Inspection on 01/11/07 for Hesslewood Care Centre

This inspection was carried out on 1st November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hesslewood Care Centre 22/09/06

Hesslewood Care Centre 17/01/06

Hesslewood Care Centre 22/09/05

Hesslewood Care Centre 04/03/05

Hesslewood Care Centre 04/08/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Hesslewood Care Centre Ferriby Road Hessle East Yorkshire HU13 0JB Lead Inspector Eileen Engelmann Key Unannounced Inspection 1st November 2007 09:30 X10029.doc Version 1.40 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 Hesslewood Care Centre DS0000000936.V354348.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 Older People and 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. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hesslewood Care Centre Address Ferriby Road Hessle East Yorkshire HU13 0JB 01482 648543 01482 640990 hesslewood@schealthcare.co.uk The.willows@ashbourne.co.uk Exceler Healthcare Services Limited 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) Mrs Anne M Devaney Care Home 86 Category(ies) of Dementia - over 65 years of age (64), Old age, registration, with number not falling within any other category (64), of places Physical disability (22) Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st September 2007 Brief Description of the Service: Southern Cross Healthcare took over the running and management of Hesslewood Care Centre in July 2006. Hesslewood Care centre is a large Victorian House with a modern purpose built extension. It is situated approximately a mile from the town of Hessle and close to the City of Hull. The original house is now a unit for younger physically disabled people, whilst the large modern extension is the home for older people some of whom may require nursing care. The home is managed as three separate units and each has their own staff compliment. Accommodation is provided on two floors and both parts of the building are served by passenger lifts. The home stands in extensive, pleasantly landscaped grounds overlooking the Humber Estuary and the Humber Bridge. People wishing to move into the home and their families are provided with information about the home in the form of a ‘Service Users guide’ with additional information provided in the home’s ‘Statement of Purpose’. People and their families are invited to visit the home and spend time there before deciding to make the move to live at Hesslewood. Information given by the manager during this visit indicates the home charges weekly fees from £500.00 to £650.00 plus the nursing band fee (where applicable). People will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information has been gathered from a number of different sources since the last key visit to the home in September 2006, this has been analysed and used with information from this visit to reach the outcomes of this report. The unannounced visit was carried out with the manager, staff and people living at Hesslewood Hall. The visit took place over 2 days and included a tour of the premises, examination of staff and people’s files and records relating to the service. The Commission for Social Care Inspection is utilising the skills of a group of people from the community who have knowledge of various care settings and use of services. These individuals are called Experts by Experience. We asked one of these experts to accompany the inspector on the second day of this visit to talk to the people using Hesslewood Hall; their comments have been included in this report. Questionnaires were sent out to a selection of relatives, people using the service and staff and their written response to these was good. We received 10 back from relatives (37 ), 13 from staff (65 ) and 22 from people using the service (67 ). The manager completed an Annual Quality Assurance Assessment and returned this to the Commission within the given timescale. In September 2007 a thematic visit took place. A thematic visit is a short, focused visit that looks in detail at a specific theme. This visit looked at the quality of care people with dementia experience when living in care homes, focussing on ‘dignity’ as an important part of people’s quality of life. A number of requirements and recommendations were made following this visit, and the progress the home has made to address these has been included in this report. Three safeguarding of adults referrals (abuse) have been made in the last 12 months to the local Social Services team. These have all been investigated and action taken where needed to protect the safety and well being of the people living in the home. What the service does well: Relatives of the people living in the home said that they are made to feel welcome by the people working in the home and that they can visit when they please. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 6 The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The people working in the home want to make sure that the people who live in the home receive good care. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well. The people spoken to are positive about the home and like living there. People living in the home expressed their satisfaction during this visit regarding the care given and the service received. Staff are hard working and do their best to meet the needs of those people living in the home. What has improved since the last inspection? What they could do better: People working in the home must make sure the information in the care plans shows the life history of those coming into the home, so activities and the care to be given reflects the needs, interests and likes or dislikes of each person using the service. People in the home who have dementia or sensory disabilities must be given a better choice of social activities to keep them happy and able to join in with others. The person who owns the home must make sure that the dining rooms have enough space to allow people to chose where they sit to eat their meals, and that peoples’ bedrooms are set out so individuals can use their en-suite showers even when they need to use hoists to help them move about. The person who owns the home must make sure there are enough staff on duty at mealtimes to meet the needs of the people using the service. People working in the home need to continue to go to different training sessions, which will help them understand more about the different needs of the people using the service. This will make the service better as people working in the home become more confident in what they do and how they do things. