Inspection on 03/07/08 for Hesley Village and College Village Green

This inspection was carried out on 3rd July 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 26 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

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

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

Hesley Village and College... 16/01/08

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

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

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

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

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

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Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Hesley Village and College Village Green Hesley Village and College Stripe Road Tickhill Doncaster South Yorkshire DN11 9HH Lead Inspector Christina Bettison and George Skinn Key Announced Inspection 3 - 18th July 2008 09:30 rd Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hesley Village and College Village Green Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hesley Village and College Stripe Road Tickhill Doncaster South Yorkshire DN11 9HH 01302 866906 01302 865473 craig.hardy@hesleygroup.co.uk www.hesleygroup.co.uk The Hesley Group Ltd Mr Craig Robert Hardy Care Home 20 Category(ies) of Learning disability (20) registration, with number of places Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 20 Service users aged 16-17 years should not be accommodated in any unit containing other service users over the age of 25 years. As service users grow older, the registered person must inform the registration authority, of his proposals to manage incidents of incontinence, where current laundry facilities ie washing machines x 2 are housed in the kitchens in this establishment. 16th January 2008 2. 3. 4. Date of last inspection Brief Description of the Service: Village Green is part of Hesley Village and College; the site is in extensive grounds in a rural setting. It is just outside the village of Tickhill and approximately 8 miles from Doncaster. Within the grounds there are 3 other registered services that provide care and accommodation for people with learning disabilities. In total the site provides a service for 72 people. Village Green provides accommodation for 20 people. The accommodation includes single flats and shared houses for groups of up to 4 people. People can access the site’s college facilities; these are available for people from across the entire site. The college facilities are within the grounds and a short walk from people’s accommodation. Hesley Village has a small shopping Mall with bakery and grocery. 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. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 5 The fees range from £178,810 to £249,492 per year. This depends on people’s 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. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is a 0 star. This means that the people who use this service experience poor quality outcomes. However since the previous inspection a new senior management team have taken over. They are fully aware of all of the improvements needed. They are working hard to change policies, systems and practices to make sure the people that live in the service receive good quality care and support and are kept safe. We are confident that the new management team will guide and manage the staff team and will make significant improvements to the service but this can only be tested out in time. This visit was announced; all four registered services were inspected by two inspectors over 6 days between 3rd July and 18th July 2008. David O’Conner- Principal, David Little and Jeff Cox - deputy principals 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 carers/support workers, team managers and registered managers to gauge their views of the service. We also spoke to staff, who worked in the HR, maintenance, training, education and psychology departments. 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 and staff supervision notes and recruitment and training records. A pharmacy inspector, Steve Baker, completed an inspection of the medication policies and procedures and staff practices. His report is also contained in this report. Before the visit the registered manager had completed an 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. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 7 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) four of these were returned to us. Staff that work at the service were given surveys and none were returned. Relatives were given surveys and six were returned. Relatives came to see us whilst we were at the service to tell us about their experiences and whether the service was meeting the needs of their relative. Placing social workers came to see us whilst we were at the service to tell us about their experiences and whether the service was meeting the needs of the person for whom they were responsible. Comments and views from everyone have been included in relevant parts of the report. A key inspection visit was previously undertaken on 16th January 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 been working in partnership with Doncaster Borough council’s Safeguarding Adults team in order to ensure that all safeguarding concerns at the service are addressed. This is ongoing. This was a key inspection and we checked all the key standards. Detailed feedback was given to David O Conner, David Little and Jeff Cox on completion of the site visit on 18/7/08 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. What the service does well: The service provided is for people with Severe Learning Disability, autism and significantly challenging behaviour, they have needs that are very complex and they would generally find it difficult to live in integrated settings within a densely populated community. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 8 The service provided helps people to stay calm in a relaxed environment, in individual living accommodation and with high numbers of staff. 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 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 people’s health. The systems for the handling, administration and recording of medication continue to be good. This means that people are receiving their medication as prescribed. This helps to maintain their health and wellbeing. 