The Hazelwell

The Hazelwell is a residential care home providing personal and nursing care to up to 55 people. The service provides support to people in need of nursing support, respite care, end of life care and general assistance with everyday living for people with dementia. At the time of inspection there were 39 people living at the home.

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

Improvements had been made to the service in regards to infection control, medicines and to the management of risk however, we identified additional improvement was needed in regards to medicines, recruitment and recording and reporting on aspects of people’s care.

We have made recommendations in regard to medicines management and recruitment.

Care plans and risk assessments were in place that reflected the needs of people living in the home, however we identified monitoring information was incomplete.

Infection control processes had significantly improved, and the home appeared clean. Accidents and incidents were managed appropriately, and the management notified CQC of significant incidents when it was appropriate.

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.

On the day of inspection there appeared to be sufficient staff on duty to deliver care safely and the provider had plans in place to reduce the use of agency staff. We observed support being provided in the home and saw that this was done in a caring, responsive and patient manner. We saw that people were comfortable in the presence of staff.

Complaints, accidents and incidents were managed appropriately, and referrals were made to other professionals in a timely way when people living in the home were in need. The provider employed activities co-ordinators and people’s dietary needs were catered for.

There were a range of effective provider and manager quality assurance processes in place, the provider had learnt lessons from the previous inspection and improved services.

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 13 August 2021).

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

This inspection was carried out to follow up on action we told the provider to take at the last inspection. 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.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk and medicines. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe section of this report.

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 based on the findings of this inspection.

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

Follow up

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

We found the following examples of good practice.

¿ People were supported by staff who had received infection, prevention and control (IPC) training, had their competencies assessed and reviewed regarding donning and doffing of PPE. All staff wore appropriate personal protective equipment (PPE).

¿ The service was cleaned to a high standard, cleaning of all areas had been completed regularly. The home appeared clean with no odours.

¿ The provider's infection control policy was up to date and the registered manager completed regular IPC audits to maintain oversight and ensure correct procedures were in place and being completed.

¿ The service completed a programme of regular testing for people, staff and visitors according to Government guidance. The registered manager had implemented an auditing system to ensure guidelines where adhered to.

¿ The provider had an admissions policy in place, and we found evidence this was being followed. People were supported to self-isolate as required.

¿ People were supported to stay in contact with friends and family. The service had multiple rooms for visiting and external areas to meet outside.

¿ Temperature, vaccine status and testing checks were completed on all visitors.

The Hazelwell is a care home providing personal and nursing care to 31 people aged 65 and over at the time of the inspection. The service can support up to 55 people across three separate floors. One of the floors is currently decommissioned and another is for providing support to people who requiring nursing care.

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

Medicines were not always managed safely. Guidance was not in place for the use of topical creams, medication patches, ‘as and when needed’ medications and appropriate risk assessments of people self-medicating were not in place. The audits of the medications had not been used effectively to ensure safe practice and the staff had received training and competency checks however this was called into question following the findings of the inspection.

Health needs of people were not always monitored in their care records. Examples included, those people who needed their fluid intake monitored or their weight monitoring. We saw conflicting information in people’s care plans that could lead to inappropriate care being provided to an individual. Additionally, this service had had previous breaches of the same regulations in the most recent inspection. This meant that the provider had not taken and sustained adequate action to improve the service.

Feedback we received from people and relatives was positive. However, some comments made indicated that staff were sometimes problematic. Comments we received stated that there was a high number of agency staff and that staff were a bit short especially at night which could impact call bell response times. Family members told us there was no reception cover at weekends so this meant staff had to come and answer the door and do the lateral flow tests sometimes resulting in long waits. The concerns we received was that this was taking staff away from their care duties.

There were infection control processes in place however we identified that staff practice needed updating and some systems in regard to government guidance, for example twice daily temperature testing of people, was not taking place.

The recruitment of staff was safe and there were enough staff on duty on the day of inspection to meet people's needs. Risks to people's health and safety within the home had been assessed and mitigated with equipment such as hoists and lifts regularly maintained and serviced. Accidents and incidents were recorded and reviewed in order to minimise the risk of reoccurrence.

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.

There were a range of provider and manager audits in place, however, some of these were not effective due to the issues we found.

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 22 November 2019).

At this inspection enough improvement had not been made/sustained, and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

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.

The inspection was prompted in part due to concerns received about medicines and staffing. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement. 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 The Hazelwell on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines, risk monitoring and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Hazelwell is a purpose-built care home that is registered to provide personal and nursing care to older people. The care home accommodates up to 55 people across three separate floors. One of the floors provides support to people who requiring nursing care. On the day of inspection 36 people (three of which were receiving respite care) were using the service.