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 7 We would like to thank everyone who completed a questionnaire and/or took the time to talk to us during this visit. Your comments and input have been a valuable source of information, which has helped create this report. 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. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 6 (Older People) and 1, 2, 3, 5 (Younger Adults). People who use the 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 undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. EVIDENCE: Information about the home is in a brochure pack that is available to anyone who asks about the service. The pack includes the home’s Statement of Purpose and Service User Guide, plus information about the company itself. The documents are printed in a clear type and include a number of pictures and photographs. The information is also available in an audiotape format. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 10 At the thematic inspection a recommendation was made that ‘The provider should make sure that the Statement of Purpose clearly tells people that services are provided to people with dementia, what these services are, how they will help people and what training has been provided to staff. This will help people to make an informed choice as to whether or not the services provided by the home will meet their needs’. Checks of the statement of purpose at this visit showed that information about the categories of care provided at the home and the training that staff have undergone are not itemised in this document, but they are in the Service User Guide. Discussion with the manager indicated that she would ensure the above information is put into the Statement of Purpose. The recommendation from the thematic visit will remain in this report. The majority of people and relatives said they received sufficient information to make an informed choice about the service before accepting the placement offer. These individuals have also received a contract/statement of terms and conditions from the home. Individuals commented that ‘the home was recommended to me’, ‘my carer brought me here, I was impressed and thought it very nice’ and ‘at the time I moved in it was right for me’. Each person has their own individual file and six of those looked at had a need assessment completed by the funding authority or the home before a placement is offered to the person. The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from the person and their family. Those people at the home who receive nursing care have undergone an assessment by a NHS registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of their specific problems/abilities and the care given on a daily basis. Discussion with people showed that they were satisfied with the care they receive and have a good relationship with the staff. There was a mixed response in the relative surveys when asked if the home met the needs of the people using the service. Individuals wrote that ‘the needs are always met, but people with a sensory impairment such as blindness could do with extra help at mealtimes’, and ‘the high turnover of staff and shortages of staff cause frustration for people as they only just get used to certain people and they all change again’. Other relatives commented that Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 11 ‘people are generally well care for, dressed appropriately and are always clean and tidy’. The people who spoke to the expert by experience and us were happy with their care and enjoyed living at the home. The expert by experience spoke at length with four people and briefly with several others. They were all full of praise for the staff and especially the manager who was described as a “mother figure, whose door was always open”. They agreed their needs were reviewed regularly (a member of staff told the expert this would be about once a month). One person sitting in the foyer was from the nursing unit, and was pleased they could walk around at will and go outside for some fresh air. They had complex medical needs and felt “lucky to be here and be so well cared for”. Information from the training files and training matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, and have access to a range of more specialised subjects that link to the needs of people using the service. A number of people using the service have dementia needs. The thematic visit in September 2007 identified ‘a lack of staff training around dementia care’ and a requirement was made that ‘The provider must make sure that staff receive appropriate training about dementia. This will make sure that they have a good clear understanding of dementia, what the different types of dementia are, how they affect people and how they can help people with dementia’. Discussion with the manager indicated that all the staff have undergone a one day course in dementia care and that she is looking at accessing an East Riding College programme for the staff, which will offer them an ASET certificate in Dementia Level 2. The company have written to us to say ‘Southern Cross are already aware of the need for comprehensive training in dementia care for all staff. The Yesterday, Today and Tomorrow training is being made available to staff and will be completed before April 2008’. Whilst we acknowledge the positive actions the home is making to meet this requirement, it will remain on this report until the training is completed. Information from the Annual Quality Assurance Assessment and discussion with the people living in the home indicates that all of the people are of white/British nationality, although there are a number of people with different faiths and religions. