Archived: Hesslewood House

People’s experience of using this service and what we found:

People received care from staff who were caring and responsive, but improvements were needed to aspects of medicines management, record keeping and risk management. We have made a recommendation about quality assurance processes, to ensure they are more effective in identifying and addressing shortfalls.

There was a system in place to make sure there were enough staff to meet people’s needs and agency staff were used to cover any gaps. The provider was taking action to try and recruit more staff, to help improve consistency of care. People were supported by staff who were safely recruited and vetted.

Improvements had been made to infection control practices in the home. Work was underway at the time of our inspection to make improvements to the environment, to support with effective hygiene practices.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager promoted a positive culture and staff felt supported. Staff worked with health and social care professionals to meet people’s needs.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 25 April 2020).

Why we inspected:

We received concerns in relation to infection control and risk management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. The provider took action straightaway to respond to our feedback and continue working on their own action plan.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hesslewood House on our website at www.cqc.org.uk.

Follow up:

We will work with the local authority to monitor progress and will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hesslewood House is a residential care home providing personal and nursing care to 53 people at the time of the inspection. The home accommodates people across three units: Oak unit for nursing care, Beech unit for older people, some of whom may have a physical or learning disability, and Cherry unit which provides support to people living with dementia. The service can support up to 66 people.

People’s experience of using this service and what we found

Since our last visit there had been improvements to the frequency of supervision and appraisal for staff. Positive changes had been made to the food provision, areas of the home had been redecorated, and the quality assurance systems in place helped to assess, monitor and improve the quality and safety of the service provided.

People said they felt safe. Staff were aware of their responsibilities to safeguard people and the provider had procedures in place. Risks to people's health, safety and well-being were assessed and care plans were in place to ensure risks were mitigated as much as possible. Medicine management practices were safe.

Recruitment practices were safe, and staff received the training they required for their role. There were adequate numbers of staff employed to ensure people's needs were met at the time of the inspection.

Systems were in place to make sure the building was safe, maintained, and kept clean.

Staff were attentive to people’s needs. They knew people well and treated them with dignity and respect. Care plans contained personalised information about how people wanted their care to be given.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Consideration was given to providing leisure and social activities for people to enjoy if they chose to. This included the introduction of regular days out.

A suitable process was in place to respond to any concerns or complaints.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was requires improvement (published 19 February 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: People and their relatives told us the service was safe. Care plans contained appropriate assessments of risk to people and provided instructions to staff to reduce the likelihood of harm. Appropriate recruitment checks were conducted and there were enough staff on duty to support the needs of people and keep them safe.

People, relatives and staff all had concerns with the food provided at the service. An external catering company prepared and provided the food. The management team were aware of the issues relating to the food within the service and were working with the external company to improve this.

On the first day of inspection we identified areas of the environment that required refurbishment. On the second day of our visit, some of these areas had been re-decorated and the manager had implemented an action plan for the remainder of the work needed.

People and relatives were positive and spoke highly of staff. We observed staff were kind and caring and people were observed to be content and happy in staff presence. People told us they were encouraged to be as independent as possible and staff respected their privacy and dignity.

Care plans were developed with people and their relatives. Staff were encouraged to complete activities in communal areas of the service. A complaints procedure was in place in an accessible format.

People and their relatives spoke positively about the registered manager. Staff told us the registered manager was supportive and approachable. Systems were in place to monitor the service to ensure the service was consistently monitored and quality assurance was in place but not effective.

Rating at last inspection: Requires Improvement (Report published 22 February 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection. We brought the inspection forward due to information we received of risk.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The service is divided into three areas; ‘Oak’ provides nursing care, ‘Beech’ provides personal care for adults and older people, some of whom may have a physical disability, learning disability or dementia related condition and ‘Cherry’ provides support to people living with dementia.

The inspection was unannounced and took place over two days on 28 November and 7 December 2017. At the previous inspection in September 2015 the service was rated Good. On the first day of this inspection there were 61 people using the service.

The provider is required to have a registered manager as a condition of their registration and there was a registered manager in post. They had been registered since June 2017. 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 2008 and associated Regulations about how the service is run.

Most people and relatives we spoke with told us they felt safe living at the service. Care workers received training on safeguarding vulnerable adults and knew how to raise any concerns. Risk assessments were in place and regularly reviewed. Accidents and incidents were recorded and analysed by the registered manager. Systems were in place for the ordering, storage and administration of medicines.