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. Staff are well trained to ensure the staff were adequately equipped to work in a safe way; on 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 commenced. They all appear to have the drive, commitment and skills to take this service forward and make the improvements required. A full Quality Assurance audit of the services has been completed and a detailed action plan has been developed to ensure improvements are made within reasonable timescales. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 9 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, these are now referred appropriately to the safeguarding adults team at Doncaster Borough council for investigation. 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. The statement of purpose, service user guide and contracts have all been looked at and developed in a draft format. 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. People’s views do not underpin the self-monitoring systems within the service and this directly affects people’s experience of the services. There have been improvements in the systems for ordering medication and in identifying how & when each person prefers to take their medicines. This means fewer doses of medication are missed each month. 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 qualified 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 people’s 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 people’s daily lives. All of the people needs to have structured activity timetables that meet their individual needs, wants and aspirations and ensure that activities provide do not just fit in with what’s 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. Staff are trained to use restrictive physical interventions to support and protect people but techniques used are not included in the guidance documents this means that staff may not always be acting in the best interests of the people Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 10 they are supporting and because of this people’s safety, rights, welfare and dignity may not always protected People need individualised support to manage their money and people need to have enough money to make sure that they can live the lifestyle of their choice. People need to have risk assessments that are followed to help them to take part in activities and outings in a safe manner and to ensure that other people are kept safe. 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. There needs to be enough staff in the service 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. People’s views do not underpin the self-monitoring systems within the service and this directly affects people’s experience of the services. Areas identified as needing to be improved from the organisations Quality Assurance process now need to be actioned to make sure that the service improves. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 11 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 12 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 13 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the 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 on file, therefore all of the staff may not be aware of what peoples needs are and may not be able to meet them. People have not been given clear information about the terms and conditions of their stay in the home and what they are expected to pay for. EVIDENCE: The information that is provided to people who may wish to use the service and their relatives is still in the process of being updated, this includes the statement of purpose, service user guide and contracts. We were told once they are completed they will be issued to everyone. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 14 All of these documents must be updated and give correct and unambiguous information for the people living in the service. The placing local authority, relatives and/or advocates must be consulted about what the people living in the service are expected to pay for and this needs to be clearly detailed in the statement of purpose/ service users guide and contracts. Because of previous concerns about the quality of the service being provided Hesley group have agreed a voluntary embargo on any new placements, therefore there have been no new placements to the service since the previous inspection. As part of this visit two care files were examined, neither file had an assessment completed by the placing Local authority. There was a lot of information on files however the files were untidy, disorganised and there was a lot of duplication of information. This means that staff may not be aware of what peoples needs are and may not be able to meet them. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 15 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples basic needs are generally met by a staff team that know people well. However detailed service users plans need to be developed to ensure that all of peoples needs are identified and met. All areas that pose a risk to people must be assessed and guidance for the management of difficult behaviour must be prepared and implemented so that people are protected from the risk of harm. EVIDENCE: As part of this visit two care files were examined. Care files were found to contain a lot of information however the files were untidy and disorganised. Care planning and documentation does not fit in with the Hesley groups own policies and procedures, areas commonly missing are promotion of independence skills (personal care plans don’t say what people can do for Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 16 themselves and what they need help in) communication methods (Speech and Language therapy assessments in place but no plans) finance, diet and nutrition, culture and faith needs and contact/relationships with family and friends and incorporation of views. In one persons care file there were basic plans for aspects of personal care but these did not guide staff on what the person can do for themselves and what areas they may need help with. It was recorded that this person cannot have “coke of any