Hailsham House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People told us they felt safe. The provider had policies and processes in place to safeguard people from abuse and potential harm. Staff had received training in safeguarding and felt able to report any concerns. The home was clean. People received their medicines as prescribed and were supported by trained staff in the safe handling of medicine. Staff were recruited safely. There was limited evidence of a learning culture. Accidents and incidents were not always reviewed, and lessons had not always been learned when things went wrong. Assessments of any risks to people’s safety and welfare had not been robustly completed and we found that plans had not always been put into place to help mitigate these risks or that staff were aware. Staff recruitment was safe and pre-employment checks completed. Staff were confident in their management of risks to people’s safety. Most care plans contained clear information for care staff in how to manage those risks appropriately. However, we identified some examples of care plans that required more detail, for example wound care. The provider was responsive to all feedback raised during and after on-site visits. They took appropriate action and put plans in place to quickly resolve the concerns highlighted.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from people and their relatives. Some people and relatives told us staff responded promptly to any issues raised. One person said, “Yes, I fell between the bed and the wall and was jammed there, then the mattress fell on top of me. I think I was there about three-quarters of an hour before I managed to move and ring the call bell. They did come quickly. They moved the bed and have put the brakes on. I feel safe in bed now.” A relative told us, “My relative did once fall out of bed but now has pressure mat on the floor next to the bed.” However, we were also told, “We raised concerns with a senior manager two months ago and still have not had a response” and “No point in raising anything, I’ve tried and not felt listened to.”

Staff told us they had received training in communication, documentation and reporting, and safeguarding which had been underpinned by organisational policies and procedures. Staff told us they would not hesitate to raise concerns if they saw unsafe care or had concerns. Staff completed accident and incident forms with details and immediate actions taken but these were not all supported by an action plan to prevent a further occurrence. One staff member when asked about a person’s three skin tears, said “Well they are not all that recent.” However, the person was on continuous bedrest and was not mobile so when asked how they might have occurred the staff member had no thoughts and did not seem to think it was unusual. There was no evidence that the cause of the skin tear had not been explored. One skin tear had deteriorated in to a wound which needed further treatment.

The management team had an overview of all incidents, accidents and near misses on their computerised care system. Whilst these were reviewed there was no evidence of the actions taken or advice sought. The manager completes a monthly quality and governance tool, which includes the number of accidents and incidents. The completed one for the month of April 2024 showed 29 accidents and 19 incidents. The focus of the quality tool did not mention or identify a need to reflect on the 29 accidents to direct learning and reduce accidents and incidents. Complaints and safeguarding were entered into a log and a file kept. However, these were incomplete and lacked actions taken and lessons learnt. Following discussion during the assessment process, the management acted immediately and introduced new forms to evidence lessons learned. For example, the safeguarding log will focus on individual outcomes and lessons lesson learnt to continuously improve. Accidents and incidents will be more robustly reviewed and discussed at daily meetings. The deputy manager and unit managers will use the clinical governance meetings as a forum to analyse trends, track incidents and make adjustments to care if required to reduce risk. This will also include decisions on whether to report to the local authority.

One person told us, “I was seen in hospital before I came here, they asked me a lot of questions, I appreciated it.” A relative told us, “They were very kind, we visited first and then they took details to make sure they could support (my relative), we have no complaints.” Some people told us how they were supported to access health and social care services when needed, and this was reflected in peoples care notes. A person told us, “I can see a GP, Chiropodist and Hairdresser.” Another person told us, “Anything I need can be arranged; staff know me well.”

The management team told us how they assessed people before they moved into the home to ensure their needs could be met safely. The manager said, “We do a very thorough assessment before anyone comes to live here, we need to know we can support them. We also like them and their families to choose their room, that’s important.” Staff we spoke with were knowledgeable about people’s needs.

Staff worked in partnership with other agencies such as nurses, local authority, social workers, and podiatrists. A healthcare professional told us, “I have found them professional and knowledgeable when enquiring.” Another healthcare professional told us, “Really good service I think, they are always polite and professional. They know their residents well. I have never noticed a lack of staff. We offer support and they are happy to accept.”

