CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE
Hesslewood Care Centre Ferriby Road Hessle East Yorkshire HU13 OJB Lead Inspector
Mrs Rosalind Sanderson Unannounced Inspection 17th January 2006 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.V276162.R01.S.doc Version 5.1 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.V276162.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Hesslewood Care Centre Address Ferriby Road Hessle East Yorkshire HU13 OJB 01482 648543 01482 640990 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) the.willows@ashbourne.co.uk Exceler Healthcare Services Limited 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.V276162.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd September 2005 Brief Description of the Service: 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. Hesslewood Care Centre DS0000000936.V276162.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day with two hours preparation having taken place prior to this. Two inspectors, Ros Sanderson and Sarah Sadler, carried out the inspection. The focus of the inspection was on the key standards that have not yet been assessed in this inspection year and those that had a shortfall at the previous inspection. The inspection process involved speaking with service users, their relatives and staff and taking their views into account. Comments made by them are included in the summary and body of this report. Records looked at included service users care plans, staff recruitment and training records, and health and safety records. The home was found to be warm and welcoming and service users were occupied and seemed content. What the service does well:
Service users appreciate the activities that the home offers whilst also appreciating the fact that they participate only as they wish. Comments received include, ‘‘The activities on offer are sufficient, I join in when I want to but often spend time in my room reading.’ Although the home is split into three separate units the service users are free to move around safely and meet other service users. One commented, ‘‘We all join in together for activities, we don’t have to stay in our wings, we get to know each other.’ Visitors enjoy visiting the home and service users are encouraged to maintain contact. One visitor said, ‘We come when we can and don’t have set times. We’re always made to feel welcome and the staff keep us well informed about how……….is doing.’ A service user commented, ‘My family visit often and telephone each day. When they come I see them in private in my room’ Care plans showed that service users social likes are recorded sensitively. Examples of this are as follows: ‘Patience is needed to allow him time to express his needs and wants’ ‘……enjoys group activities, ensure that he is informed daily of events happening’ Service users views are sought about the home and service users feel valued, one commented, ‘‘If we don’t like something, we say and don’t get jumped on; what we say is recorded and they try to act upon it.’ Hesslewood Care Centre DS0000000936.V276162.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: 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. Hesslewood Care Centre DS0000000936.V276162.R01.S.doc Version 5.1 Page 7 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.V276162.R01.S.doc Version 5.1 Page 8 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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. Standard 6 (OP) is not applicable EVIDENCE: Hesslewood Care Centre DS0000000936.V276162.R01.S.doc Version 5.1 Page 9 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 to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 9 (20 NMS Younger Adults) Continued unsafe practice in the handling and security of medications has the potential to place service users at unnecessary risk. EVIDENCE: There is a monitored dosage medication system in operation. Risk assessments are in place for service users who wish to self medicate. A requirement was made at the last inspection to make sure that the medication trolley was not left open and unattended in the home. Whilst looking around the nursing unit the medication trolley was seen unattended and open with medication blister packs accessible to service users.
Hesslewood Care Centre DS0000000936.V276162.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 (12,13,15 (NMS younger adults) Service users live busy and varied lives choosing how they spend their days and with whom. EVIDENCE: There is a programme of activities displayed in the hallway of the home. Service users said that they all join in together for activities and do not stay in the separate units. One service user said, ‘We all join in together for activities, we don’t have to stay in our wings, we get to know each other.’ Activities on offer are varied including theatre and pub outings, panto at Christmas and in house activities such as music, quizzes and bingo. Service
Hesslewood Care Centre DS0000000936.V276162.R01.S.doc Version 5.1 Page 11 users are encouraged to join in but if they choose not to their wishes are respected. One said, ‘The activities on offer are sufficient, I join in when I want to but often spend time in my room reading.’ Visitors are welcome at anytime and two spoken with confirmed this saying, ‘We come when we can and don’t have set times. We’re always made to feel welcome and the staff keep us well informed about how……….is doing.’ A service user commented, ‘My family visit often and telephone each day. When they come I see them in private in my room’ Service users social assessments are completed in the care plans and address in a sensitive manner how social needs should be met. Examples of this are as follows: ‘Patience is needed to allow him time to express his needs and wants’ ‘Enjoys group activities, ensure that he is informed daily of events happening’ There are no records kept to show what activities each service user has participated in. Hesslewood Care Centre DS0000000936.V276162.