kind, caffeine free coffee and tea only, no milk or dark chocolate” however there was no medical assessments or best of interest meeting notes to evidence why these restrictions had been placed on this person and no indication as to whether they have capacity to make this decision for themselves. This does not promote their rights and choices. A significant number of risks had been identified for this person which included; - damage to property, attempting to run away, getting anxious and presenting with behaviour that may pose a risk to themselves or others, however none of these risks had been assessed and there were no strategies in place for minimising the risks. There were some generic risk assessments on file that covered; - use of the trampoline, visiting the pond and boardwalk, bird feeding and field studies, but these were the same on each file examined and not individual to the person. There was a document on file entitled psychology risk assessment that stated; “ (Persons name) may attempt to throw items especially when out for meals (glasses and plates) “and (persons name) has no sense of road awareness and may attempt to run over a road, (persons name) will also jump in any water (ponds and lakes) and may also attempt to climb fences and gates” There was no guidance for staff on how to manage these high risk areas and keep the person and others safe. There were some “autism specific guidelines” prepared by the psychologist, however they were generic and the same on all files examined. There was however some evidence of very good documentation and guidance prepared by staff, i.e. Care guidelines for staff on how to ensure the person had access to a specific item that they were very attached to and a very detailed night time routine. In another file examined, again there was a lot of information but no specific care plans and what plans were there were very basic and did not cover all aspects of the persons personal, heath and welfare and did incorporate any aspects of independent living. This person wears a helmet but there was no Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 17 assessment or care plans to identify why this is the case and whether it is worn all of the time or not. There have been some safeguarding adults referrals regarding this person relating to assaults on other people within the service, but there was no mention of this on file and no direction for staff on how to manage this and keep people safe. Behaviour management guidelines were very poor. (This is detailed further in the complaints and protection section of this report) There was some good evidence of staff using appropriate communication techniques, and symbol key rings, but plans on files didn’t specify what signs and symbols individuals knew and used therefore this approach is reliant on staff memory and skills and there is little guidance for new staff/agency staff. Some people had a daily journal and some did not, this is inconsistent practice and for some people there is no daily record maintained. Some of the records used language such as “good and bad behaviour” “girls and boys” Reviews appear to be happening more regularly however it is not clear yet as to how the recommendations or changes made at reviews will be incorporated into the care plan (as these need a lot of work). There were 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) Relatives told us; “The combination of space, security, high staffing levels and on site activities enables the residents to experience much greater freedom and choice in how they live their day to day lives than living in the local community” “ We looked at many options when choosing a placement for our son, non of them came close to what Hesley could offer our son. His challenging behaviour is well managed and minimised. He has an excellent quality of life and we believe he is very happy living at Hesley village” “After the traumatic placements our son has experienced since he left school we never thought such success could be achieved. We have at last found a placement where his complex needs are both understood and met” staff told us;“We are starting to develop person centred plans, the files and plans indicate that RPI is used a lot and its not, paperwork needs to be better” Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 18 As part of the visit a group of staff were seen, Some staff said that they were not happy about the gates now being unlocked and felt that service users were not being kept safe, but other staff said that all staff have radios and can ask for help and also that people absconded before even when the gates were locked. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 19 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14, 15,16 and 17 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A range of activities provided within the service means that people have the opportunity to participate in activities however inadequate planning and recording does not evidence that these activities fully meet peoples individual needs, wants and aspirations. 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. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 20 Staff and relatives spoken to and surveyed all commented that access to external activities (away from the village) are not provided, this appears to be due to; - no detailed structured plans, staff shortages, lack of available transport and drivers and some staff were not aware that there was a taxi fund or that they can claim for petrol if they use their own cars to take people out. In one care file examined the persons list of likes identified; - Horticulture, gym, cookery and a signing class, however the records indicated that they had participated in shopping, lots of walks in the woods, visit to mc Donald’s, one bike ride and trampolining once since January 2008. There had been an incident in the community involving this person and a member of the public and since then this person had not been able to go out into the community, this was the subject of a complaint which has been satisfactorily resolved however the behaviour management guidelines that the manager of the service had updated ensuring that staff keep people safe had been removed from the file by the psychologist therefore staff had been acting without appropriate guidance