and capability and disciplinary procedures. Person centred planning, mental capacity act and autism specific training is now being provided, however it will take some time for all staff to complete this training. In addition to this training is being provided in Nutrition and how to prepare basic healthy meals and kitchen hygiene. Care Homes for Adults (18-65 years) Page 35 of 47 Evidence: Care Homes for Adults (18-65 years) Page 36 of 47 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 managed by a skilled and motivated group of managers who are working hard to make the improvements needed however the service still has inadequate health plans and poor quality risk assessments and there still needs to be further improvement in the service users plans otherwise people may be placed at risk of not having their needs met and not being kept safe from the risk of harm. 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 OConnor principal and Jeff Cox deputy principal and manager. Actions achieved since the previous inspection include;Additional staff have been appointed to help the service to develop further, i.e. clinical staff, IT staff, two activities coordinators and a person centred planning mentor. Care Homes for Adults (18-65 years) Page 37 of 47 Evidence: A dietician from the PCT has completed a review of the food and meal provisions and staff are starting to be trained. Additional training is now being provided for staff in autism, person centred panning and the mental capacity act. Different departments within the Hesley Group are now working more closely together i.e. operations and care, maintenance and servicing, HR, and psychology and speech and language therapy. Ivy Cottage is in the process of being refurbished to be utilised as a staff facility for meetings, training, supervision etc. However, there are still some areas requiring improvement and these shortfalls are having a direct impact on the safety and well being of the people who live at Village Green. Areas that still require improvement are Incidents that affects the safety and well being of people and that places them at the risk of significant harm must be referred to the Doncaster Metropolitan Borough Council safeguarding team for a decision on how to proceed. Until this happens on every occasion the Care Quality Commission cannot be satisfied that the Hesley group are following the multi agency policies and procedures for the protection of vulnerable adults, that they are being open and transparent and aiming to keep people safe. Some people may need an assessment of their mental health needs so that resources and clinical professionals can be made available to meet those needs. Service user plans must continue to be developed in detail using a co ordinated approach to ensure that staff are working directly with people have a clear understanding of all of peoples needs,including their mental health needs and are able to meet those needs. Health action plans must be developed to ensure that the service is pro active in meeting all of peoples health needs and can support them to lead healthy lifestyles within limitations and informed choice. Activity and lifestyle plans must be further developed that actually meet peoples assessed needs and monitoring and recording must accurately reflect activity Care Homes for Adults (18-65 years) Page 38 of 47 Evidence: undertaken and identify how these might change or how people are making informed choices. Information that we have received in relation the number and severity of staff injuries raised some concerns. We asked Doncaster Metropolitan Borough Council to undertake an investigation of the issues. Doncaster Metropolitan Borough Council confirmed to us that they carried out a full Health and Safety inspection of Hesley Village and College on the 14th May 2009. Their findings at the time of writing this report are as follows;The purpose of the visit was to assess compliance with Health and Safety law and assess concerns raised regarding safety of staff in respect to violence and aggression from residents. The visit revealed that the management structure of the organisation had substantially changed in the last 12 months. As a result of this change, the majority of the Health and Safety documentation either had or was in the progress of being reviewed and a new Health and Safety adviser was appointed in April 2009 to assist in this task. The organisation also recognised that they may have had a problem with violence and aggression from residents in 2008. As a result, they had identified five residents for which they believed Hesley Hall may not be the most appropriate placement. These five individual were gradually moved from the site between December 2008 and February 2009. Since January 2009, there have been substantially fewer serious accidents reported to us. Although the company complied with many Health and Safety requirements, the visit still gave us some concern regarding whether suitable and sufficient risk assessments had been completed in respect to the risk of violence and aggression to staff. To allow us to audit the quality of the documentation we requested full person specific risk assessment for five residents, which we identified from the incident records of February to March 2009 as contributing to more than 40 of the recorded injuries to staff due to violence and aggression. The Hesley Group complied with this request. These documents identified detailed risks and precautions to be taken by staff when dealing with specific residents, to prevent and to correctly act in cases of violence and aggression. If correctly implemented and regularly reviewed, this type of documentation would satisfy our requirement of suitable and sufficient risk assessment. It was noted that most of these documents had been written in the last six months. Care Homes for Adults (18-65 years) Page 39 of 47 Evidence: Although we recognise that the company has greatly improved in the last 12 months and that the new support plans are adequate, we have written to Hesley Group detailing the following requirements, 1.We accept the Hesley Groups format with risk assessments for violence and aggression being incorporated in individual care plan. However to satisfy the legal requirement all residents who have been identified as medium or high risk for violent and aggressive behaviour towards staff and others, should have appropriate multi disciplinary support plans, emergency management crisis support plans and individual crisis support plans when appropriate in place. 