Assessments of people’s needs took place before they moved into the home to ensure their care needs could be met. This included ensuring the room the person was due to move into or return to remained suitable. People's care records showed referrals were made to healthcare professionals where concerns had been identified. For example, where there were concerns about a person’s dietary intake or mental health, referrals had been made to appropriate professionals. Records showed staff followed recommendations made. Feedback from healthcare professionals confirmed that staff worked well with them and followed their advice. Feedback consisted of, “When we come across any issues such as wounds or dermatological issues, we provide feedback to the home, and they act on this accordingly” and ”I see good collaborative professional interactions between the wider multi-disciplinary team (MDT) and with the families.” The management team worked to ensure continuity of care, including when people moved out of the service and on to new placements. When people were supported to go to hospital, either through routine and planned admission, emergency admission or consultation day visit, an ‘emergency pack’ on their computerised care plan would be generated to accompany them. The emergency pack contains all important information to assist hospital/care staff important information about them and their health when they go to hospital or to a different care home.

People we spoke with said they felt safe. People told us, “Very happy here, no complaints, not at all. I feel quite safe, no sign of any form of abuse ever”, “Yes, I do feel safe due to the staff and their care” and “I feel very safe, no reason to not feel safe here.” One relative told us, “They feel [relative] is safe and wouldn’t let her stay here if they thought she was being abused.”

Staff were aware of the signs of abuse and how to report safeguarding concerns. Staff confirmed that they had read the policies as part of their induction and refreshed at subsequent safeguarding training. They were confident the management team would address any concerns regarding people’s safety and wellbeing and make the required referrals to the local authority. Staff had a good knowledge of whistleblowing procedures and would use them if they felt their concerns had been ignored. One staff member said, “Definitely a safe environment here, any safeguarding concerns I would go straight to the trained nurse. I have never witnessed any abuse, but I would confront it and report it.” Another staff member told us, “Good teamwork here, Safeguarding is good with continuity of care promoting safeguarding.”

During the inspection we observed staff engaging positively with people. There was a calm and relaxed atmosphere on Orchard, Beech, and Holly units. However, on Willow unit a person was calling “Help.” Staff did not respond immediately. The rooms including bedrooms were generally a good size and light. However, the position of call bells, especially for people that were bed-bound, were out of reach.

Safeguarding incidents were reported to the relevant organisations, including the local authority and the Care Quality Commission. There was an organisational safeguarding and whistleblowing policy which set out the types of abuse, how to raise concerns and when to refer to the local authority. This was supported by safeguarding training and guidance from the local authority. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. Any conditions related to DoLS authorisations were being met. Care records showed how consent from people had been obtained and/or their capacity to make a decision assessed. Where necessary a DoLS application was completed if a person lacked capacity to make a decision about a specific restriction. For example, DoLS applications were in place for people who required one-to-one support to keep them safe.

Some people and their relatives told us told us staff supported them to manage risks and stay safe. A person told us, “I have been in here for 3 years, I feel very safe. The environment and staff are all very good. I have a safety mat in my room. Very attentive staff.” A relative told us, “She has fallen out of bed twice. So now she has a low bed and a pressure mat but yesterday when I came in the mat was not even plugged in.” Some people were at risk of falls, and they told us how they were supported to stay safe. One person said, “I have a Lifeline watch if I fall out of bed.” Another told us, “Staff look after me well, but I can fall over so not always safe.”

Staff were able to tell us about people and the risks associated with their care. They told us how they supported them safely. This included pressure area management, mobility and when people may become distressed. However, we also found people who had had recurrent falls and skin tears over a period of 3 months with minimal information recorded. When discussed with staff there was a lack of professional curiosity. Staff told us, “We read care plans and risk assessments. We are good at responding to risk. We pick up when people are not themselves. We also check peoples’ skin daily.” We discussed with staff, certain people who they were supporting regarding hand coverings, bruising and pain management. Staff said, “We didn’t see that [bruising], but someone will have noted it.” On speaking with care staff, it had not been documented. There was a lack of pain monitoring. Staff were not able to tell us how they identified people’s pain or discomfort.

