Hazelwood Gardens Nursing Home

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

There had been improvements following the inspection of 20 March 2019. We observed medicines as they were being administered to people at lunchtime. The medicines trolley was not found to be left unattended and was kept locked. A medicines fridge with cool storage was now in place. People’s medicine administration records (MARs) were fully signed with no gaps found. They had all been signed to confirm people had received their medicines as prescribed. Written MAR charts were countersigned by a second staff member. If people had their medicines crushed then this was clearly recorded by the clinical lead, family members and professionals. Governance systems at the home had been strengthened. The audits carried out helped to address any shortfalls within the home.

We identified some shortfalls in relation to infection control. On the arrival to the home we found that staff were not wearing face masks. We brought this to the attention of the registered manager who took immediate action and implemented mask wearing straight away. The registered manager told us they thought face masks were no longer needed. Staff demonstrated a good level of understanding in relation to safeguarding. Appropriate referrals to the local safeguarding team had been made. Staff were trained in safeguarding and understood their responsibility to protect people from harm. Staff were recruited safely and there were enough staff to provide safe and effective care. Safety checks of the premises and equipment had been undertaken.

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.

Staff were enthusiastic and happy in their work. The staff told us they felt supported within their roles. Staff described working together as a team, they provided person-centred care and helped people to achieve their potential.

Rating at last inspection

The last rating for this home was rated requires improvement (published 27 April 2019). At a previous inspection carried out 20 March 2019, we rated the home requires improvement in the key question ‘Safe and Well-Led’.

At our last inspection we found the provider had failed to ensure that medicines were safely stored and were accurately recorded. Whilst systems were in place to monitor and evaluate the quality of the service provided, actions were not always promptly taken when there were shortfalls. This placed people at risk of avoidable harm. At this inspection we found improvements had been made

Why we inspected

We carried out an inspection of this service on 20 March 2019. We rated the service requires improvement in Safe and Well-Led due to the shortfalls we identified. During this inspection we followed up on the improvements from the inspection.

The provider completed an action plan after this inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check the provider 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 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 home has remained 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 Hazelwood Gardens Nursing Home on our website at www.cqc.org.uk

We found the following examples of good practice.

There were arrangements in place to take people’s temperature on arrival at the home to screen for covid symptoms. Hand sanitisers were available and lateral flow tests were carried out. Various entrances and exits to the home had been identified for use, should they be needed, in order to avoid unnecessary movement of visitors through the home.

A designated area of the home had been set aside for visits. This had its own entrance and a screen separating people and their visitors. This wasn’t a solid perspex screen as is recommended. However, there were other measures in place to ensure people’s safety including lateral flow tests being carried out and social distancing on either side of the screen. The registered manager was up to date with new rules around care home visiting that were due to come in, shortly after our inspection. If families were unable to visit, arrangements were made for video calling.

Staff had received training in donning and doffing Personal Protective Equipment (PPE). There were suitable arrangements for disposing of PPE after use. We saw staff were wearing masks throughout the home. The registered manager told us how they had experienced difficulties at the outset of the pandemic being able to obtain PPE. However, this was resolved, and they were now ordering PPE through the government portal.

The home had not experienced cases of covid 19 but had clearly planned for the eventuality. Individual staff had been risk assessed and plans were in place to ensure staff who were at low risk from covid 19, would work with anyone testing positive. Regular testing was being undertaken of people in the home and staff to help ensure any positive cases were identified quickly.

Regular cleaning of the home was taking place, with attention being paid to high touch points such as stair bannisters. An infection control audit was carried out to monitor infection control in the home.

Hazelwood Gardens is a care home with nursing that provides personal and nursing care for up to 36 older people. At the time of the inspection, there were 31 people living at the service.

People’s experience of using this service:

People received assistance to take their medicines. However, medicines were not always stored safely or recorded accurately.

Overall, improvements had been made to the environment and communal areas of the home has been decorated since the last inspection. Some of the equipment in use was stained and not clean.

People told us they felt safe. They were cared for by a consistent staff team who had received sufficient training to carry out their roles.

People were supported to access health care services and regular visits were undertaken by the GP. People’s dietary needs were assessed and where needed, people received support to eat and drink.

