Hailsham House

Hailsham House provides nursing care and accommodation for up to 90 people who live with a dementia type illness, for example, Korsokoffs disease or/and a mental health illness, such as Schizophrenia. The home also provides care and support for people with Huntingtons chorea and Creutzfeldt-Jakob disease The home is divided in to three units, (Holly, Willow and Orchard) each with their own lounge and dining areas. There were 62 people living in the service at the time of inspection.

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

The governance of the service had not supported the service to consistently improve and sustain improvement. Audit systems and processes whilst in place had failed to identify risks to people's safety and other aspects of the service that required improvement. Whilst improvements had been made in some areas since their last inspection, there were also repeated shortfalls in respect of pressure relieving equipment, management of covert medicines and aspects of health-related risk assessments. Additional concerns were identified during this inspection in relation to the risk assessment process for the call bell system and non-functioning lifts. There was a lack of clear and accurate records regarding some people's care and support. For example, diabetes and fluid support.

Risk management was an area identified as needing improvement to ensure peoples’ health and well-being was protected and promoted. We identified shortfalls in respect of the management of specific health problems. Staff practices regarding covert medicines needed to be further developed to ensure that staff follow the organisational policy for safe administration and recording of these medicines.

People received care and support from staff who had been appropriately recruited and trained to recognise signs of abuse or risk and understood what to do to safely support people. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible.

There were COVID-19 policies in place for visiting that was in line with government guidance. Families told us that they were welcomed into the home and followed the guidance currently in place.

Referrals were made appropriately to outside agencies when required. For example, GPs, community nurses and speech and language therapists (SALT). Notifications had been completed to inform CQC and other outside organisations when events occurred.

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

Rating at last inspection and update:

The last rating for this service was Requires Improvement (published 29 August 2019)

Why we inspected

This inspection was prompted due to information received of risk and concern in relation to staffing levels, communication and safeguarding concerns which had impacted on care delivery. We also used this opportunity to look at the breaches of Regulation 12 and 17 from the last inspection published in August 2019.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

The concerns raised were looked at during this inspection and have been reflected in the report. The provider took immediate action to mitigate risk to people.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led questions of this full report.

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

Enforcement

We have identified continued breaches in relation to safe care and treatment, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Hailsham House provides nursing care and accommodation for up to 90 people who live with a dementia type illness, for example, Korsokoffs disease or/and a mental health illness, such as Schizophrenia. The home also provides care and support for people with Huntingtons chorea and Creutzfeldt-Jakob disease The home is divided in to three units, (Holly, Willow and Orchard) each with their own lounge and dining areas. There were 79 people living in the service at the time of inspection.

We found the following examples of good practice.

People were supported by staff to have visits from their friends and family in various ways throughout the pandemic. When face to face visits had not been possible, people had, had window/door visits or in a room with a Perspex partition. Essential carers and visitors for people receiving end of life support were able to have visitors in their room throughout the pandemic. There was a risk assessment process to support essential visitors. People also used phone and video calls to keep in touch with their loved ones.

The staff have a booking system to ensure people received their visitors safely. All people had a COVID-19 health and visitor risk assessment, which was reviewed and updated regularly. Staff provided people and their relatives with updates to keep them informed of what’s happening at the home and any changes to visiting. The website for Hailsham House Nursing Home also has up to date information in regard to COVID-19.

Visitors at this time were asked to wear personal protective equipment (PPE), have a lateral flow test on arrival if they had not done one and have their temperature taken. This included health professionals. There was a visiting policy to support visitors regarding this.

There was a contingency plan for staff to follow in the event of an outbreak. The layout of the home meant that in the event of an outbreak, people could be supported to safely isolate. People that lived with dementia and unable to self isolate were able to be supported by staff to maintain social distancing within a risk assessment. Additional cleaning was also undertaken by staff.

The home was clean and hygienic. Cleaning schedules showed how staff had included contact areas. Personal protective equipment (PPE) stations had been placed throughout the home for staff to access easily.

Staff had received specific COVID-19 training from the provider, and this included guidance for staff about how to put on and take off PPE safely. Updates and refresher training took place to ensure all staff followed the latest good practice guidance. They were seen to be following correct infection prevention and control practices (IPC). Hand sanitiser was readily available throughout the home.