Throughout the inspection staff responded to call bells promptly. However, the units were very different over the 3 site visits. Orchard unit had a calm, happy atmosphere. Staff treated people with kindness and respect. From observations people in communal areas of Holly received timely care. However, we could not evidence that those in their rooms on bedrest received the care and support they needed. One person’s position was not changed as per their care plan. The hand supports were grubby and not in the correct position for their purpose. Another person was halfway out of bed, and we had to ask staff to attend to them as the sensor mat had not alerted staff they were on the move. Some people’s fluids were not refreshed. We could not see from fluid charts if people had sufficient fluids.

The records for wound management did not follow NICE (The National Institute for Health and Care Excellence) good practice guidance. There was minimal recorded information regarding the status of wounds. Protocols were not consistently followed regarding wound photographs. During the assessment process, new documentation and an information folder for wounds was introduced to support nurses in the recording of wounds and provide the management team an overview of wounds progress. Further training for nurses in respect of wound care has been sourced. Risk management for people at risk of falls was in place. Staff reviewed risk assessments monthly and put actions in place to reduce these risks but did not revisit to see if the action had mitigated risk. The overview of falls was monitored and audited, however there was no record of preventative actions for those who have multiple falls. The management of behaviours that may distress did not reflect strategies to manage and evaluate these. There were people on one-to-one staff support that had a list of incidents but no reflection of how it was managed, what worked well and what didn’t. The care plans had not been updated to reflect the deterioration of the person and the increase in behaviours that distress.

People and their relatives told us the environment was safe. Comments included, “All the equipment is kept clean and always work” and “I’ve not any concerns about the safety of building, only thing would be access to a call bell. It’s not always near my [relative].” Another person told us, “I think is well maintained. No complaints. There was an issue with the lift on Holly, but this was dealt with.”

Staff were aware of safety procedures and their responsibilities around maintenance and health and safety in the home. Staff explained that there was a fire marshal on every unit on every shift. This was confirmed by the duty rota. Staff we spoke with were able to tell us what they did on hearing a fire alarm and how they would support people. The training matrix also evidenced fire evacuation training. Staff told us that any maintenance issues were reported and dealt with.

The environment was safe and well cared for. We observed care equipment that was in good working order. There was no clutter, and the home was accessible for people with mobility needs. The corridors were wide, and people’s names or items of reference were on most people’s doors which helped them to orientate themselves in the home. We identified a few issues with the placement of a ski vac. This was immediately addressed by staff.

Detailed fire risk assessments, which covered all areas in the home, were in place. People had Personal Emergency Evacuation Plans (PEEPs) to ensure they were supported in the event of a fire. These were specific to people and their needs. Premises risk assessments and health and safety assessments were reviewed on an annual basis. This included gas, electrical safety, legionella, and fire equipment. Risk assessments included contingency plans in the event of a major incident such as fire, power loss or flood. The registered manager ensured health and safety and maintenance checks were regularly completed and appropriate certification was in place. The provider had a business continuity plan which provided guidance on contingency plans in case of various emergencies and untoward events that could affect the service.

People and their relatives gave us mixed feedback from about staff. Some felt there were enough staff to keep people safe. A person told us "Very good staff, friendly. They show an interest in you as a person, asking after you. There are enough staff." A relative told us "We feel that [person] is kept very safe here. Seems to be enough staff when we visit weekly.” However other people and their relatives told us more staff were needed. Comments included, “A bit short at weekends. Seems a lot of agency staff used”, “Sometimes seem short of staff, but mostly ok. Don’t wait too long for help”, “Plenty of staff when I visit but I do feel less agency would be better but I know it can be difficult” and “Enough staff, answer the bell quickly.” This was fed back to the provider to address.

Staff told us there were enough adequately trained staff to provide care to people. Staffing levels were based on the dependency levels of people using the service. One staff member said, “We feedback if people’s needs change, because it might mean we need more staff or additional training.” The manager explained they review training against people’s needs. Staff receive a full training programme. Staff would like more face to face and that was being arranged. Staff confirmed they received regular supervisions and appraisals. Staff felt they worked well as a team and were supportive of each other.