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 12 The employment records show that the manager is using a selective approach to recruitment; ensuring new staff have the right skills and attitude to meet the needs of people in the home. Checks of the staffing rotas and observation of the service showed that the home employs male and female care staff and a number of staff are from different countries and cultures. Discussion with the people living in the home indicates that they have no difficulties communicating with the staff and that they can express their preferences of staff gender for individuals giving their personal care. The home does not have any intermediate care beds and therefore standard six does not apply to this service. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 (older people) and 6, 9, 16, 18 and 20 (younger adults). People who use the 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 service and staff are meeting the health care needs of people living in the home. People are encouraged to be independent within their daily lives using a risk assessment approach to care. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 14 EVIDENCE: Information from the surveys indicates that the majority of people who responded are satisfied that the staff give appropriate support and care to those living in the home. People said they are able to make their own decisions about their daily lives most of the time; that staff treat them well and listen and act on what they say. Comments from the surveys said ‘staff show great consideration towards people, some of whom can be difficult at times’, ‘all staff are friendly and polite, they care about the people in the home’, and ‘staff provide a high standard of care, in a professional way that is approachable and given by people who listen to you’. A requirement was made in the thematic visit report (September 2007) that ‘The provider must make sure that the care plans are detailed and individual to the person they are about, putting the person at the centre of it, and giving a picture of who they are as well as what their needs are and how to met them. This will make sure that staff have access to information that will help them to provide person centred care and support. The plans should meet relevant clinical guidelines produced by professional bodies concerned with the care of older people with dementia’. Checks at this visit found that some progress has been made to improve the care plans, but more work is required. The requirement will remain in this report. The care of six people was looked at in depth during this visit and included checking of their personal care plans. Some effort has been made since the thematic visit to ensure that a life history of each individual is in place, but a number of plans did not have these completed or they were not detailed enough to give a picture of the person at the centre of the plan. The manager has started to include information about the medical conditions of some people in their individual plans, but this is not in place for all people. The plans are very task orientated and do not explore fully the personal wishes or needs of the people living in the home. The plans would benefit from additional information about the individuals abilities, strengths, weaknesses, personal preferences, likes and dislikes. Some of the language used in the plans generally ‘labelled’ people, for example the term ‘wanderer’ was used for people who walked around the unit. The manager said she is asking staff to rewrite the care plans and remove this description from the records. A recommendation made in the thematic report was that ‘The provider should make sure that staff are reminded about the policies relating to dignity and follow them. This will help to make sure that people receive help discreetly and are not ‘labelled’ as ‘wanderers’ or ‘feeders’. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 15 This recommendation is now met as discussion with the staff indicated they have been asked to re-read all of the policies and are taking more care to remove this terminology from their daily conversations. Staff enable people to take responsible risks in their every day lives and information within the care plans includes a number of risk assessments covering activities of daily living. Talking to the people living in the home and watching them go about their daily business showed that some individuals find it relatively easy to maintain their independence and are able to make their choices and decisions known without a lot of input from the staff. Others require a lot more from the staff because of communication difficulties, physical support and assistance and this is managed well on a day-to-day basis. People said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the people and relatives indicate they are satisfied with the level of medical support given to the people living at the home. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. The nurses within the home carry out specialist tasks such as PEG tubes/feeding regimes and wound dressings. Pressure areas are monitored carefully and proactive measures include risk assessments and special mattresses/beds and seat cushions. People are able to access physiotherapy through their GP and the home also has input from its own physiotherapist. Comments from three relatives indicated that they had some concerns about the medication practices within the home. The relatives said that ‘staff had not given out medication to one person and had to be reminded by relatives to give the correct medication’. We observed that a tablet had been dropped on the floor of an unoccupied room, when questioned about this the nurse said it must have dropped out of the blister pack and she had not noticed it at the time. These concerns were discussed with the manager who said she would speak to all the staff to ensure they paid more attention when giving out medication to ensure procedures are followed correctly. Checks of the medication records showed these are up to date and accurate, including those for controlled drugs and refrigerated items. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 16 People and relative comments show they are satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. Feedback from the expert by experience’s report was that “I found a very happy, well cared for group of people who “wouldn’t want to live anywhere else”. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 (older people) and 7, 11, 12, 13, 14, 15 and 17 (younger adults). People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People with dementia or sensory impairment are provided with a limited choice of social events, giving them little opportunity for stimulation or recreational activities to suit their interests or abilities. Improvements are needed to the provision of suitable dining areas within the home as those in current use limit people’s choices of where to eat and with whom. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 18 EVIDENCE: A requirement was made in the thematic visit report (September 2007) that ‘The provider must make sure that people are occupied with appropriate activities that are meaningful to them. This must take into account their needs and preferences and use information that should be in the person centred care plans and ‘life history’. This will help to promote and maintain peoples dignity and social well being Staff must receive appropriate training and guidance around activities for people with dementia’. Discussion with the staff indicated that the company is offering training for those organising activities within the home, and this includes some work around people with dementia needs. However, the home caters for a number of people with sensory and disability needs and the meeting of these needs must also be looked at as part of the training. As mentioned in the previous section of this report, care plans still require more development around life histories and person centred care. This requirement will remain on this report. Talks with the younger people living in the home indicated that five of them attend an Information Technology class (computers) at South Hunsley College every Monday morning. One individual spoken to has their own computer in their room and enjoys helping the activity organiser produce the posters and information sheets that are on display in the entrance hall. Not everyone is happy that they are getting the assistance they need to be able to exercise their choice of activities. Three people said ‘I don’t like to take part’, ‘there is nothing suitable for me to do’ and I would like more activities’. The home offers a programme of activities during the day from Monday to Friday, but the manager accepts that evenings and weekends are not well catered for and this is an aspect of practice that she is looking at developing further. One activity organiser has left the home and the company is actively recruiting to fill this position, however, in the meantime one person is trying to do all the work previously covered by two. People were enjoying a game of bingo on the residential side of the home on the morning of this visit and individuals were offered the chance to do some artwork for bonfire night in the afternoon. Other activities available throughout the month are dominoes, scrabble, music therapy, art and crafts. One person told the expert by experience that ‘I go out for a walk most afternoons and often see rabbits, peacocks and hedgehogs in the grounds. I enjoy reading the newspaper, which a friend brings in for me, but a book would be too long’. The home shares a minibus with its sister home in Hull and people are offered this facility three times a week for outings. Outside entertainment is booked every two months and a resident’s meeting is held every week. Individuals Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 19 living in the home can talk about the events coming up at the meetings, ask about any issues regarding their leisure time and discuss future venues for their trips out. At the moment there are no church services in-house, but people can access the local church in Hessle. The manager said she is talking with the Salvation Army who are interested in coming into the home to carry out regular services. People living in the home are encouraged to celebrate Christian festivals such as Christmas, Easter and Harvest Festival; birthdays are celebrated with a cake and card for the individual. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or friends. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. Staff have received training around current legislation in equality, diversity and disability matters in their induction and National Vocational Qualification’s, so they understand individual rights within the care home and out in the community. People told us that the home encourages them to bring in small items of furniture and personal possessions to decorate their bedrooms. Three relatives wrote in the surveys that they would like more information from the home and for meetings with the manager to be more flexible time wise. Individuals said ‘there are fairly regular meetings about the running of the home, but always at inconvenient times for working people such as myself’, ‘we get nothing by post, which would be helpful as we live a fair distance from the home’ and ‘by the time we hear anything the decisions have been taken’. Discussion with the manager indicated that she has tried in the past to hold the relative meetings at different times, but at the moment they are usually in an afternoon. She agreed to alternate the times so one is held in an evening and another in the afternoon. The newsletter for the home is on display in the building, but does not go out to everyone. The manager said she would consider sending a copy out to relatives so they are aware of any events coming up. The home has three dining rooms, one each for the nursing, younger adults and residential units. Observation of the lunchtime meal over the two days of this visit showed that there are some problems with seating everybody especially on the nursing unit. Here staff were seen to move people around trying to fit wheelchairs and ambulant people into the few available seats. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 20 Some individuals were sent downstairs to the residential dining area to create more space upstairs. The dining tables on the nursing unit block the through access and staff would struggle to get by if there was an emergency. The expert by experience participated in the dining experience on the residential unit during their visit and his/her report says “The dining areas were welcoming, light and airy. The vegetable soup was rather glutinous. The main course of fish and chips and mushy peas was nicely cooked but rather plain and I felt could have been enhanced by the addition of a lemon wedge or a sauce. There was a nice choice of three different sweets. Several people described the food here as ‘all right’ or ‘a bit institutionalised’. They could only recall having sandwiches later in the day, although other options were listed on the menu I saw. The staff unobtrusively assisted people who needed help with eating and drinking. Water could have been more readily available on the table, and the use of napkins with rings could have brought a personal touch’. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 (older people) and 22 and 23 (younger adults). People who use the 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 home has a satisfactory complaints system with some evidence that peoples’ views are listened to and acted upon. EVIDENCE: The manager has dealt with six complaints since the last key visit to the home, these have all been investigated and resolved. Information contained in the manager’s investigations into the above complaints show that some problems have arisen due to poor communication between the staff and the manager, with important messages and information not being passed on to the manager. The manager said to us that she has recognised the need to improve this aspect of practice and it will be discussed at the next staff meeting and through individual supervision. The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. The policy is available in a number of different formats on request. Eighteen out of twenty-one people who completed a survey showed a clear understanding about how to make their views and opinions heard and four Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 22 people told the expert by experience that ‘they would not hesitate to mention anything of concern to any member of staff’. Nine out of ten relatives who completed a survey said they were satisfied with the complaints process and were happy that the home responded appropriately when they made a complaint. Three safeguarding of adults referrals (abuse) have been made to the local authority since the last key visit. Two were allegations of poor staff practice and care. The local authority and the manager have investigated both of these and no further action was required, although some staff practices have altered as a result of the investigations. The third allegation was regarding financial abuse and the police investigated this; criminal proceedings against an individual have been started and the home has completed internal disciplinary procedures. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of people’s money and financial affairs. Information in the staff training files showed that 86 of the staff have attended Safeguarding of Adults training, 90 have attended Challenging Behaviour training and 87 have attended dementia awareness. Staff have a good understanding of their roles and responsibilities around Safe Guarding of Adults procedures (abuse) and have knowledge of how and when to make referrals to the appropriate Social Service Teams. Discussion with the people using the service indicates that they feel safe within the home and are confident that staff would help them if they had any concerns or problems. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22 and 26 (older people) and 24, 27, 29 and 30 (younger adults) People who use the 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 home is comfortable and there is a maintenance programme in place to improve the decoration, fixtures and fittings. This will provide people using the service with a better quality environment. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 24 EVIDENCE: Observation of the premises showed that the home is in need of redecoration and some areas need refurbishment. Paintwork in the bedrooms and corridors is marked and damaged from use of electric wheelchairs and moving/handling equipment. The first floor corridors have a bland appearance and lack things of interest, the corridor lighting is very dim and the temperatures on the upper floors is high due to doors being closed (fire protection) and little through air. The stairways up to the first and second floors are dirty and have cobwebs in place and one stairway has visible water damage where rain has driven under the fascia boarding above the upper windows. The layout of a number of bedrooms makes it difficult for staff to use lifting equipment to enable people to make use of their en-suite shower rooms. People have to use the communal facilities, which reduces their personal choices regarding bathing. Electric hoists are recharged in the corridors, but a lack of suitable sockets means that some equipment is positioned in narrowed areas, which makes it difficult for people in wheelchairs or with Zimmer frames to walk by in comfort. The expert by experience walked around the home and their report states that ‘The outlook from the large windows across the grounds was very pleasant, especially with the autumn colours. One person said they enjoyed walking occasionally in a group with a carer, when they could go a bit further. However the large number of patio pots, which were empty and visible from the windows, did not enhance the view. I was told there were only two people who smoked and they preferred to smoke