Regular testing for people and staff was taking place. All staff have had a weekly PCR and three lateral flow device test (LFD) weekly. This has changed this week (16 February 2022) to daily LFD tests and a PCR only if the LFD is positive.

Due to being currently in an outbreak there are no admissions however when open to admissions all new arrivals to the home from hospital will only be accepted with a negative polymerase chain reaction (PCR) test. If it is unsafe for the person to isolate, then the person will have daily LFD tests and supported to adhere to social distancing.

Hailsham House has large lounge/dining rooms on each unit and people who chose to visit the dining area/communal area were supported by staff to maintain social distancing. For example, chairs and tables had been arranged to allow more space between people.

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

Hailsham House provides nursing care and accommodation for up to 87 people who live with a dementia type illness, for example, Korsokoffs disease or/and a mental health illness, such as Schizophrenia. The home also provides care and support for people with Huntingtons chorea and Creutzfeldt-Jakob disease The home is divided in to three units, (Holly, Willow and Orchard) each with their own lounge and dining areas. Within these three units there was a mixture of people on normal contracts and those on a tenancy agreement. There was no difference in the provision of care for people under a tenancy agreement. The provider had purchased the service with the tenancy agreement and would be phasing this out naturally. 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 the care and support throughout the day.

People’s experience of using this service

Although regular quality audits were completed to manage oversight of the service, we found improvements were needed to ensure the safety and well-being of people. This included the management of pressure relieving equipment, risk of choking, safe moving and handling which linked to the effective deployment of agency staff. Aspects of medicine management such as medicines given covertly and those for people in pain at the end of their life needed improvement to ensure their safe use. Improvements were needed to ensure people were not isolated without a clear rationale and that staff followed good guidance in food hygiene.

Activities whilst planned did not ensure people were engaged in meaningful activities that provided stimulation and prevented social isolation.

The providers’ governance systems had not identified the shortfalls found at this inspection in respect of care documentation. There was a lack of clear and accurate records regarding some people's care and support and of people capacity for decision making. There were gaps in essential maintenance checks and whilst we were told these had been addressed in March 2019, there were no records to evidence this.

People told us they experienced safe care. People told us, “I am comfortable here, it’s clean and I love the garden.” Another person said, “The staff are all very caring, very polite and respectful.” A relative said, “All the staff are very approachable and will always make time to talk to us.” We observed, and people told us that staff met their needs with care and kindness.

Training, policy guidance and safe systems of work minimised the risk of people being exposed to harm. Staff understood how to safeguard people at risk and how to report any concerns they may have. People’s needs and the individual risks they may face were assessed and recorded. Incidents and accidents were recorded and checked or investigated by the manager to see what steps could be taken to prevent these happening again. This ensured lessons were learnt.

There were policies and procedures in place for the safe administration of medicines. Registered nurses followed these policies and had been trained to administer medicines safely.

Safe recruitment practices had been followed before staff started working at the service. Staff were deployed in a planned way, with the correct training, skills and experience to meet people’s needs. Nursing staff received clinical supervision and training.

The premises were clean and infection control measures followed. People told us the home was clean and tidy. Relatives spoken with had no concerns about the cleanliness of the service. There were some odours that were identified but these were known and were being managed by new flooring.

Care plans had been developed to assist staff to meet people’s needs in an effective way. Staff applied best practice principles, which led to effective outcomes for people and supported a good quality of life. The care plans were consistently reviewed and updated. Referrals were made appropriately to outside agencies when required. For example, GPs, community nurses and speech and language therapists (SALT).

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The care offered was inclusive and based on policies about Equality, Diversity and Human Rights.

People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. There had been known issues with the provision of meals and a new chef was due to start work in August 2019.

Staff always treated people with respect and kindness and were passionate about providing a quality service that was person centred.

The care was designed to ensure people's independence was encouraged and maintained. Staff supported people with their mobility and encouraged them to remain active. Activities were provided and were under review as it was known that improvements were needed. A new minibus had been purchased and trips out would be started as soon as staff received the necessary driver training.

People were involved in their care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives. End of life care was delivered professionally and with compassion.

People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated.

Rating at last inspection:

This is the first inspection since Hailsham House was registered in July 2018.

Why we inspected:

This inspection took place as part of our planned programme of inspections.

Enforcement

We have identified breaches in relation to the legal requirements related to safe care and treatment and good governance at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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.