Hazelwell Lodge

We found the following examples of good practice.

Most people at the home were living with dementia and were unable to talk with us about their care. However, people were observed to be comfortable, relaxed and interacting freely with staff. One person spoken with said they had, “no complaints”, with another stating it is “quite pleasant and staff are quite nice.”

Risks of infection to people were minimised because staff had received appropriate training and were observed to be following good infection prevention and control practices.

The building is divided into three areas, The Bay, The Lilies and The Orchids. Isolation and zoning within these areas had been used to manage the risk of infection spreading.

Measures were in place to prevent the spread of infection by visitors to the service. All visitors, including people’s relatives, were required to have a negative COVID-19 lateral flow test prior to entering the home, as well as temperature checks completed.

The home had been following government guidelines to ensure people could stay in touch with friends and family. They had enabled window visits, and also had a visitors room available which was accessible without entering the home. Video calls were also used to help people stay connected.

New admissions were safely managed, following the current guidance.

The premises were clean and odour free. Enhanced cleaning and disinfection of all areas of the home continued in order to reduce the risk of cross contamination.

A regular programme of testing for COVID-19 was in place for staff and people who lived in the home.

There was a good supply of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser available. Used PPE was disposed of safely.

Hazelwell Lodge is a residential care home registered to provide personal care and accommodation to up to 50 people. The home specialises in the care of people living with dementia. At the time of the inspection 36 people were living at the home.

The building is divided into three areas, The Bay, The Lilies and The Orchids but people are able to move around all areas of the home.

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

People lived in a safe environment which had been adapted to meet the needs of people living with dementia. There was space for people to move around freely, including outside space, and objects for people to interact with. Risk assessments were completed to promote people’s well being and safety.

People received care and support from well trained staff who had the skills and experience to meet their specialist needs. People’s mental and physical healthcare needs were monitored, and they had access to professionals outside the home.

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.

People were cared for by a stable and caring staff team who treated them as individuals and were respectful of their wishes and preferences. People and their representatives were involved in planning their care as far as they were able. People made choices on a day to day basis.

People had comprehensive care plans which ensured staff had information about their needs and wishes even if they were unable to fully express themselves. This helped to make sure staff provided care and support in a way that respected people’s personalities and preferences.

People were able to have visitors at anytime to help them to keep in touch with friends and family. Visitors told us they were always made welcome and staff communicated well with them.

People benefitted from a clear management structure who kept up to date with good practice and legislation. This helped to make sure people received a high standard of care and support. The management of the home was open and approachable and constantly looked at ways to make improvements to people’s care and support.

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

Rating at last inspection

The last rating for this service was good (Published 15 July 2017.)

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.

At the last inspection in October 2015, the service was rated Good.

At this inspection we found the service remained Good.

This inspection was bought forward due to a high number of safeguarding notifications received from the provider. We therefore wanted to check people were safe and comfortable at the home.

People at the home were living with dementia and some were unable to fully express their views or wishes verbally. During the inspection people looked relaxed and comfortable in their environment. There was good engagement between staff and people and all incidences of people becoming upset or unsettled were responded to promptly.

Staff were able to recognise the signs of abuse and knew how to report concerns. The registered manager and provider worked in partnership with other agencies to make sure all concerns were fully investigated and action was taken to keep people safe.

People had care plans which outlined their abilities and the things they required support with. Care plans relating to people’s behaviour which may impact on other people were clear and staff were following the guidelines in these. We found that some improvements could be made to make sure care plans supported staff to be pro- active in monitoring and recording people’s physical healthcare needs.

Staff were well trained in meeting people’s specialist dementia care needs. The registered manager was experienced and knowledgeable about current practice for people living with dementia. They provided on-going formal and informal training for staff to make sure people benefitted from their knowledge.

People were cared for by staff who were kind and patient. Staff knew people well and used different approaches with different people according to their personalities and likes. There was a warm and happy atmosphere with lots of laughter and good humoured banter. One person told us, “Staff are very patient, they help you and never find fault.” A visiting relative said they found all the staff to be “Helpful and kind.”

People received care that was responsive to their changing needs and took account of their individuality. People were encouraged to maintain their independence where possible and make choices about their day to day lives. One person said “They don’t do everything for you. I can still do lots of things even if I am nearly 100.” The staff sought advice from healthcare professionals if they had concerns about a person’s well-being.

