Archived: Hailsham House

At our inspection in January 2016 we found Breaches of Regulation of the Health and Social care Act 2008 (Regulated activities) Regulations 2014 that had not ensured the safety of people who lived In Hailsham House. The safe question was rated as inadequate. At that inspection, we found the deployment of staff within the service had not ensured people's health and social needs were being met. We also found significant risks to people due to the poor management of medicines and individual risk assessments to maintain people’s health, safety and well-being were not in place for everyone and this had placed people at risk. People had also been placed at risk by ineffective management of specialised pressure relieving equipment which was not set correctly for their individual needs. Due to concerns about people’s safety and well-being we undertook a focused inspection in August 2016 to look at the safe question. At that inspection we found that improvements had been made and the provider had met Regulation 12 and 18 of the Regulation of the Health and Social care Act 2008 (Regulated activities) Regulations 2014.

This unannounced comprehensive inspection was carried out on the 09 and 12 December 2016 to see if the improvements had been sustained. We found that the improvements had been sustained.

People spoke positively of the home and commented they felt safe. one person told us, "“We are lucky to have a place where we are safe and so well looked after” “I am safe-I have a big room with a view all round –that makes me feel safe.” Another person said, "Another said “I feel safe because there is always someone around.” Our own observations and the records we looked at reflected the positive comments people made.

There was a registered manager at Hailsham House. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences and requirements. Risk assessments included falls risk, risk of pressure damage, behaviours that may challenge, nutritional risks including swallowing problems and risk of choking and moving and handling. For example, cushions were in place for those that were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and epilepsy. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. Staff had received training in end of life care and were supported by the Hospice community team. There were systems in place for the management of medicines and people received their medicines in a safe way.

Nurses were involved in writing the care plans and all staff were expected to record the care and support provided and any changes in people's needs. The manager said staff were being supported to do this and additional training was on -going. People received adequate food and fluids to maintain their health and evidenced by food and fluid charts that were completed correctly. Following internal audits and surveys which identified food delivery could be improved, a new chef had been employed. People told us that food was ‘good,' 'plentiful’ and ‘varied.’

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles. People previously isolated in their room were seen in communal lounges for activities, meetings and meal times and were seen to enjoy the atmosphere and stimulation.

A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. Activities were provided throughout the whole day, five days a week and were in line with people's preferences and interests.

The provider had progressed quality assurance systems to review the support and care provided. A number of audits had been developed including those for accidents and incidents, care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and, they were always made to feel welcome and involved in the care provided.

Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there was a sufficient number with the right skills when people moved into the home. The provider had made training and updates mandatory for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care, falls prevention and dementia care. Staff said the training was very good and helped them to understand people's needs.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns, and they had a clear understanding of making referrals to the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. People said they felt comfortable and at ease with staff and relatives felt people were safe.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff said the management was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the registered manager was always available and, they would be happy to talk to them if they had any concerns.

We undertook an unannounced inspection of this service on the 11 August 2016.There were 111 people being supported at this time. Currently there are 25 people living on Holly Unit, 24 people in Orchard Unit, 31 people on Willow Unit, and 31 on Beech Unit.

At our last inspection in January 2016 we found Breaches of Regulation of the Health and Social care Act 2008 (Regulated activities) Regulations 2014 that had not ensured the safety of people who lived In Hailsham House. The safe question was rated as inadequate. At that inspection, we found that the deployment of staff within the service had not ensured people's health and social needs were being met. We also found significant risks to people due to the poor management of medicines and individual risk assessments to maintain people’s health, safety and well-being were not in place for everyone and this had placed people at risk. People had also been placed at risk by ineffective management of specialised pressure relieving equipment which was not set correctly for their individual needs. At this inspection we found that improvements had been made and the provider was now meeting Regulation 12 and 18 of the Regulation of the Health and Social care Act 2008 (Regulated activities) Regulations 2014.

There was a registered manager at Hailsham House. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Risk assessments which guided staff to promote people’s comfort, nutrition, skin integrity and the prevention of pressure damage were in place and accurate. Emergency procedures were in place in the event of fire and staff had received training. Equipment used to prevent pressure damage was set correctly and people identified at risk from pressure damage had the necessary equipment to prevent skin damage. Medicines were stored safely and securely. People were given their medicines following best practice procedures, by appropriately trained staff.