outside. I was shown the smoker’s room, which was like a walk-in cupboard and appeared unused. The thematic visit (September 2007) found that ‘The décor of the unit is hotel style and not ‘homely’, all corridors and room doors look the same and there is no clear sign posting to help people with dementia find their way around easily. The pictures used are modern and did not attract people’s attention or promote conversation and there were limited ornaments or objects for people to look at or handle’. A recommendation from the thematic visit was that ‘The provider should look at current research and good practice guidance about environments for people with dementia. This should be used to make the environment more ‘enabling’ for people with dementia, helping them to maintain their dignity and a higher degree of independence around the home’. This recommendation will remain in this report. Written confirmation from the company was received during this visit that Southern Cross Healthcare will be undertaking a full refurbishment programme of Hesslewood Care Centre over the next eighteen months. Refurbishment will be undertaken one unit at a time. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 25 All areas seen during this visit were found to be warm, safe and comfortable. The home has an infection policy in place and staff receive training around this area of practice. Comments from the day of this visit indicate that the people using the service find the home to be clean and they are satisfied with the laundry service provided by the home. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 (older people) and 32, 33, 34 and 35 (younger adults) People who use the 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 standards of recruitment, induction and training of staff are satisfactory with appropriate employment checks being carried out and staff demonstrating a clear understanding of their roles, ensuring that people are protected from risk and looked after by motivated and knowledgeable people. Improvements to the knowledge and skills of the staff around dementia care have been recognised and are being acted on by the company, ensuring that the needs of people living in the home are met. EVIDENCE: Comments from the relatives and people using the service indicate that the home is extremely busy at times and individuals may wait for attention at peak Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 27 times, but the friendly attitude of the staff and their willingness to help make up for this. The thematic report (September 2007) said that ‘At lunchtime one carer sat between two people helping them both to eat and assisting the other two people at the table, other staff were busy serving lunch’. We asked the staff about this and they agreed that due to the number of people needing help with eating and drinking, it was quite possible that more than one person was assisted at the same time. We also observed this in practice. A recommendation from the thematic report states that ‘The provider should review staffing levels in order to be sure that there are enough staff on duty at key times of the day, when people might need more help and attention. For example: at meal times. This will mean that staff do not have put peoples dignity aside by helping two people to eat at the same time. This recommendation will remain on this report. Discussion with the manager about the creation of two sittings at the lunchtime meals indicated this might solve the above problem. At the time of this visit there were 67 people living in the home. The staffing rotas show that there are the following levels of staff on duty Nursing Unit Morning – One nurse and four care staff Afternoon – One nurse and three care staff Younger Disabled Unit Morning – One nurse and four care staff Afternoon – One nurse and four/five care staff Residential Unit Morning – Four care staff Afternoon – Three care staff Information from the Annual Quality Assurance Assessment about the number of staffing hours provided, and information gathered during the inspection about the dependency levels of the people using the home, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the recommended guidelines. There is an induction course for new members of staff, and 53 of the care staff have achieved an NVQ 2 or 3, with 5 working towards this award and another 4 waiting to start the training. The home provides a mandatory staff-training programme and this includes some more specialised training to help staff develop their skills and knowledge Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 28 around pressure care, wound care, diabetes, supervision, dementia awareness, customer care, and care planning. The thematic visit report says that ‘Staff said they had done a one day course about dementia and challenging behaviour approximately four or five months ago. Their knowledge about the different types of dementia, how they affect people and what they can do to help them was limited. ‘Person centred care’ had not been covered and meant very little to them’. Discussion with the manager indicated the company has taken on board these comments, and further training looking at dementia in depth will take place. A requirement from the thematic visit report states that ‘The provider must make sure that staff receive appropriate training about dementia. This will make sure that they have a good clear understanding of dementia, what the different types of dementia are, how they affect people and how they can help people with dementia’. Whilst we acknowledge the company are planning to improve dementia training it is not yet completed, so the requirement will remain on this report. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 30 31, 33, 35 and 38 (older people) and 23, 37, 39 and 42 (younger adults) People who use the 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 management of the home is satisfactory overall and the home reviews aspects of its performance through a programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. EVIDENCE: The manager is registered with the Commission for Social Care Inspection and has been in post for nine years. The manager has a certificate in management and she is a trained nurse with an active registration with the Nursing and Midwifery Council. She has access to the company’s management training programme and attends regular training updates to keep her skills and knowledge current and proactive. Discussion with the manager indicates she operates an open door policy for people, staff and visitors to come and talk to her. Regular supervisions and staff meetings take place to give individuals feedback on their performance. The home has achieved the local councils quality award (QDS) parts one and two and Investors in People status. Meetings for people using the service are held on a regular basis and minutes are circulated to people living in the home. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. People and staff agreed that they are able to express ideas; criticisms and concerns without prejudice and the management team will take action where necessary to bring about positive change. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager completes in-house audits of the home and its service on a monthly basis, and the responsible individual does spot checks and completes the regulation 26 visits. A copy of the monthly visit is available within the home for inspection. Feedback is sought from the people using the service and relatives through regular meetings and satisfaction questionnaires, and the manager has produced an annual development report as part of this process to highlight Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 31 where the service is going and/or indicate how the management team is addressing any shortfalls in the service. The importance of the Commission’s document called Key Lines Of Regulatory Assessment (KLORA) was discussed with the manager, and how it is used in the inspection and report writing process. Checks of the finance systems within the home found that computerised records are kept for people’s personal allowances; the administrator on a daily/weekly basis up dates these. People who have asked the home to look after their personal allowances are able to access their money on request, and receipts are kept for any transactions. All monies are kept safe and secure within the home and only the administrator or manager has access to the funds. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, cot sides and daily activities of living. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 2 3 3 3 4 2 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 X 21 2 22 2 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 3 Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? Yes. 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 OP4 OP30 YA3 YA35 Regulation 18 (1)(c) Requirement The provider must make sure that staff receive appropriate training about dementia. This will make sure that they have a good clear understanding of dementia, what the different types of dementia are, how they affect people and how they can help people with dementia. The provider must make sure that the care plans are detailed and individual to the person they are about, putting the person at the centre of it, and giving a picture of who they are as well as what their needs are and how to met them. This will make sure that staff have access to information that will help them to provide person centred care and support. The plans should meet relevant clinical guidelines produced by professional bodies concerned with the care of older people with dementia. The provider must make sure that people are occupied with DS0000000936.V354348.R01.S.doc Timescale for action 30/12/07 2. OP7 YA6 15 30/01/08 3. OP12 16 (2)(m) (n) 30/12/07 Page 34 Hesslewood Care Centre Version 5.2 YA14 4. OP15 YA17 5. OP19 OP21 OP22 YA24 YA27 YA29 appropriate activities that are meaningful to them. This must take into account their needs and preferences and use information that should be in the person centred care plans and ‘life history’. This will help to promote and maintain peoples dignity and social well being Staff must receive appropriate training and guidance around activities for people with dementia. 16(1) The provider must make sure people are given adequate dining areas to eat and drink in comfort and at flexible times. This will protect and promote people’s rights of choice, privacy, dignity and independence. 13(4) The provider must make sure 23(1)(2)(a) the environment within the (f) home is improved to meet the peoples’ individual and collective needs and promote their rights of choice and independence. This will enhance the quality of life for people living in the home and enable them to live as independently as possible. 01/01/08 01/10/08 Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 35 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 OP1 YA1 Good Practice Recommendations The provider should make sure that the Statement of Purpose clearly tells people that services are provided to people with dementia, what these services are, how they will help people and what training has been provided to staff. This will help people to make an informed choice as to whether or not the services provided by the home will meet their needs. The provider should look at current research and good practice guidance about environments for people with dementia. This should be used to make the environment more ‘enabling’ for people with dementia, helping them to maintain their dignity and a higher degree of independence around the home. 2. OP20 OP22 OP24 YA26 YA28 3. YA29 OP27 YA33 The provider should review staffing levels in order to be sure that there are enough staff on duty at key times of the day when people might need more help and attention. For example at meal times. This will mean that staff do not have put peoples dignity aside by helping two people to eat at the same time. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Hesslewood Care Centre DS0000000936.V354348.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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