The Short Observational Framework for Inspection (SOFI) showed us that staff were visible and available to support people’s requests for help and take the time to sit with people and attend to their emotional wellbeing. Staff on one-to-one support sat with the person they were supporting and interacted with them with pictures and books or walked with them. Our observations showed there were enough staff to meet the needs of people who used the service at this time. People received timely care, and call bells were answered promptly. Communal lounges were supervised at all times.

Systems and processes were in place to ensure sufficient staffing levels, safe recruitment of staff and appropriate levels of training for staff. The provider regularly monitored staff training records to ensure they were up-to-date. People's changing needs were considered when deciding on the appropriate ratio of staff. There were processes in place to ensure staff receive the support they need to deliver safe care. This included supervision, appraisal, and support. We reviewed 4 months of rotas. Staffing levels were consistent on all units. Rotas identified training sessions, for example fire marshal training. We reviewed 6 staff recruitment files and there was continued evidence of robust recruitment procedures. All potential staff were required to complete an application form and attend an interview, so their knowledge, skills and values could be assessed. The provider continued to undertake checks on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining at least two references from previous employers and Disclosure and Barring Service (DBS) checks. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people. Registered nurses have a unique registration code called a PIN. This tells the provider that they are fit to practice as nurses. Before employment, checks were made to ensure the PIN was current with no restrictions. Agency staff all had a folder with checks completed by the agency provider. These contained details of training and the induction completed on their first day of working at Hailsham House. However, there was no record of where the agency was deployed and not all agencies wore a name badge. This made it difficult for the manager to investigate complaints.

People and their families told us staff kept the care home clean and odour free. Comments included, “It’s clean and smells fresh. No complaints about the housekeeping staff. [They] work hard and it shows” ,“very clean and tidy” and “I have a nice room. It is kept clean and tidy.”

Staff aware of their responsibilities in relation to infection prevention and control. Staff told us, “We all do infection control training and food safety training" and "We have to do training and we get updates on infection control measures and guidance."

The home appeared clean and there were not any overpowering smells. The home was well maintained. There were infection prevention and control stations around the premises. Hand gel and hand wash easily accessible. We saw staff use personal protective equipment (PPE) effectively and safely.

There were organisational infection control policies and procedures for staff to follow. Cleaning schedules were in place to guide staff on maintaining the cleanliness of the care home. The provider followed current best practice guidelines regarding the prevention and control of infection. Policies and procedures were up to date. There were systems in place that ensured the safe disposal of medical and domestic waste.

People’s medicines were managed and administered safely, and our observations confirmed this. A person told us, “I get my medication regularly. I missed one last week.” Another person told us, “My medication has to be given regularly and on time, staff always update me of any changes.”

Nurses and senior care staff, known as medicine givers, had received appropriate training and competency assessments. We observed staff on the medication rounds were wearing the ‘do not disturb medication apron.’ All medicine givers wear red tabards and ask that they are not disturbed. Staff gave medicines safely. We observed staff take the trolley and dispense medicines individually. Staff asked the person first if they were ready for their medicines. Staff gave the medicine and waited for the person to take it before completing people’s electronic medication administration records (EMaR).

Medicines were stored, administered, and disposed of safely. People's electronic medication administration records (EMaR) confirmed people received their medicines as required. The system alerts staff immediately if a medication is late or missed. Staff told us this system had reduced medicine errors. We saw medicines remained stored securely when being given out, medicine givers ensured the trolley was locked. Medicines prescribed on an 'as and when required' basis (PRN) had protocols which informed staff of when the medicines were required, for example, pain relief. These were generic and there was work being undertaken to ensure these are person specific and related to the reason prescribed. This will include end of life medication. Not everyone had a management of pain care plan and there was inconsistent use of pain assessment charts. During the assessment process, the manager immediately implemented a new form to complete care plan. A new folder was created with up-to-date information, with examples for the nurses to reflect on recording. End of life training was provided immediately, and further training booked.