Hazeldene House

Hazeldene House is a residential care home providing accommodation and personal and nursng care for up to 75 people. The service provides support to people with complex nursing needs and those living with dementia. At the time of our inspection there were 35 people using the service.

Hazeldene House is also a domiciliary care service, providing personal care to people living in their own homes. These people live on the same premises and have a separate tenancy agreement for their accommodation. This service provides support to people with complex nursing needs and those living with dementia. At the time of our inspection 41 people were using the domiciliary care service. Everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. The accommodation is arranged across three floors with lift access to all levels.

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

People told us they felt safe and were happy living in Hazeldene House. One person said, “The staff are excellent in every way.” Relatives agreed their loved ones were safe and happy. One said, “[Relative] loves the staff and they let me know if they have any concerns.” Another relative said, “[Relative] looks well, the room is spotless, and clothes are tidy; they seem very happy here.”

People received safe care and treatment from staff who knew them well. Medicines and infection control were both managed safely, and lessons were learned when things went wrong.

People were involved in decisions about their care and they received care which promoted their dignity and encouraged independence. Relatives told us they were involved in their relative’s care plans and were always kept up to date with any changes. One relative told us, “They always notify us of any incident however trivial.” Another relative said, “They contact me if anything happens, even at three in the morning.”

People enjoyed the food and their dietary needs and preferences were met, for example food intolerances such as lactose. People were offered a choice of meals, but there was always something else available if they didn’t like what was on offer. Relatives described the food as ‘excellent’ and ‘fantastic’. One relative told us their loved one had a food intolerance but said, “[Relative’s] never had a problem there.”

Effective quality assurance processes were in place to monitor the service and regular audits were undertaken. Staff had received appropriate training. At the time of our inspection the manager had recently left. A deputy manager was providing management oversight; staff found them supportive and approachable.

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.

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 10 July 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 25 and 26 April 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective, responsive and well led. 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 changed from requires improvement to good. This is based on the findings at this inspection.

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

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.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hazeldene House is a domiciliary care service and a care home. A domiciliary care agency provides personal care to people living in their own homes. Under this arrangement people's care and housing are provided under separate contractual agreements .

Hazeldene House is registered to provide accommodation, nursing and personal care for 75 people. It can accommodate older people and people who live with dementia. It can also provide care for people who need support to maintain their mental health and/or who have physical adaptive needs .

There were 62 people living in the service at the time of our inspection. 52 people who were living in the service at the time of our inspection had rented their accommodation in Hazeldene House. All these people received their nursing and personal care from members of staff employed by Hazeldene House Limited who was the registered provider .

Ten people received both their accommodation and care as part of a single package that was also delivered by the registered provider. Each person who lived in the service had their own bedroom with a private bathroom.

People’s experience of using this service:

People told us that they feel that Hazeldene House is in a "much better" place. People and relatives felt they were being listened too and were confident any concerns would be addressed.

Some people did not receive safe care and treatment in line with national guidance from nurses and care staff.

Staff had not always received or had kept up to date with training needed to support people's needs.

There were enough nurses and care staff on duty to meet people’s needs.

Medicine administration was not always recorded correctly. We made a recommendation about this.

People were safeguarded from the risk of abuse.

Lessons had been learnt when things had gone wrong. Falls within the service had reduced.

People and their relatives were consulted about the care provided and their consent had been obtained.

Nurses and care staff were courteous and polite and confidential information was kept private.

Equality and diversity was promoted and people were supported to pursue their hobbies and interests.

There were robust arrangements to manage complaints.

People were treated with compassion at the end of their lives and supported to have a pain-free death.

People and their relatives had been consulted about the development of the service and quality checks had been completed.

The service met the standard of Good in Caring and Requires Improvement in all other areas. There were two breaches of regulation.

Rating at last inspection:

At the previous inspection (published on 2 January 2019) the service was rated as Inadequate and placed into special measures.

Why we inspected:

This was a planned inspection based on the previous rating. At the time of this inspection we were aware of incidents that were still being investigated by third parties.

Follow up:

The overall rating for this service is Requires Improvement. This means we will keep the service under review and we will re-inspect within 12 months to check for improvements.

This service has been in Special Measures. Services that are in special measure are kept under review and inspected again within six months. We expect services to make significant improvements within this time frame. During this inspection, the service demonstrated to us that improvements had been made an is no longer an inadequate service overall or in any of the key questions. Therefore, the service is now out of Special Measures.

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

Hazeldene House is registered as a domiciliary care service and a care home. A domiciliary care agency provides personal care to people living in their own homes. Under this arrangement people's care and housing are provided under separate contractual agreements. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. In this case the Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Hazeldene House is registered to provide nursing, personal care and accommodation for up to 75 people, and at the time of the inspection there were 74 people living there. Most people were receiving personal care from staff and had rented their accommodation within Hazeldene House. They also received support from nurses who were employed by the registered provider under a separate agreement. Ten people received both accommodation and care as part of one agreement. The service provided support to older people with dementia. It was arranged over three floors, with each floor having its own communal lounge area.

The service had a registered manager. 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.