and the person had been restricted from access to the community. We were told that under the previous management arrangements psychologists, speech therapists and education staff had not worked together or with the care staff in producing relevant and appropriate guidance for staff, this had created a fragmented approach to the delivery of care and support and is not in the best interests of the people living in the service. This is now in the process of being addressed. None of the 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. It was noted at the previous inspection “The Hesley Village has locked gates and a small perimeter wall around the site. People who live at the village, and visitors, cannot get in or out without a member of staff with a pass” This practice has now stopped and the gates around the village are not locked. It was also noted at the previous inspection “Staff told us people have a budget of £26.50 per week for food. They do their shopping at local supermarkets, and can use Hesley Village shop to stock up on milk and bread. In addition to this, each person receives a weekly meal voucher to use at Hesley Village’s restaurant. People receive the same food budget regardless of their health and diet needs. If people want to purchase food from the restaurant, over and above their meal voucher, they use their own spending money” Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 21 The money for food has increased to £30 per person per week and we were told that meals taken at the village restaurant will now be free to the people that live in the village. In addition to this we were told the organisation is considering enabling people to have a “direct payment” so that they can be helped to spend their weekly money on the things that are important to them. We were told that a dietician had been approached to come in and review the meals cooked and provided for people to ensure that they are suitable, wholesome and nutritious and meet peoples individual dietary needs. We were told that additional vehicles are being purchase to ensure access to the community can be facilitated and the recruitment drive was looking for more drivers. Relatives told us; “ Opportunities are good on site, it is not always possible to get off site though because of transport limitations. On site education still follows school term times! So there are gaps in the holidays for things to do. This has been a problem for my son – Hesley needs to engage more with the outside world and outside agencies- its been self- referential for too long” “There are too few minibuses for the number of residents and our son’s outings are often dependent upon using a member of staffs own car” “With its non judgemental approach the college successfully gives a meaningful life to adults with disabilities so severe that other colleges cannot address. (Persons name) has developed from barely being able to stay in room with other people to having a small job (recycling) of which he is enthusiastic and proud, the only detail we feel is there is a need for a few more mini buses for off site trips” “ We would like our son to go out more, especially when the college is closedwhich is for long periods. I cannot understand why the college is not open all year round given that it only operates for the clients of the Hesley organisation” “Improve the budget for meals and facilitate more trips off site” “on site social activities could be enhanced during leisure hours, although we understand this is being addressed” “There is regular written and verbal communication between the college and ourselves. We receive a weekly phone call from (person name) carers telling us what he has been up to and he is asked if he would like to talk to us on the phone which he usually does” Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 22 staff told us;“Activities off site don’t happen as much as they should, this is due to staff shortages and lack of vehicles, but we udest6and three new vehicles are being leased and we are advertising for drivers” “£30 per week for food is not enough and doesn’t take into account individuals likes/dislikes and staff don’t eat with students and often they will for example eat a mars bar in front of a student” Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 23 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s 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 all of peoples health needs are met. EVIDENCE: 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 were poor. Health action plans were very basic and did not detail action to be taken to meet all of peoples health need and incorporate healthy lifestyle goals. Records of visits to GP, dentists, optician, and chiropody was patchy and non existent in some cases. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 24 Weights appear to be routinely monitored and no account taken of individual needs for this. This is institutionalised practice and not person centred. In one persons care file examined it stated; - “I have medication for my skin, please make sure you know what to do” “I am only allowed certain drinks, please follow my guidelines” There were a number of references to “please follow guidelines but there were no guidelines on file to follow. There were notes on file of this person having hay fever, tiredness and high blood sugar levels but no medical basis for this and no care plan as to how these area of health need will be met. There was a note for a referral to a chiropodist in June this year but no evidence that this had happened. There were several entries of PRN (medication prescribed on an “as and when required” basis) paracetomol given for toothache/headache/cold/pain but no record of how staff will know when this person is in pain. There were several entries of unexplained bruising and at one time part of a thumbnail missing, no records of how this had happened. The management team were asked to look into this and consider a referral to the safeguarding adults team. There is little information about medications prescribed and what side effects might be prevalent and PRN protocols are not specific in terms of what the medication is for, when can it be taken, how long after can a second dose be given. When PRN medications are used for behaviour management purposes it is not part of a behaviour management plan. There is no monitoring of the effects of medication and whether it is effective or not. As part of the visit a pharmacy inspection was carried out the inspector reported; “The new ordering records were examined and found to be well completed. They now contain the quantities of ‘as required’ medicines carried forward each month as previously recommended. Monthly prescriptions are checked before the medication is delivered. Together, these changes help to make sure that enough medicines are always available for people’s needs. Medication storage areas are kept clean & tidy and room temperature monitoring records are in place. Medicines labels display the dates of first opening so that staff know how long to keep them in use. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 25 There are very few gaps on the MAR charts meaning that the use of medicines is accurately recorded. Helpful information describing how and when each person prefers to take their medicines is kept with the MAR charts. This good practice helps to reduce the number of times people refuse to take their medicines. Deterioration in health or wellbeing could take place if people don’t take all their medicines regularly. The seizure management protocols kept with the MAR charts have been updated since the last inspection. This means staff are following the latest good practice guidance when supporting someone having a seizure. The medication policy & procedures along with easy access to current professional guidance help staff to know exactly what is expected of them when handling & administering medicines. This helps to reduce medication errors and protect people from harm” Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 26 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience poor quality outcomes in this area. This judgement has been made using available 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 risk that peoples needs will not be met and they may be at risk of harm. EVIDENCE: Hesley group have polices and procedures for complaints, safeguarding adults and whistle blowing. Historically the senior management team have not acted appropriately when staff, residents or relatives have raised issues with them. A new management team have taken over at Hesley. Staff and relatives told us that there was a much more open and responsive attitude; they felt that their concerns were being listened to at last and resolved. This will only be tested out in time. Village green have had three complaints since the previous inspection; these include a complaint from a placing local authority about poor preparation and Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 27 planning for a review meeting, various care issues from an anonymous source and an incident in the community between a person and a member of the public. Some concerns and complaints are outstanding and still need to be investigated and resolved. All of the above 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. Complaints need to be resolved more quickly and all of the people who live at HVC must have behaviour management guidelines that clearly indicate what (if any) RPI (Restrictive Physical Interventions) can be used and in what circumstances. There have been 11 safeguarding adult’s referrals made to Doncaster Borough council all relating to this service. Hesleys Policy and Procedure relating to the use of RPI states; - “ if a student/resident engages in Challenging Behaviour you should whenever possible respond in the way specified in the students/residents individual behaviour management strategy” The (Hesley Groups) behaviour management proactive reactive guidelines for people all state to use 1- 2 person touch support and 2 person supine techniques, these are not individual and do not detail what techniques/strategies to be used prior to getting to this position. Behaviour management guidelines do not follow best practice guidance and do not detail specific RPI that can be used for individuals and these have not been agreed by placing LA and families, therefore there are numerous occasions when staff have to use unplanned RPI, this is not acting in the best interests of the people that live at Hesley and does not safeguard them from the risk of harm and does not protect the staff that work with them. Staff told us; “We are starting to develop person centred plans, the files and plans indicate that RPI is used a lot and its not, paperwork needs to be better” “ staff are now reporting bad practice, but there are still some cliques, we will get there” In the course of the visit a group of staff were seen, Some staff said that although they have lot of safeguarding adult referrals they know that some other places don’t report them, but there was no point Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 28 reporting before (previous management arrangements) because nothing was done. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 29 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available 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: Village Green is part of Hesley Village and College; the site is in extensive grounds in a rural setting. It is just outside the village of Tickhill and approximately 8 miles from Doncaster. Within the grounds there are 3 other registered services that provide care and accommodation for people with learning disabilities. In total the site provides a service for 72 people. Village Green provides accommodation for 20 people. The accommodation includes single flats and shared houses for groups of up to 4 people. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 30 People can access the site’s college facilities; these are available for people from across the entire site. The college facilities are within the grounds and a short walk from people’s accommodation. Hesley Village has a small shopping Mall with bakery and grocery. 