Care workers were recruited following robust recruitment procedures. There were mixed views about staffing levels at the service. We found there were sufficient care workers to meet people’s needs safely but have made a recommendation in our report that the provider reviews how staff are deployed in order to maximise people’s opportunities for social engagement and emotional well-being.

People were supported to make their own decisions and when they were not able to do so, decisions were made in their best interests. The provider had submitted appropriate Deprivation of Liberty Safeguards (DoLS) authorisation applications, however some improvement was required to the provider’s systems to ensure that staff were knowledgeable about any conditions of people’s DoLS authorisations.

Care workers received induction, training and supervision. The registered manager took action after our inspection to organise additional training in relation to epilepsy and diabetes.

People’s needs were assessed and there were care plans in place to guide care workers on how to support people. Some care files contained personalised information about people’s wishes and preferences. However, there was some inconsistency with this, and some care files lacked clarity about people’s healthcare needs. People had access to visiting healthcare professionals where required.

People had a choice of meals and received appropriate support with their nutrition and hydration needs. However, we received mixed feedback about the food available and some improvements were required to the consistency of people’s dining experience.

People told us that care workers were kind and caring and we observed positive, friendly interactions between people who used the service and care workers. Care workers ensured people’s privacy and dignity were upheld, and supported people to maintain their independence and skills where they were able to.

There were some activities available at the service but the social and leisure opportunities were limited, especially in the nursing area of the home.

There was a quality assurance system in place and the registered manager completed regular audits of practice at the home. Although there was some evidence of action taken in response to issues identified in audits, overall we found that the quality assurance systems in place had not been effective in addressing some of the concerns and inconsistencies we identified in practice across the three areas of the home.

Staff treated people who used the service with respect and only provided care and support to people with their consent. One person who used the service told us 'Staff are very respectful and very kind. Everybody shows respect and they always knock on doors'.

People told us they were satisfied with their care. One person told us 'The care is wonderful, couldn't wish for better, day or night'. Care plans were detailed and person centred. All care plans were reviewed on a monthly basis as part of a 'Resident of the day' initiative.

Care workers and registered nurses supported people to take their medicines in a variety of different ways and at times that met the individual needs and preferences of people living in the home. One person told us 'They're very good here, they've always given me my medicines properly' whilst another said 'I get my painkillers when I need them, and they always make sure I have my cream on'.

Staff were employed in sufficient numbers to ensure the needs of people who used the service were met. Additional staff had been employed to ensure consistency of staffing levels.

Quality assurance was undertaken in line with the provider's quality assurance policies and procedures. Any learning identified following complaints or safeguarding incidents was recorded and shared appropriately to inform practice.

Records were accurate, fit for purpose and were stored securely.

People that used the service were not consulted on this visit. We discussed with the manager and area manager action that had been taken to achieve compliance with the regulation. They told us new auditing and monitoring systems had been put into place and new documentation had been introduced to record these audits. They told us staff had received up-dated medication administration training and their practices had improved.

We looked at the systems that had been implemented, saw evidence the staff had been re-trained and completed a check on medication storage, administration, recording and disposal. We found that the management of medicines had improved and the regulation had been met.

People who used the service who we spoke with told us that they were happy with the support they received. We observed staff interaction with people who used the service on the residential unit and saw that staff had a good knowledge of people who used the service and treated people with respect. One person we spoke with who resided at the service told us "I love it here" and "If I get a bit upset about something there is always somebody to talk to and staff are understanding"

We saw records that showed that more staff have been employed at the service. We also saw minutes from relatives meetings and saw that actions had been taken following quality assurance audits.

The relatives of people who used the service who we spoke with told us that they were satisfied with the care and support their relatives received. One person told us "Staff have not taken away reality" and "Staff are keeping my mum's dignity". One visitor told us that the door entry system sometimes caused visitors to have to wait to access and exit the building and that staff had to leave what they were doing in order to answer the door.

We found that staff levels were not always sufficient to meet the care needs of people who used the service. We have raised concerns in this report about poor staff practices with regard to medication. We have commented on how staff were not learning from events/investigations in that proactive measures to ensure people got their medication safely and on time were not in place.