Many improvements had taken place since the last inspection. At the next inspection we will check to make sure the improvements are embedded and sustained. This is because there are currently 111 people at the home and we will need to see that as people are admitted the improvements continue, which is why the rating is requires improvement despite no breaches having been identified .

This unannounced inspection took place on the 13 and 18 January 2016. There were 111 people being supported at this time. Currently there are 25 people living on Holly Unit, 24 people in Orchard Unit, 32 people on Willow Unit, and 31 on Beech Unit.

There was a registered manager at Hailsham House. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People and visitors spoke well of the home and commented they felt safe. Our own observations and the records we looked at did not always reflect the positive comments some people had made.

At our last inspection in November 2014 we found Breaches of Regulation of the Health and Social care Act 2008 (Regulated activities) Regulations 2010. We undertook this inspection on the 13 and 18 January 2016 in response to complaints received about the service and to follow up on whether the required actions had been taken to address the previous breaches identified.

This inspection found that whilst quality assurance systems were in place they had not always identified the shortfalls we found in the care delivery and records. We found that equipment in place to mitigate potential pressure damage had not been checked by staff, and were not set correctly for specific people. This had placed people at risk from pressure damage. Discrepancies in people’s weights were found and there was no audit trail as to why records stated different weights. This had the potential to impact on safe care and treatment of people in the home. There was no clear overview of accidents that had occurred and what action had been taken to prevent a re-occurrence. There was no evidence of learning taken forward to drive improvement and to promote peoples safety.

The management style of the service was not always open and transparent. Two nurses stated that they felt disempowered as they did not have autonomy to adjust care delivery when they felt it was required. One nurse said, “It’s been challenging as a health professional to put views on care forward.” Another said “It can be difficult to suggest change as I’m still new, but we as a team are getting stronger.”

We spent time on all units in the service. We found Holly unit predominately to be lacking in leadership from nurses and was not delivering safe, and person centred care. Whilst staffing levels were appropriate and in line with assessed needs throughout Hailsham House, the deployment of staff on Holly unit impacted negatively on people who remained in their room and on continued bed rest. People were found isolated without access to a call bell or regular checks in place. On the other units only three people remained in their rooms and we observed checking these people regularly and reflecting these checks on the daily charts.

Care plans contained risk assessments specific to health needs such as mental capacity, mobility, continence care, falls, nutrition, pressure damage and a person’s overall dependency. However on Holly unit we found that not everyone’s health, safety and wellbeing was assessed and protected.

Medication administration practices on Holly unit did not ensure people’s safety and well-being. We looked at the management of medicines and found irregularities in records and medicine administration that had the potential to impact on the safety and health of people. On the other three units, people’s medicines were stored safely and in line with legal regulations.

Staff were not always working within the principles of the Mental Capacity Act 2005 (MCA). Staff were unable to tell us about how certain decisions were made such as, covert and crushed medicines, where people spent their time, or about whether people could use a call bell.

There was a lack of clarity in respect of Deprivation of Liberty Safeguards (DoLS). We found that some were classed as ‘historic’ and some expired. Staff were unaware of whether a DoLS was in place for people.

At our last inspection we found that the delivery of care suited staff routine rather than individual choice. This inspection found that there was some very person specific care being delivered to people on three of the four units.. However this was not found for people who remained in their room on Holly unit.

At our last inspection we found that not everyone had been happy with the food provided and the dining experience had not been a social and enjoyable experience for people. This inspection found that whilst improvements had been made and that people had the opportunity to eat in dining areas that were comfortable and social. We found people who remained on bed rest in the afternoon were not always encouraged to get up to join a communal evening meal.

Safe recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

People received care and support from staff who were appropriately trained, to meet their individual needs. They were able to access health, social and medical care, as required.

People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. However we also saw that many people were supported with little verbal interaction and many people spent time isolated in their room due to time pressure despite the best intentions of the staff.

Feedback had been sought from people, relatives and staff, although three members of staff said managers did not always welcome or encourage their ideas. Residents’ and staff meetings were held on a regular basis which provided a forum for people to raise concerns and discuss ideas. Incidents were recorded, and consistently investigated and acted on.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People were enabled to express their views and were involved in making decisions about their care and treatment. We found that care and treatment was planned and delivered in a way that ensured people's safety and welfare. We saw documentation that the provider responded appropriately to any allegation of abuse. There were enough qualified, skilled and experienced staff to meet people's needs. We saw that complaints were taken seriously and there was an effective complaints system available.