Archived: Hailsham House

Updated 7 January 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was an unannounced inspection on 09 and 12 December 2016. It was undertaken by three inspectors, a specialist advisor in End of Life Care and two experts by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before our inspection we reviewed the information we held about the home, including previous inspection reports and the action plan sent to us by the provider following the last inspection. We contacted the local authority to obtain their views about the care provided. We considered the information which had been shared with us by the local authority and other people, looked at safeguarding alerts which had been made and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law.

During the inspection we reviewed the records of the home. These included staff training records eight staff files including staff recruitment, training and supervision records, medicine records complaint records, accidents and incidents, quality audits and policies and procedures along with information in regards to the upkeep of the premises.

We also looked at twenty care plans and risk assessments along with other relevant documentation to support our findings. We also ‘pathway tracked’ people living at the home. This is when we looked at their care documentation in depth and obtained their views on their life at the home. It is an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

During the inspection, we spoke with 25 people who lived at the home, eight relatives, and 14 staff members. This included the registered manager and deputy manager.

We met with people who lived at Hailsham House ; we observed the care which was delivered in communal areas to get a view of care and support provided across all areas. This included the lunchtime meals. As some people had difficulties in verbal communication the inspection team spent time sitting and observing people in areas throughout the home and were able to see the interaction between people and staff. This helped us understand the experience of people who could not talk with us. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 7 January 2017

Hailsham House provides nursing care and accommodation for up to 87 people who live with a dementia type illness, for example Korsokoffs disease and Dementia with Lewy bodies or/and a mental health illness, such as Bipolar disease and Schizophrenia. The home also provides care and support for people with Multiple Sclerosis and Parkinson's disease and end of life care. The home is divided in to three units, (Holly, Willow and Orchard) each with their own lounge and dining areas. A separate building (Beech) at this location accommodated up to 31 people who had a tenancy agreement for their care suite. These people received 24 hour personal and nursing care by a separate team of staff. Some people who live in Beech Unit have care staff from an external domiciliary care agency of their choice to provide their care..

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.