We carried out a review of the data available to us about Hazelmere Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Hazelmere Nursing Home, you can give feedback on this service.
Hazelmere is registered to provide nursing, care, and accommodation for up to 28 people. There were 21 people living in the service when we visited. People cared for were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Some people were also living with dementia. Most people needed support with their personal care, eating, drinking or mobility. Accommodation was provided over two floors.
People’s experience of using this service and what we found
The management team reviewed the service through a range of governance systems that looked at ways to provide positive outcomes for people. However, it was not fully effective as it had not identified that not all people had specific care plans and risk assessments in place to meet their individual health needs. Immediate action was taken, and we received an immediate action plan to ensure systems were more robust to prevent this shortfall occurring again.
People received safe care and support by staff trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “I feel safe here, absolutely, it’s such a relief to have someone to make sure I’m safe.” A visitor said, “They seem very competent, I have faith in the staff here.”
There were enough staff to meet people's needs. Safe recruitment practices had been followed before staff started working at the service. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by appropriately trained staff, who had been assessed as competent. The home was clean, well-maintained, and comfortable. The provider ensured that when things went wrong, accidents were recorded, and lessons were learned.
Managers and senior staff created a transparent and honest culture for people and staff that was focused on ensuring everyone had the support they needed. The management were committed and enthusiastic about providing support and training for staff to enable them to provide people with the best support possible.
People, their relatives and staff were given regular opportunities to be involved in how the service was run by being provided with frequent opportunities to feedback on aspects of the service.
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 02 September 2019)
Why we inspected
This inspection was prompted by a review of the information we held about this service and age of the last rating.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
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.
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.
The home was clean and well maintained. There was regular cleaning throughout the day and this included high-touch areas. The housekeeper was knowledgeable regarding current Covid-19 cleaning guidelines and cleaning schedules were in place.
There were systems in place to ensure that people who had tested positive for Covid-19, were unwell or self-isolating were cared for in their own rooms to minimise the risk of spreading the virus. The home was currently closed to all visitors apart from those who were on a palliative care pathway and end of life. Staff supported people to remain in contact with their families through phone and video calls.
Before people were admitted to the home, they were required to have a negative Covid-19 test and then isolated in their rooms for 14 days.
Staff were provided with adequate supplies of personal protective equipment (PPE) and staff were seen to be wearing this appropriately. Staff had received specific Covid-19 training, and this included guidance for staff about how to put on and take off PPE safely. Staff were seen to be following correct infection prevention and control (IPC) practices. Hand sanitiser was readily available throughout the home. Regular testing for people and staff was taking place. All staff have had weekly polymerase chain reaction (PCR) and daily lateral flow test (LFT). In addition, they have their temperatures taken. People have had monthly PCR test with twice daily temperatures and oxygen level checks.
At present most people chose to spend time in their rooms, they were supported by staff to remain engaged with various activities. Staff told us a small group visited the lounge for coffee and lunch. Seating was arranged to ensure people could enjoy being with their friends but maintain social distancing.
Hazelmere is registered to provide nursing, care and accommodation for up to 23 people. There were 21 people living in the service when we visited. People cared for were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Some people were also living with dementia. Most people needed support with their personal care, eating, drinking or mobility. Accommodation was provided over two floors.
People’s experience of using this service and what we found:
At the last comprehensive inspection in July 2018, we told the provider they needed to improve the oversight and governance of the service. The registered manager and provider had made improvements to the governance and oversight arrangements, implementation of systems and processes to safely assess and manage risks to people, including their medicines. However, there were some areas of documentation that needed to be further developed to ensure people received safe and consistent care. This included the clear documentation of best interest decisions and the rationale behind them. The improvements made since the last inspection also needed more time to be sustained, and fully embedded into the culture of the service.