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 services manage and employ staff to run these services. The Hesley group have a domestic bursar who told us that it was now her responsibility to audit the accommodation on a monthly basis for defects and areas requiring repair, or re decoration. In addition to this staff are encouraged to report issues for attention. On the whole the environment appeared to be well maintained and people personal spaces were safe, comfortable and homely. People had personalised their rooms depending on their likes dislikes and complexity of needs. There were some areas requireing improvement i.e. bathroom floors that needed replacing, some bedrooms not personalised, some damaged plaster and paintwork, however this had been noted and plans were in place to repair and redecorate these areas. Maintenance and servicing records were checked and found to be in order. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 31 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported by a staff team that 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: As a result of a number of safeguarding adults investigations and ongoing complaints investigations a number of staff have been suspended pending disciplinary investigations and a number of staff have left the organisation. 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 agencies have been approached and contacts set up for the provision of agency staff. There has been a robust recruitment drive undertaken and a large number of staff offered posts but they are awaiting clearances before commencement. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 32 We were told that the rota will soon be changing to ensure that it fits the organisation, the service and can help staff to meet the needs of the people living there. Staff met and observed throughout the course of the inspection were seen to treat the people that live at Hesley with respect and dignity and promoting their individual choices. When incidents occurred they were calm and professional and incidents were quickly resolved. We saw some excellent practice of staff using communication techniques relevant to the person they were working with. Recruitment and induction documentation was examined and was seen to be satisfactory however the quality and quantity of supervision is inconsistent depending on who is conducting it. Records show that across the site 75 of staff are up to date with mandatory training, and 82 of staff have completed the (Strategies for Crisis Intervention & Prevention) SCIP training. Across all of the staff team (not just direct care) 544 staff have completed mental capacity act training with 236 still to do. 72 of staff have completed safeguarding adults training (Hesley) and 13 staff have completed safeguarding adults training with Doncaster BC, 2 senior managers, 1 care manager and 1 night team manager have completed the manager S/A training. 3 trained nurses on site provide training for staff in the administration of Buccal Midazolan (this is a medication prescribed for use “on an as and when basis” for the emergency treatment of epilepsy) and 212 staff have completed this training. 80 staff have completed epilepsy training. Plans for the forthcoming year with regard to training include the provision of report writing, risk assessment (student specific) intimate care, train the trainer, management induction, rewarding relationships (mentoring), assertiveness and management training. In addition to this enquires have been made about the provision of training for staff in cooking/catering. New staff to Hesley undertake a three week induction programme which includes; • First week - introduction to the group, first aid and basic food hygiene, and induction and introduction to (Strategies for Crisis Intervention & Prevention) SCIP. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 33 • • Second week- shadowing in the houses, getting to know the residents Third week- commence Learning Disability Qualification, introduction to the Mental Capacity Act and positive behaviour support. Following on from this is the probationary period within 6 weeks completion of the positive behaviour support and within 6 months SCIP foundation training. It is being planned that the second week of induction will include (Person centred Planning) PCP training. Staff completed NVQ level 2 are 74 The training department have an excellent overview of what training has been completed and what still needs to be achieved and there are training plans in place and a substantial budget for the provision of training. This progress needs to continue to ensure that all of the staff have the skills, knowledge and confidence to meet peoples individual diverse needs. Relatives told us;“ My son has been at Hesley for about six years and on the whole he has been very happy there. The staff have looked after him well and given him enough opportunities for him to decide what he likes and doesn’t like. His keyworker has been exceptionally good” “Hesley seem to have a lot of experienced staff and to be supportive of new staff. They regularly undertake further training” “The staff working with our son are caring and professional at all times. He has sable group of staff that know him well. The easy access to professionals such as speech therapist and psychologists is beneficial” “The care staff have regular training and core group meetings and we think they deal with (persons name) well” Staff told us;“All service users have a 1;1 but staffing levels are a problem at the moment, the care staff are working a lot of overtime. There is recruitment drive ongoing and agency staff are going to be used” “ we have both got NVQ level 3 and we gets lots of training” In the course of the visit a group of staff were seen, Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 34 Staff said they have got staffing problems but they knew managers were filling the vacancies and the induction programme has gone from 2 – 3 weeks. Some staff said they felt demoralised by the previous inspection report and taken it personally, one person said the staff are all heroes here. Most staff said they felt confident when dealing with challenging behaviour; they get good training and de briefing after incidents. They said behaviour management plans were good and they were consulted. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 35 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. This service is now managed by a skilled and motivated group of managers who are taking action to make the improvements needed. However this will take time and the current staffing shortages, inadequate care plans/health plans and lack of risk assessments and behaviour management guidelines for staff means that currently 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 and Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 36 they would generally find it difficult to live in integrated settings within a densely populated community. 