2.The individual documents above should be easily identifiable, correctly crossreferences and easy to find, access and understand for member of staff and other professionals. 3.All support plans should be reviewed and appropriately updated whenever a serious violent incident occurs towards either a member of staff or other resident. 4.Ensure all employees are trained and competent in the control techniques identified in the plans to control violent and aggressive behaviour. 5.Ensure that when risk assessment identifies a need for Personal Protective Equipment, such as caps, arm guards etc, to be used when dealing with a particular resident, this should be detailed in that residents multidisciplinary support plan. To review the effectiveness of the new documentation we will continue to investigate any further RIDDOR reportable incidents of violence and aggression to staff or residents, and make further recommendations if necessary. Care Homes for Adults (18-65 years) Page 40 of 47 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 41 17 The organisation must 31/03/2009 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 records reflect the care delivery and decisions made. This will ensure that records reflect the care delivery and decisions made. Care Homes for Adults (18-65 years) Page 41 of 47 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 2 12 Requests must be made for 30/09/2009 assessments for people under the Mental Health Act where the use of seclusion is prevalent or where they are at risk of harming themselves or others. This will ensure that peoples rights are promoted and that they receive the safeguards and protection that they need. 2 6 15 Care plans must be developed further and staff must understand what actions they need to take to ensure that thay meet poeples needs This will ensure that all peoples needs are met. 3 9 13 The risk assessment tool 30/09/2009 currently in use must be reviewed against guidance issued by the Department of Page 42 of 47 31/08/2009 Care Homes for Adults (18-65 years) 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 Health - Best Practice in Managing Risk, June 2007 to ensure compliance with this best practice guidance. This will ensure that risks are identified, minimised and people are kept safe from the risk of harm. 4 19 12 The role and practice of contracting in Psychiatry services must be reviewed. Arrangements must be put in place to ensure services are available locally in the event of a psychiatric emergency. Notes from psychology and behavioural analysts interventions must also be kept on the persons file. This will ensure that staff are aware of all of someones needs and are able to monitor the side effects of medication and keep people safe. 5 23 13 Incidents that affect the 31/07/2009 safety and well being of people and that places them at the risk of significant harm must be referred to the DBC safeguarding team 30/09/2009 Care Homes for Adults (18-65 years) Page 43 of 47 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 for a decision on how to proceed. Until this happens on every occasion CQC cannot be satisfied that the Hesley group are following the multi agency policies and procedures for the protection of vulnerable adults, that they are being open and transparent and aiming to keep people safe. 6 42 18 Management systems must be in place to ensure that staff are kept safe from the risk if injury and that RIDDOR reporting procedures are followed. This will ensure that the service is managed effectively and staff are able to undertake their duties safely and meet peoples needs. 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 31/07/2009 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 2 5 Care Homes for Adults (18-65 years) Page 44 of 47 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 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. 3 7 The organisation should ensure that the people are involved in and their views recorded in the risk assessment process so that they are centrally involved in decisions about their care. This will ensure the recorded risks are accurate and that everyone including the person is aware of the management plans. The organisation should ensure that independent advocacy services are made available for people and that their consent to be involved in videos, have photographs taken and to take their medications is obtained, if people do not have the capacity to consent that best interest meetings are undertaken for these areas. The organisation should ensure that people are able to have a job, continue their education and, or take part in fulfilling activities. The organisation should 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 should ensure that people have access to and choose from a range of appropriate leisure activities. The organisation should ensure that care plans include peoples dietary needs and they must reflect the individuals needs and choices and nutritional needs. Peoples nutritional 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. 9 20 The organisation should ensure that each area has a BNF guide for reference so that staff can understand what medication people are taking, what for and the side effects to look out for. 4 7 5 12 6 13 7 8 14 17 Care Homes for Adults (18-65 years) Page 45 of 47 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 Details of side effects of medication must be more explicitly detailed within health files so that staff are aware of what to look out for. 10 20 People on large quantities of medication including neuroleptic medications must be reviewed more frequently and side effects and contra indications taken into consideration. The organisation should review and monitor the effectiveness of training in the use of RPI with staff. The organisation should ensure that all staff are provided with Autism training and this is regularly refreshed and updated and follows best practice guidelines so that staff have the skills to support the people that live in the service. The organisation should 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 & college. This will ensure that people are kept safe from the risk of harm. 14 39 The organisation should ensure that the QA system continues to highlight areas for development and improvement and action taken to continue the improvement of the service. 11 12 23 35 13 37 Care Homes for Adults (18-65 years) Page 46 of 47 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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