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards not assessed at this inspection EVIDENCE: Although these standards were not assessed at this inspection a complaint had been received by the Commission for Social Care inspection from a service users relative. The details of the complaint centred on the provision of special diets, suitability of the environment for wheelchairs and the homes fire procedures. The complaint had been referred to the providers for investigation and the outcome was that the complaint was partially upheld in respect of the environment but not upheld in the other areas. The complainant was satisfied with the outcome. Hesslewood Care Centre DS0000000936.V276162.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Hesslewood Care Centre DS0000000936.V276162.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29&30 (32,34&35 NMS Younger adults) Service users are supported by staff that are well trained but recruitment practices could put service users at risk. EVIDENCE: The homes training programme ensures that all staff receive induction training on commencement of employment and annual mandatory training. Care staff are encouraged to undertake NVQ training to at least level 2 and currently 43 of staff hold this qualification. A member of staff commented, ‘The organisation is very supportive and assists with your training requirements’. Some service users on the younger disabled unit have multiple care needs and staff would benefit from receiving specific training in these areas. Staff recruitment files showed that staff are started in employment before the necessary checks are completed including CRB checks and verification of trained nurses P.I.N. numbers. In two cases no check had been requested against the P.O.V.A. register
Hesslewood Care Centre DS0000000936.V276162.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35&38 (37,39&42 NMS younger adults) Although service users feel valued, an inconsistent approach to the management of the home could place them at risk Hesslewood Care Centre DS0000000936.V276162.R01.S.doc Version 5.1 Page 16 EVIDENCE: The registered manager is qualified and has many years experience in care. She operates an ‘open door’ policy and staff feel well supported by her. The manager seeks the views on how the home is performing from service users, their relatives and professionals that visit the home. There is also an audit tool that is used to measure how well the service is performing and this looks at medication, environment and care plans to state a few. Results from these quality assurance tools are used to develop the annual business plan. One service user commented, ‘If we don’t like something, we say and don’t get jumped on; what we say is recorded and they try to act upon it.’ The home looks after pocket money for a few service users and although the monies are held together individual accounts can be produced to show how much an individual has and what transactions have taken place. Receipts are kept for all transactions and those issued jointly for chiropody and hairdressing are photocopied so each service user has a copy. To fully comply with Data Protection, individual receipts should be issued. Health and safety certificates seen were all up to date and observation of fire fighting equipment showed that it is regularly serviced. All mandatory training is up to date for staff including moving and handling. However during the inspection two members of staff were observed moving a service user using the ‘underarm drag lift’. This move is not safe and could cause serious harm to the service user and staff. The service users moving and handling assessment indicted that the service user could transfer with one carer and a Zimmer frame. Hesslewood Care Centre DS0000000936.V276162.R01.S.doc Version 5.1 Page 17 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 X 2 X 3 X 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x ENVIRONMENT Standard No Score 19 X 20 X 21 X 22 X 23 X 24 X 25 X 26 X STAFFING Standard No Score 27 1 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 2 36 X 37 X 38 1 x Hesslewood Care Centre DS0000000936.V276162.R01.S.doc Version 5.1 Page 18 x 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 OP9YA20 Regulation 13(2) Requirement The registered manager must: • Ensure that medication is not left unattended in the home at anytime Timescale for action 17/01/06 PREVIOUS TIMESCALE OF 22/9/05 NOT MET 2. OP9YA20 13(2) The registered manager must: Arrange for all staff that deal with medications to receive training in the safe handling and administration of medications so that they understand their responsibilities in this area. The registered manager must ensure that: • Staff have received specific training in order that they can fully meet the needs of the service users with multiple care needs.
Version 5.1 Page 19 31/03/06 • 3 OP27 18(1(c(i)) 31/03/06 Hesslewood Care Centre DS0000000936.V276162.R01.S.doc 4 OP29YA34 19(4(b(i)) The registered manager must ensure that pre employment checks are obtained for each prospective member of staff prior to commencement of employment including: • • A satisfactory CRB check If a P.O.V.A. 1st check is used the staff member must work under supervision until a full CRB check is received 17/01/06 5 OP38YA42 13(6) The registered manager must ensure that, following full risk assessment, only safe and acceptable systems are used for moving and handling service users. 17/01/06 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. 2 Refer to Standard YA11OP12 YA23OP35 Good Practice Recommendations It is recommended that an individual record is kept for each service user of all activities that they have participated in. It is recommended that service users monies are stored individually. Hesslewood Care Centre DS0000000936.V276162.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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