The registered manager and provider continually monitored the quality of care, the building and equipment to make sure the service remained safe and comfortable for people, staff and visitors. Where shortfalls in the service were identified, action was taken to make sure improvements were made.

Below is a summary of what we found. It is based on our observations during the inspection, discussions with people living at the home, and with the staff supporting them, and on looking at records.

Is the service safe?

People told us they felt safe. We saw that staff treated people with respect. Safeguarding procedures were in place, and staff knew how to recognise abuse. Arrangements were in place to make sure that the registered manager and staff learnt from incidents and investigations. Safeguarding incidents were reported to the appropriate authorities.

Medicines administration needed to be improved, but the registered manager was clear about what needed to be done, and had communicated that to staff.

People who lived in the home were only deprived of their liberty when this had been authorised by a Supervisory Body under the Deprivation of Liberty Safeguards. This meant that the provider only restricted people's liberty if they needed to be kept safe and did not have capacity to make decisions.

There were enough staff on duty to keep people safe.

Food was prepared and served following recognised safety procedures.

Is the service effective?

The service provided care in line with people's individual needs. This was recorded in care plans. The service specialised in caring for people with dementia, and all staff were trained in this aspect of care.

The philosophy of the home was one that encouraged a relaxed atmosphere for people with dementia. It took account of recent developments and guidance in dementia and end of life care.

The quality of care was monitored to make sure that it was effective. Where shortcomings were identified, measures were put in place so that improvements could be made.

Is the service caring?

People were supported by caring staff. A relative told us, 'I can't sing their praises enough.' We saw staff speaking to people in a kind and considerate way. One person told us, 'I consider I'm very lucky to be here.'

Staff were trained to understand people's needs. One staff member told us, 'I really enjoy working here. The atmosphere is different; there is team cohesion. Everyone works well together'.

People's wishes were recorded in care plans, and support was provided in accordance with them.

Is the service responsive?

We saw that staff listened to what people wanted, and gave them time to make their wishes known. Several staff told us about the importance of giving people choice, one saying, 'You never make assumptions (about what people want).'

The service responded to people's changing needs. When people were unwell or they needed specialist assessment, the provider asked community professionals to undertake assessments.

Nutritious food was always available, and the service responded as people's dietary needs changed. For example, high quality fruit smoothies were available to supplement regular meals.

There were relatives' meetings that were introduced after people asked for them, showing that the service listened and made changes.

Is the service well-led?

The service had a system of regular quality assurance that monitored care and showed where it could be improved.

The registered manager was experienced in dementia care and had introduced a number of initiatives to improve people's experience of care.

Staff understood their roles and responsibilities. There were clear lines of accountability and staff knew what to do if they had concerns.

People who lived at the home said that they were never made to do anything they did not wish to do. One person said 'The girls do their best to please you. They help you with the things you ask them to but they don't make you do anything.'

Everyone who lived at the home appeared comfortable and relaxed with the staff who supported them. People told us they felt well cared for and received the help that they needed. One person said 'They care about me and help me with everything.'

People we spoke with said the home supported them if they were unwell and ensured they were seen by appropriate professionals. One person said 'If you aren't well they take you to the doctor or get them to come here. They stay with you and so it's never frightening and you don't have to remember what they say. The girls have become my memory and that really helps.'

There was a robust recruitment process which ensured that new staff had the relevant skills and were of good character.

There were systems in place to effectively monitor the quality of care and to identify and minimise risks to people.

People told us that they were able to make choices about their day to day lives. One person said 'You can do what you like really; the staff aren't strict about anything.' Another person told us 'I have a routine that suits me fine and keeps me independent.'

People were happy with the care and support they received at Hazelwell Lodge. Comments included; 'Staff are good and I am well cared for' and 'Everything is brilliant.'

We saw people who were unable to express their views appeared relaxed and content. People appeared very comfortable and all were well dressed and clean which demonstrated that staff took time to assist people with their personal care needs.

People we spoke with were complimentary about the staff who supported them. Comments included; 'The staff are lovely,' 'Most staff go out of their way to please you and make sure you are happy' and 'Staff are always helpful.'

No one we spoke with had any complaints about their care. People who were able to express an opinion said that they would be comfortable to speak with a member of staff if they were unhappy about the service they received. A visitor told us that in the past they had raised a minor issue and were happy with the action that was taken.