Archived: Hazeldene House Residential Home

At our last inspection on 17 July 2014 we found all regulations were being met and no concerns were identified.

A registered manager was in post. 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.

People were happy, comfortable and relaxed with staff and said they felt safe. They received care and support from staff who were appropriately trained, competent and confident to meet their individual needs. People were able to access health, social and medical care, as required.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were opportunities for additional staff training specific to people’s needs, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

Up to date policies and procedures were in place to assist staff on how keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Thorough 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.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff demonstrated a sound understanding of the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

Quality assurance audits and a formal complaints process were in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

Below is a summary of what we found.

Is the service safe?

We found that accurate and appropriate records were maintained that helped to ensure people were protected from the risks of unsafe or inappropriate care.

Is the service effective?

Consent was mostly obtained for people's care and appropriate arrangements were in place if people could not consent for themselves, for example due to dementia.

Is the service caring?

People told us they were happy with the care they received at the service. One person said, "I think it's much better here now. Nicer. The staff are great.' We observed staff providing people's care were positive and encouraging in their approach and they gave people options and choices as they provided their care.

Is the service responsive?

The provider had made changes since our last inspection to ensure the service met people's needs.

Is the service well-led?

The registered manager was ensuring that relevant information and events were notified to the CQC.

We had identified concerns in relation to the systems that were in place to support people to have adequate nutritional intake. We also found that the systems that were in place to monitor the quality of service provision were in need of further development.

This inspection was to follow up on these areas of concern to make sure the provider was now meeting the required standards of quality and safety. We were pleased to find considerable improvements had been made in most areas of service provision although some minor concerns remain.

We used a number of different methods to help us understand the experiences of the twelve people using the service, because some had complex needs which meant they were not able to tell us their experiences. We did however speak with eight people who used the service and two of their relatives. We also spoke with the provider, acting manager, the chef and three care staff.

We looked at documents held at the service which included care files and medication records. We observed the support people received from care staff and also carried out an inspection of the building, which included people's bedrooms and the home's communal areas.

People expressed very positive comments about the quality of the service they received. One person said, 'I'm looked after very well here. I get everything I need.'

Relatives of people residing at the home also expressed satisfaction with the quality of service provision. They told us, 'The staff treat all the residents very well. They understand Mum's needs and can identify when mum is not well. They call the GP in if needed and that's one of the main reasons why I would like mum to stay there, she's safe.'

We found that carer workers always asked for people's consent prior to performing interactions, and all observed interactions were unrushed, respectful and took into account peoples individual abilities and preferences.

We found the provider had ensured that people were provided with a choice of suitable and nutritious food and drink in sufficient quantities to meet their individual needs and preferences. One person told us, 'The food is good and you get a hot meal at lunchtime.' Another person said, 'You can't complain about the food. I think it's very good.'

We found that the home was maintained to a good standard of hygiene and d'cor. One person told us, 'It's always clean as a pin,' another person said, 'I really like my room it's always nice and clean.'

We found that appropriate arrangements were in place in relation to the management of medicines.

The provider had developed an effective system to assess and monitor the quality of service that people received and people using the service were encouraged to contribute to this process.

People's views had not always been taken into consideration when determining their resuscitation status. We also established that events that affected the health, safety and welfare of people using the service had not always been reported to Care Quality Commission (CQC) as required.

Whilst we found that the quality of record keeping had improved significantly since our last inspection, we found that further developments were required to ensure accurate and appropriate records were maintained in all instances.

At our last visit in April 2013 we found continued non- compliance in a range of areas. The provider had submitted action plans informing us how they were going to improve the service. The purpose of this visit was to assess if sufficient improvements had made to the care provided at Hazeldene House. Although we found some improvements in areas such as staff recruitment, training and medicines management, we found concerns in a number of standards.

The provider did not have suitable arrangements in place to ensure that people were consulted about their care and their rights were protected under the Mental Capacity Act and Deprivation of Liberty safeguards. None of the people we spoke with could recall giving consent to care and treatment, but they all told us they were happy with the care and treatment being provided. Where people did have the capacity to make their own decisions these were offered.

We found that care was not always planned and delivered to meet people's needs, and that care plans were not all in place as required. This meant that risks to people's health and welfare were not always being managed, including in relation to maintaining a healthy weight. Care records were not always accurate or up to date.

The home and grounds were sufficiently well maintained to ensure that people lived in an environment that promoted their wellbeing. We observed bedrooms that were clean, tidy and recently decorated, with personal belongings on display. People told us they liked their rooms. However, we found concerns with the way people were protected from the risks of infection.

While people were receiving prescribed medicines when they needed them, staff did not always administer or handle medications in the correct manner.

All registered providers have a legal duty to report to the Care Quality Commission, without delay, any significant incidents resulting in harm to a person using the service. We found the provider had not been doing this.

Overall, the provider did not have proper systems in place to monitor the quality of the service and ensure that any risks to people using the service were identified and reduced.

The two people we spoke with were satisfied with the care they received; they told us the staff were, 'Friendly and helpful'. However we found that the provider was still not meeting a number of essential standards of quality and safety.

People's care plans were not always sufficiently detailed and we observed unsafe medication practices as staff did not ensure people took their medicines and some medicines were out of stock.

Actions have been taken to improve safety standards at the home. Works are complete to ensure the home meets fire safety regulations. However, people living at the home and staff employed there were not sufficiently protected against the risk of infection.

The provider did not have proper staff recruitment procedures in place. Some staff had commenced work without all required checks having been carried out. Not all staff had received suitable training, and the provider did not have effective systems in place to monitor the quality of the service.

We spoke with two relatives during our visit, they were satisfied with the care people in the home received. Whilst positive feedback was received from the relatives we spoke with, during our visit we found a range of concerns in the home.

We found care records and risk assessments were missing or insufficiently detailed to ensure staff knew what care to provide to people. We found that people were not always receiving safe and effective care. They were not adequately supported to eat and drink, and their medicines were not properly managed.

The fire officers found the home did not meet fire safety regulations. They are taking action to address this. The provider has failed to monitor the quality of the service and widespread serious failings were evident.

We spoke to the deputy manager and two staff during our visit. We found that there had been improvements made to the system for recording and monitoring training. One staff member told us an increased level of training was being arranged and delivered.

Whilst some training had been completed we found there were still deficits, for example in relation to training in the Mental Capacity Act 2005 (MCA) and caring for people with diabetes.