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 commenced which consists of David O,Connor – principal, Jeff Cox- deputy principal and David Little – deputy principal, they all appear to have the drive, commitment and skills to take this service forward and make the improvements required. At the beginning of the 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. There is going to be a major re configuration/staffing re structure commencing with the new management team and a new rota to be introduced in September 2008. A dietician from the PCT has been asked to undertake a review of the food/meal provisions and make some recommendations. There is an intention to ensure that different departments within the Hesley group work more closely together i.e. operations/care, maintenance and servicing, HR, and psychology and speech and language therapy. 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. 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. 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. • • • A regulation 26 visits procedure is in place and the independent lady who undertakes these told us that under the previous management she couldn’t see any of her findings or recommendation followed through. However she was pleased with the new management team and felt that things will be different in the future. The manager for this service currently is Julie Fletcher who has worked for the Hesley group since 2000, she commenced as a support worker and gained Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 37 promotion through the Helsey group and was a team manager for 5 years. She was asked to act up as care manger and is on a temporary contract until the end of august. Julie has achieved NVQ level 3 and the registered managers award and is soon to commence on NVQ level 4. She has also completed an introduction to first line management, child and adult protection training and is an internal verifier for NVQ. In general 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 we cannot at this time be assured that they are being protected for the risk of harm. Staff told us;“The poor CSCI reports affected the morale of staff and it’s a frightening time with new systems being implemented. But we realised there had been different approached across site. The new managers are directive and its good to know what’s needed, I trust them to get it right, they are knowledgeable and listen” In the course of the visit a group of staff were seen and they told us; Most staff said there has been lots of improvement with the new senior managers and that they are much more approachable and respond quickly to requests and issues that need resolving. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 38 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 x 1 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 3 x 3 x 2 x x 3 x Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 39 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4 (1) Requirement The organisation must ensure that the statement of purpose is up to date and accurately reflects the service to be provided. The organisation must ensure that people, their families and representatives have clear and accurate information about the services at Hesley Village Green. The organisation must: Make sure people, their families and representatives, have upto-date Service User Guides The information in the Service User Guide must reflect the service people receive The Service User Guide must include the correct contact details of the Commission for Social care Inspection. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 40 Timescale for action 31/10/08 2. YA1 5 (1) 31/10/08 3 YA2 14 (1 a and b) 4. YA5 5 (Previous timescale of 30/06/08 not met) The organisation must 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 provide people with an upto-date contract that gives them clear information about their terms and conditions This must include clear information about the organisations fees and additional charges This will help protect people’s rights (Previous timescale of 30/06/08 not met) The placing local authority relatives/advocates must be consulted on behalf of the people so that they are not at risk of exploitation. 31/10/08 31/10/08 5 YA6 15 6 YA6 12.2 The organisation must 31/10/08 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 31/10/08 examine and improve the way it carries out people’s reviews and how they DS0000046970.V367888.R01.S.doc Version 5.2 Page 41 Hesley Village and College Village Green involve external professionals (such as people’s social workers) The organisation must make sure that information about people’s complex needs and incidents is clear and accurate This will help external professionals and people’s families and representatives support people to make the right decisions about their care. And it will help protect people’s rights and give people support to make decisions about the care they receive. 7 YA7 13 (6 and 7) The organisation must 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 people’s freedom of movement and choices have only been taken to meet their individual needs. Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 42 31/10/08 This information must then be recorded on people’s individuals’ files. This will better protect peoples’ rights. 8 YA7 12.2 The organisation must make 31/10/08 sure that staff involve people in day-to-day choices and include them in conversations and decisions. The organisation must improve the support they give people to help people have a better say in their care, routines and preferences. The organisation must 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 ensure that risk assessments are completed for all areas that pose a risk to people, to include; • Protection of others • Absconding • Safety around water • Road safety The organisation must ensure that people are able to have a job, continue their education and/or take part in fulfilling activities. The organisation must ensure that people are able to become part of and participate in the local community in accordance with assessed needs and 9 YA7 14 31/10/08 10 YA9 13 (4) and 14 31/10/08 11 YA12 16 (2 m and n) 31/10/08 12 YA13 16 (2 m and n) 31/10/08 Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 43 the individual plans. 