Action was not always taken to protect people from risks once they had been identified. Risk management strategies were not always being followed by staff. There was insufficient guidance provided to staff in order to manage the risks. There were not always enough staff available to meet the needs of people at the service. This had an impact on the safety of people living at the service. People were not being protected from abuse. The registered manager had not followed up on all safeguarding concerns reported to them. The registered manager had failed to notify us of a notifiable event in a timely manner.

Some staff were not always able to communicate with people or their relatives in a way they could understand, because the staff did not always understand spoken English. We made a recommendation about this. We saw more positive interactions between other staff and people. People were encouraged to take part in the reviews of their care and relatives had access to up-to-date information about how people were being supported. However, the registered provider was not always providing information to people in a way they could understand. We have made a recommendation about this. People were supported to be independent.

People’s needs were assessed but their care was not always delivered in line with current legislation. When the service was responsible, people were supported to eat and drink enough to maintain a balanced diet. Appropriate referrals were made to health professionals such as speech and language teams. However, staff were not always following guidance when it had been provided. Staff received training which ensured they had the skills and knowledge to deliver effective care. 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.

People received their medicines safely. People were protected by the prevention and control of infection. The service was clean and smelt fresh.

People received care that was responsive to their needs. Relatives told us they knew how to complain, and would be happy to do so if they had any issues or concerns. However, complaints were not always treated as such, and we made a recommendation about this. There was nobody receiving end of life care at the time of the inspection, but staff knew how to support people if they needed to in order for people to have a pain free and dignified death. People, their families and staff were encouraged to be involved with the service. There were links with the local community, including the Alzheimer’s Society and the local hospice.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two breaches of Care Quality Commission (Registration) Regulations 2009. Full information about the Care Quality Commission's regulatory response will be added to the report after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There were 77 people living in the home at the time of our inspection, 76 of whom lived with dementia. Not all of the people living in the service were able to express themselves verbally and communicate with us.

This inspection was carried out on 19 and 21 January 2016 by two inspectors and an expert by experience. It was an unannounced inspection.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. There were thorough recruitment procedures in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

People’s care suites were respected by staff as being their private quarters and these were personalised to reflect people’s individual tastes and personalities.

Staff knew each person well and understood how to meet their support and communication needs. The premises were well maintained and suited people’s needs.

Staff had received essential training and were scheduled for refresher courses. New recruits did not work on their own until they were able to demonstrate the relevant competence. Staff had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions and were scheduled for an annual appraisal. This ensured they were supported to work to the expected standards.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005 requirements. Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed when necessary about particular decisions and meetings were held with appropriate parties to make decisions in people’s best interest.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

Staff communicated effectively with people, responded to their needs promptly, and treated them with kindness and respect. People told us they were very satisfied about how their care and treatment was delivered.

People were involved in their day to day care. People’s individual assessments and care plans were reviewed monthly with them or their legal representatives and updated when their needs changed. Relatives were invited to attend reviews that were scheduled.

Clear information about the service, the facilities, and how to complain was provided to people and visitors.

People were able to spend private time in quiet areas when they chose to. People’s privacy was respected and people were assisted in a way that respected their dignity.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People were involved in the planning of activities that responded to their individual needs. People’s feedback was actively sought, encouraged and acted on.

Staff told us they felt valued by the registered manager and the management team. The registered manager was open and transparent in their approach. Emphasis was placed on continuous improvement of the service.

A relatives described the management of the service as “Really efficient.” The registered manager kept up to date with any changes in legislation that might affect the service and comprehensive audits were carried out regularly to identify how the service could improve. They acted on the results of these audits and made necessary changes to improve the quality of the service and care.

We spoke with 18 people that used the service and three visitors to the service. We also received six completed comment cards. People told us they were happy with the care provided and felt that their needs were met. We found that people had their needs fully assessed and planned for and they were involved in the planning of their care. Staff knew people well and knew how to meet their needs. We saw that staff provided the care people's plans said they needed and did so in a way that promoted their independence and rights. One person using the service told us 'This is a lovely home, I have no complaints'. We saw that staff were responsive to people's needs and people were treated with dignity and respect.

we found that the service worked effectively with other health and social care providers to ensure that people's needs were met. People were supported to access the services they needed.

The provider had effective systems in place for monitoring the quality of the service provided to people with dementia. Risks were assessed and managed and people's views were taken into account in the ongoing improvement of the service.

We used a number of different methods to help us understand the experiences of people using the service, because people had complex needs which meant they were not able to tell us their experiences. We observed how people spent their time during the day, how staff met their needs and how people communicated and interacted with staff. The registered manager was not on duty during the inspection so we telephoned them shortly afterwards to check on some information and give feedback on the inspection.

We observed that people were given choices about what to do, what to eat and where to spend their time each day. Their preferences and care and support needs were recorded on their care plans which were kept up to date.

People were comfortable in the presence of staff and staff demonstrated a good understanding of people's individual needs. Staff respected that people needed to retain their independence as far as was possible.

Relatives who were visiting told us they were satisfied with the service. A relative said they were 'very happy with the home' and another that their relative was happy living there.

The provider had effective systems in place to regularly assess and monitor the quality of the service. This included asking people and their representatives for their views about it.