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

In most cases, risks to people had been identified and assessed with guidance in place for staff to follow to ensure people did not come to harm. However one person’s risks assessments had not identified factors that could result in them falling. This meant measures had not been put in place to prevent them coming to harm.

Overall, medicines were safely managed and administered to people at the right times. However, one person had not received medication that was required to help manage their condition effectively. Some people’s records had not been completed to show when and where medicines such as creams and ointments had been applied.

Whilst systems were in place to check the quality and safety of the service, they had not always identified issues that we found during the inspection, especially those related to medicine records.

Most people’s needs and choices had been thoroughly assessed both prior to and after moving into the home. However, one person’s needs had not been fully assessed prior to them moving into the home which resulted in care plans not being in place to guide staff in providing effective care and support.

We made a recommendation regarding this.

On the whole people were supported to access other health and social care professionals and staff sought advice from external agencies in a timely manner. However, for one person staff had not sough important medical advice in a timely way. We found no evidence that this person had come to any harm.

We made a recommendation regarding this.

Enough staff were on duty at the time of our inspection. However, at times it was noted that staff were not always deployed effectively across the three floors which left other staff feeling rushed during busy times. This was discussed with the registered manager and staff during the inspection.

People told us they felt safe living at the home and explained that staff were quick to respond when they needed support. Family members and friends also told us they felt confident people were safe and treated well. Staff showed a good level of understanding around how to identify safeguarding incidents and were confident in reporting concerns to the relevant people.

People were provided with support to maintain a healthy balanced diet. Both care and kitchen staff had good knowledge of people’s dietary requirements and any risks associated with poor food and drink intake or difficulties with swallowing. Staff were observed to provide support at meal times in a sensitive and patient way and the overall mealtime experience was positive. People told us they enjoyed the food which had been compared to “5 star restaurant standards”.

Staff were knowledgeable and showed they knew people well and how to support them. Staff had received a range of training appropriate to their role and people’s needs and told us they felt supported in their role. Two ‘home trainers’ had been recruited to help address issues regarding records and to provide regular consistent training support to staff.

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 spoke highly of the caring approach of all staff describing them as “Marvellous,” “Truly brilliant” and “Superb.” It was clear that positive relationships had been developed between staff and people. Family members and friends told us they were always made to feel welcome and described how their loved ones appeared “much happier and settled.”

People received care that was person-centred and based on their needs and preferences; care plans contained information that reflected this and provided staff with information about people’s life histories and what was important to them. People were supported to access a range of activities and spoke positively about what was provided.

The registered manager was open and transparent about areas that needed improving and was keen to implement changes to achieve this. They showed a desire to promote a person-centred culture within the staff team and the positive comments from people and visitors evidenced this. People, visitors and staff all felt engaged with and told us overall communication from the registered manager was clear and effective.

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 (report published 26 April 2017).

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Why we inspected: This was a planned inspection based on the previous rating.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home is a converted and extended four-storey property set in its own grounds in a residential area overlooking the Dee Estuary in Heswall, Wirral. There were bedrooms on the ground, first and second floors, however the second floor was unoccupied at the time of the inspection. Communal areas were provided on each of these floors, with staff and service areas on the third floor.

The home had a manager who was registered with the Care Quality Commission. 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.

There were enough qualified and experienced staff to meet people’s needs and keep them safe. The required checks had been carried out when new staff were recruited and all staff had received induction training before they commenced employment.

We found that the home was clean and well maintained and records we looked at showed that regular health and safety checks were carried out. All areas were furnished and decorated to a very high standard and people had a choice of comfortable sitting areas both indoors and outdoors.

Medicines were managed safely and records confirmed that people always received the medication prescribed by their doctor.

Where appropriate, applications had been made to the local authority for Deprivation of Liberty Safeguards. People were very happy with their meals and told us that choices were always available.

The members of staff we spoke with had good knowledge of the support needs of the people who lived at the home. The staff we met had a cheerful and caring manner and they treated people with respect. People who lived at the home and visitors who we spoke with expressed their satisfaction with the care provided and with the staff.

The care plans we looked at gave information about people’s care needs and how their needs were met. They also gave detailed information about people’s individual choices and preferences.

There was a friendly, open and inclusive culture in the home and people we met during our visits spoke highly of the home manager. Quality audits were completed and identified where improvements were needed.