Archived: Hazelgrove Nursing Home

Updated 21 July 2015

This inspection report includes the findings of the focused inspection. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, looked at the overall quality of the service, and provided a rating for the service under the Care Act 2014.

We carried out a comprehensive inspection of all aspects of the home on the 26 and 27 November 2014. The comprehensive inspection identified numerous breaches of regulations. We undertook an unannounced focused inspection of Hazelgrove Nursing Home on 2 June 2015. This inspection was to check that improvements to meet legal requirements planned by the provider after our inspection on the 26 and 27 November 2014 had been made.

This visit was unannounced, which meant the provider and staff did not know we were coming. The inspection team consisted of two inspectors. Before our inspection we reviewed the information we held about the service. We considered information which had been shared with us by the Local Authority and looked at safeguarding alerts that had been made and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law. We also contacted the Local Authority and Clinical Commissioning Group (CCG) to obtain their views about the care provided in the service.

During the inspection we spoke with three people who lived at the service, six visiting relatives, the manager, the deputy manager, the provider, an activities co-ordinator and three care workers.

We looked at areas of the building, including people’s bedrooms, bathrooms, the dining room and both lounges. Some people had complex ways of communicating and several had limited verbal communication. We spent time observing care and used the short observational framework for inspection (SOFI), which is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed records of the service, which included quality assurance audits, staff training schedules and policies and procedures. We looked at six care plans and the risk assessments included within the care plans, along with other relevant documentation to support our findings.

We also ‘pathway tracked’ people living at the home. This is when we followed the care and support a person’s receives and obtained their views. It was an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

Updated 21 July 2015

We carried out an unannounced comprehensive inspection at Hazelgrove Nursing Home on 26 and 27 November 2014. Breaches of legal requirements were found and as a result we undertook a focused inspection on 2 June 2015, to follow up on whether the required actions had been taken to address the previous breaches identified, and to see if the required improvements had been made.

You can read a summary of our findings from both inspections below.

Comprehensive Inspection of 26 and 27 November 2014

Hazelgrove Nursing Home is registered to provide care to people with nursing needs, many of whom were living with dementia. The home is purpose built, with a lounge/dining areas and a further two lounges arranged over one floor. The service can provide care and support for up to 37 people. There were 17 people living at the home during our inspection.

An interim manager was in post, as there was no registered manager. The home has been without a registered manager for over five months. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

At the last inspection in August 2014, we asked the provider to make improvements in respect to supporting workers and quality assurance. An action plan was received from the provider and we found that improvements had been made regarding supporting workers. However, although the provider now carried out regular audit and monitoring activity to assess the quality of the service and make improvements, not all recognised improvements had been met or followed. We also identified further concerns in many other areas.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at did not always reflect the positive comments some people had made.

People’s safety was being compromised in a number of areas. Care plans and risk assessments did not routinely reflect people’s assessed level of care needs. People’s medicines were stored safely and in line with legal regulations and people received their medication on time. However, there were numerous errors and omissions in the recording of administration of medicines, PRN medication (as required) and controlled drugs (CD).

Hazelgrove Nursing Home was not meeting the requirements of the Mental Capacity Act 2005 (MCA). Mental capacity assessments were not routinely completed, or in line with legal requirements.

Care plans lacked sufficient information on people’s likes, dislikes and individual choice. Information was not readily available on people’s life history and there was no evidence that people were regularly involved in their care planning. The opportunity for social activity and recreational outings were extremely limited. No regular meaningful group or individual activities took place or were planned for people.

Everyone we spoke with was happy with the food provided and people were supported to eat and drink enough to meet their nutrition and hydration needs. However, we found people ate their lunch either in their rooms or sitting in armchairs in the lounge/dining area, and the communal table dining experience was not made available.

Staff felt supported by management, said they were well trained and understood what was expected of them. However, there was insufficient day to day management cover to supervise care staff and care delivery. The current management staffing structure at the home did not provide consistent leadership or direction for staff.

People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapports with people and people responded well to staff.

Feedback was regularly sought from people, relatives and staff. Residents’ and staff meetings were held on a regular basis, which provided a forum for people to raise concerns and discuss ideas. However, we identified concerns in respect to communication within the home. Incidents and accidents were recorded and acted upon.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Focused Inspection on 2 June 2015.

After our inspection of 26 and 27 November 2014, the provider wrote to us to say what they would do to meet legal requirements in relation to person centred care, consent to care and treatment, quality assurance, and the management of medicines.

We undertook this unannounced focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found significant improvements had been made, but we continue to have concerns with the recording and systems in place at the service in respect to the management of medicines. There were 29 people living at the home during our inspection.

People’s medicines were stored safely and in line with legal regulations and people received their medication on time. However, there were errors and omissions in the recording of administration of medicines and PRN medication (as required). We have identified this as an area of practice that continues to cause concern, and have asked the provider to make improvements in this area.

There was a manager employed who had been in post for approximately six months. However, in this time an application to register the manager with CQC had not been made. We have identified this as an area of practice that requires improvement.

Despite the above concerns, the provider had taken action to improve the safety and delivery of care people received. Risks had been appropriately identified and robustly addressed both in relation to people’s specific needs and in relation to the service as a whole. Staff were aware of people’s individual risk assessments and knew how to mitigate the risks. There was constant monitoring and reassessment of risks which ensured that staff took actions to protect people.

The delivery of care was suited to the person and not task based, and people and visiting relatives spoke highly of staff and the quality of care provided. People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. A relative told us, “I can honestly say there isn’t one member of staff here who doesn’t care”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People could choose how to spend their day and they took part in activities. People told us they enjoyed the activities, which included arts and crafts, exercises and themed events, such as visits from entertainers. One person told us, “I enjoy the activities. I’m painting today, there’s always something to do”. A relative said, “I barely see my husband now when I visit, he’s always doing activities”.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

People were supported to eat and drink well. There was a varied choice of food and drink available and mealtimes were a pleasurable and sociable experience for people and staff. People were encouraged to be independent and supported to be involved in a communal meal, or to stay in their rooms as they wished.

Staff felt well supported and listened to, and had clear lines of management and communication available to them.

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