13 YA14 16 (2 m and n) The organisation must 31/10/08 ensure that people have access to and choose from a range of appropriate leisure activities. The organisation must 31/10/08 review practices that can lead to institutionalised care. They must improve these to give people more personalised care They must make sure their services meet people’s individual needs and aspirations and avoid ‘set rules’ that do not take into account people’s needs, preferences and aspirations (For example people’s front doors propped open, activities only available in term time, use of derogatory language, routine weighing of people) 15 YA16 12 (1,2, 3, and 4) The organisation must assess, record and keep under review people’s imposed limitations on freedom and choice They must include the person it involves and their representatives in this process This will help protect peoples rights under the mental capacity Act 2005 16 YA17 16.2(i) The organisation must ensure that care plans include peoples dietary needs and they must reflect DS0000046970.V367888.R01.S.doc 14 YA16 12 (1,2, 3, and 4) 31/10/08 31/10/08 Hesley Village and College Village Green Version 5.2 Page 44 the individuals needs and choices and nutritional needs. People’s 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 Previous timescale of 30/06/08 not met) 17 YA18 12.2 The organisation must review all physical intervention practices. Make them safer and design them to respect and protect people’s rights. The review and improved practices must include; • • Safer systems to minimise injuries Systems that include peoples consent and choices about interventions Safer supine interventions Better procedures to follow up incidents leading to supine, injuries and staff concerns. 31/10/08 • • Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 45 Action must be taken to ensure that people are safeguarded from inappropriate restraints by staff. The scale and nature of any physical intervention must be proportionate to both the persons behaviour and nature of the harm they may cause. 18 YA19 13 (1) The organisation must ensure that people’s 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. 31/10/08 19 YA20 13 and 15 20 YA23 13 (6) The organisation must 31/10/08 ensure that where medications are administered PRN that guidelines for administration are written up and followed by staff. The organisation must 31/10/08 improve staff awareness of safeguarding adult procedures that exist outside of the Hesley complex For example National ‘No secrets’ guidance and South Yorkshire local authority procedures The organisation can do this by giving staff access to Doncaster Local Authority safeguarding adult training This will help to prevent people from the risk of experiencing isolated, Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 46 abusive and inconsistent care approaches. 21 YA23 13.6 The organisation must improve the service they provide to people, and identify, and take action, to reduce incidents where people are at risk of institutional and situational abuse. 31/10/08 22 YA33 18 23 YA33 18 The organisation must 31/10/08 ensure that the service has an effective staff team with sufficient numbers skills to support peoples assessed needs at all times. The organisation must make 31/10/08 sure staff teams deliver safe and effective care so that people can have dignified and safe lifestyles. Therefore staffing levels must be reviewed to ensure that at all times appropriately qualified and experienced persons are working in the service in such numbers that are appropriate for the health and welfare of people. The organisation must look at the standard and content of staff training on Restrictive physical interventions and provide staff with safer skills to handle difficult behaviours and improve how this impacts on people’s dignity, respect and rights The organisation must ensure that quality and quantity of supervision is adequate so that staff have the support and guidance DS0000046970.V367888.R01.S.doc 24 YA35 18 31/10/08 25 YA36 18 31/10/08 Hesley Village and College Village Green Version 5.2 Page 47 26 YA39 24 they need to be able to meet people’s needs. The organisation must ensure that areas for improvement identified within the QA audit are implemented and steps taken to improve the service. 31/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The organisation should make sure that staff understand what information is in people’s service user guides and contracts. This will help staff to give people accurate and up-to-date information about what to expect from the service. 2 YA6 The organisation should ensure that care plans follow person centred planning principles. These need to reflect people’s real experiences, their needs, wants and aspirations. To help people have more say in their care and support care plans should have better information, about people’s opinions, choices, and preferences, under each section of their plans. 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 must assess people’s dietary needs and make sure the budget they provide is suitable for people’s individual dietary needs and choices Plans that affect people’s health and welfare (for example nutritional care plans) should include professional input DS0000046970.V367888.R01.S.doc Version 5.2 Page 48 3 YA14 4 5 YA17 YA17 Hesley Village and College Village Green and good practice guidelines 6 7 8 YA22 YA33 YA35 The complaint procedure should be made available to all of the people who live at the service in an appropriate way to meet their individual needs. The organisation should ensure that staff meetings take place regularly so that the staff team are supported and guided to be able to meet peoples 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 9 YA36 The organisation should ensure that all staff are aware of the whistle blowing policy with staff and ensure they have the confidence to use it Hesley Village and College Village Green DS0000046970.V367888.R01.S.doc Version 5.2 Page 49 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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