People received safe care and support by staff who had been appropriately recruited, trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “Very safe here, no complaints at all,” and “I came here because I had been ill, it’s clean, good food and considerate staff.” People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by trained and knowledgeable staff, who had been assessed as competent. There were sufficient staff to meet people's needs. The provider used a dependency tool to determine staffing levels. Staffing levels were reviewed following falls or changes in a person's health condition.
Safe recruitment practices had been followed before staff started working at the service. Staff were deployed in a planned way, with the correct training, skills and experience to meet people’s needs. Nursing staff received clinical supervision and training. Staff told us that they had they got to know people and their needs well and received the training they needed to meet people’s needs safely and effectively. One staff member said, “We get lots of training and have regular supervision.” People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals.
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.
Everyone we spoke to was consistent in their views that staff were kind, caring and supportive. People were relaxed, comfortable and happy in the company of staff and engaged in a positive way. People’s independence was considered important by all staff and their privacy and dignity was also promoted.
Activities reflected people’s preferences and interests. People were encouraged to go out and meet family and friends. Staff knew people’s communication needs well and we observed staff communicating with people in an effective way.
Staff were committed to delivering care in a person-centred way based on people's preferences and wishes.
People were involved in their care planning as much as they could be. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives.
People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated. The provider and registered manager were committed to continuously improve, and had developed structures and plans to develop and consistently drive improvement within the service and maintain their care delivery to a good standard.
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 19 September 2018) and there were three 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.
The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.
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.
This was the first inspection of Hazelmere Nursing Home following the change of provider to Inspiricare Ltd on 22 May 2017.
Hazelmere Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The home is registered to provide nursing and personal care and accommodation for up to 23 older. At the time of the inspection there were 19 people living there. People had different health care needs. Some people required support and guidance with personal care, while others needed continual nursing care due to frailty and medical conditions, including living with dementia.
The registered manager was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (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 had attended safeguarding training. However, staff failed to demonstrate a clear understanding of protecting people from harm and, the provider had not ensured that referrals were made to the local authority in line current guidelines. In addition, the provider had not informed CQC of incidents that had occurred within the home, which may have affected the support provided.
An effective quality and monitoring system was not in place, which meant the issues identified during the inspection had not been identified; or if they had been identified they had not been addressed. This included care plans, risk assessments, daily records and the management of medicines.
The provider had introduced an e-learning training programme that was accessible to staff and systems were in place to support staff to complete this, to ensure they were up to date with their practice. However, staff had not all completed the required training for their role. For example, not all nurses had completed the e-learning medication training even though there were concerns with their practice.
There were sufficient staff working in the home. Robust recruitment procedures ensured the staff were safe to work in care and, Supervision supported staff to be aware of their roles and responsibilities and people told us staff provided the care and support they needed.
Emergency procedures had been developed to support people if they had to leave the building and staff followed the provider’s infection control policies to protect people from infection. There was ongoing maintenance of the home and continued improvements to the environment, with regular checks to ensure the health and safety of people, visitors and staff.
Staff had an understanding of the Mental Capacity Act 2005 (MCA) and the need to support people who did not have capacity to make decisions. The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the MCA and DoLS and were aware of current guidance to ensure people were protected. DoLS applications had been requested when needed to ensure people were safe.
From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. Staff were aware that people had different communication needs, such as sensory loss, and were able to explain how they supported people to communicate. However, staff had not all completed the training. We have made a recommendation that the provider seeks advice and guidance from a reputable source, about Accessible Information Standards (AIS) to ensure staff were aware of their responsibilities.
People enjoyed the meals provided, they said the food was good and they could ask for what they wanted. If there were concerns about people’s diet staff contacted their GP for advice and support. Records showed that health professional were contacted when needed and people were supported to lead a healthy lifestyle.
People were encouraged to keep in touch with relatives and friends. Visitors told us they were made to feel very welcome and felt people received the support and care they needed. Feedback was sought from people, relatives and staff about the changes since the new provider took over and positive comments and suggestions had been received.
We found three breaches 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 the report.