People received care that was kind and respectful.

Care plans were not always reviewed and updated regularly and when people’s needs changed.

People and their relatives knew how to complain. No people were receiving end of life care at the time of our inspection visit.

There was a programme of quality assurance and monitoring checks. However, actions were not always promptly taken when shortfalls were identified.

More information is in detailed findings below.

Rating at last inspection:

Requires Improvement (report published in April 2018).

Why we inspected:

This was a planned inspection based on the rating from the last inspection when we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This failing related to the lack of quality assurance systems in place to assess, monitor and mitigate risks to people.

At this inspection whilst sufficient improvements had been made to meet the regulation relating to quality assurance, further improvements were needed. In addition, we identified a breach of the Health and Social Care Act 2009 (Regulated Activities) Regulations 2014, relating to the safe management of medicines.

The service remained rated Requires Improvement overall. This is the third consecutive inspection where the service has received this rating. We will arrange a meeting with the provider to discuss how they will make the required improvements within agreed timescales.

Follow up:

All services with this rating are re-inspected within one year of our prior inspection. We will continue to monitor the service to inform the assessment of the risk profile of the service and to ensure the next inspection is scheduled accordingly.

The registered person had registered with the Care Quality Commission to manage the service. 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.

At the last inspection on 18 May 2017, the service was rated Requires Improvement. We found breaches in the regulation relating to safe care and treatment and we served a Warning Notice. We found a further three breaches in the regulations relating to consent to care, submission of statutory notifications to the Commission and quality assurance systems. We issued requirement actions. The provider sent us an action plan telling us the actions they had taken to meet the requirements of the regulations.

We carried out a comprehensive inspection on 27 February 2018. At this inspection, whilst we found improvements had been made, we continued to find a breach of the regulations relating to quality assurance and the service has been rated Requires Improvement for the second time.

Improvements had been made to the management of people’s medicines and most people received medicines when they were needed. Further improvements were needed to make sure the management of medicines was consistently safe.

Sufficient numbers of staff were deployed to provide safe care at the time of our visit. Staff performance was monitored. Staff received supervision and training to enable them to meet people’s needs.

Staff demonstrated a good understanding of safeguarding and whistleblowing and knew how to report concerns.

Risk assessments and risk management plans were in place. We found improvements were needed to make sure the care plans fully reflected changes in care when the condition of a person changed.

Incidents and accidents were recorded and the records showed that actions were taken to minimise the risk of recurrences.

People were supported with food and fluids and provided with choices at mealtimes.

Staff were kind and caring. We found people were being treated with dignity and respect and people’s privacy was maintained.

Activities were provided and a vehicle had been purchased to provide opportunities for more trips out of the home. A sensory room had been introduced to provide a quiet, relaxing and calming area for people.

Systems were in place for monitoring quality and safety. Actions were taken where areas for improvement and shortfalls had been identified. However, the audits had not identified the shortfalls we found.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of this report.

The registered provider had registered with the Care Quality Commission to manage the service. 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 not always safe. Risk assessments and risk management plans did not identify and mitigate risks to people’s safety. These included risks associated with the unsafe use of equipment and risk due to lack of operational systems to check the safety of fire, water and electrical provision. People’s medicines were not safely managed.

Quality monitoring systems were not in place to identify, monitor, manage and mitigate risks to people’s safety and welfare.

Staff that had received training and understood their responsibilities with regard to keeping people safe from abuse.

Consent to care was not always sought in line with legal requirements and there was insufficient detail of best interest decisions made on behalf of people.

People‘s healthcare needs were met. Staff had access to, and obtained support and guidance from, external health care professionals. People received the support they needed with eating and drinking.

Staff received training relevant to their roles. However, staff did not receive supervision in line with the provider’s policy.

Staff demonstrated a kind and caring approach and they treated people with dignity and respect. Staff knew people well and were able to tell us about people’s likes, dislikes and preferred routines.

There were activities that people could participate in and people were enjoying group activities on the day of our visit.

People, staff and relatives told us the home was well-managed. People and relatives told us the registered manager was readily accessible and available to them. Staff told us they were well-supported and described the home as a good place to work.

During this visit, we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded. You can see what action we told the registered provider to take at the back of the full version of the report.