Hazelwood House

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

Risks in relation to people receiving treatment and care were not managed appropriately.

Medicines were not always managed safely, guidance for the administration of specific medicines were not available.

Care records did not always clearly reflect peoples likes, dislikes, and wishes to provide staff with the relevant guidance to ensure care was provided in a person-centred way.

Quality assurance systems were in place, but these were not effective as they did not identify some of the shortfalls identified during our inspection.

The registered manager and provider acted upon feedback from the inspection and were in the process of addressing the issues identified.

People told us they felt safe at the service, and they could find a member of staff to help them. Staff rota's showed shifts were covered. Medicines were managed safely. People told us they were kept informed about their medicines and why they needed to take them.

Staff demonstrated they were aware of their safeguarding responsibilities and how to report concerns. Lessons learnt took place at the service after an incident and staff confirmed they took part in meetings to learn from lessons.

Staff were supported in their role and mostly received appropriate training.

People were able to enjoy food they liked and were supported to have enough to drink.

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. Consent to care and treatment was requested and staff did not force people to do something they did not want to.

The service worked well with external health professionals to ensure people received support when they became unwell. Care plans were person-centred and detailed peoples likes/dislikes and social history.

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 good (published 20 July 2021).

Why we inspected

The inspection was prompted in part due to concerns received about risks in relation to people receiving treatment and care not being managed safely. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

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.

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

Enforcement and Recommendations

We have identified breaches in relation to the management of risk, safe management of medicines, care plans not clearly reflecting people's needs and governance systems to improve the quality of the service not being fully embedded and effective.

We recommended that the service sought further guidance form a reputable source around the provision of tailored activities and the assessment of needs for people who used the service.

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.

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

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Hazelwood House is a residential care home providing accommodation and personal care to up to 15 older people some of whom also need support to maintain good mental health. At the time of our inspection there were 14 people using the service.

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

People living at the service were safe as there were systems and processes in place to safeguard them from abuse. The risks to people’s safety were well managed and there were enough staff safely employed to meet people's needs. People's medicines were managed safely, and staff worked in a way that promoted the prevention of infection. The registered manager had processes in place to learn from adverse events at the service. 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.

The management team were responsive and there were effective quality monitoring processes in place to monitor people's care.

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

Rating at last inspection and update - The last rating for this service was good (report published 20 July 2021)

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 by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to initial inquiries to determine whether to commence a criminal investigation. 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 of falls. 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 good and well-led sections of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hazelwood House 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.

Hazelwood House is a residential care home providing personal and accommodation to 14 people aged 65 and over at the time of the inspection. The service can support up to 15 people. The service provides care and accommodation for older people and people with mental health issues.

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

People who used the service told us that they felt safe. Staff knew how to report allegations and concerns of abuse. Risk in relation to people receiving support had been assessed and robust management plans were in place to minimise the risk. Sufficient staff were deployed, and appropriate recruitment checks were carried out to ensure were suitable to support people who use the service. Peoples medicines were managed safely. Incidents and accidents were clearly recorded, and actions were taken to learn for these and reduce the likelihood of similar events from happening in the future.

Robust and effective quality assurance monitoring systems were used to maintain and improve the quality of care provided to people. The service has systems in place to obtain peoples view about the care they received. Care provided is centred around people’s needs and preferences.

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 Good (published 7 September 2018). We undertook a targeted inspection in December 2020 but didn’t change the rating.

Why we inspected

We undertook a focused inspection because we received information of inadequate risk mamangemement as a result of this we reviewed the key questions of Safe and Well-led only.

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 not changed from 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 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.

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.

Hazelwood House is a care home without nursing. Hazelwood House is in Harrow and is registered for 15 older people who may have dementia or a mental illness. During our inspection there were 14 people living at Hazelwood House. Hazelwood House is located close to public transport and local shops.

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

The provider ensured that fire equipment and the fire alarm system were maintained to ensure people who used the service were safe in the event of a fire. Enough care workers were deployed to ensure people’s needs could be met. The provider had continued to provide training throughout the COVID-19 pandemic.

Suitable infection prevention and control measures and practices were in place to keep people safe and prevent the spread of the coronavirus and other infections. Staff had received appropriate training. Staff had access to enough stocks of personal protective equipment (PPE).

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 Good (published 7 September 2018).

Why we inspected

We undertook this targeted inspection to check if people continued to receive safe care and if the service had implemented the requirements made by the local safeguarding team in response to a recent safeguarding alert. We also assessed if the service followed safe infection control procedures during the current COVID-19 pandemic and if people received person-centred care. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on specific issues. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

The provider sent us an action plan in July 2017 telling us that they had taken the appropriate actions to address the breaches found during our inspection in June 2017 and that they were no longer in breach of the regulations.

We found during our inspection in May 2018 that the provider had taken action and had improved the management and auditing of peoples financial records. Staff had been provided with regular training and support to ensure they had the right skill and knowledge to meet people’s needs. The provider had introduced a robust and effective system to monitor and assess the quality of care.

Hazelwood House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hazelwood House is in Harrow Northwest London and is registered for 15 older people who may have dementia or a mental illness. During the day of our inspection there were 13 people living at Hazelwood House. Hazelwood House is located close to public transport and local shops.

The registered provider is also the 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.

Staff demonstrated good understanding of their responsibilities in respect to ensuring that people who used the service were safe. Staff told us that they had attended training regarding safeguarding adults and learned about different forms and types of abuse, how to recognise it and how to report it. The provider followed safe recruitment procedures and ensured staff were appropriately checked prior to being offered employment. Medicines were managed safely and staff had received appropriate training and were competent to administer medicines to people who used the service. Any risks associated with people’s care had been assessed and appropriate risk management plans were put into place to ensure risks were managed safely.

Staff spoken with and records confirmed that staff had received appropriate training which gave them the skills and confidence to carry out their responsibilities. Training included moving and handling, first aid, health and safety, fire prevention, safeguarding, and food hygiene. The service was meeting the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff said that they had received training in DoLS and MCA. People were offered a choice of food at each meal, and drinks and snacks were provided throughout the day in line with their preferences and dietary requirements. Appropriate healthcare professionals were involved in the care of people when required.

Staff supporting people were respectful and caring. People and relatives spoke highly about the staff and how they enjoyed their company. People’s likes and dislikes were documented in people’s care records. People who used the service and relatives were involved in all aspects of people’s care and people’s privacy and dignity was promoted, while their independence was maintained.

Care records were informative and reflected the care and support being given. Care records included details of people’s activities of daily living which explained how best to support the person. An external company provided activities twice a week, and in addition to this staff provided activities to people. People told us that they were happy with the activities offered. The home had a large well-maintained garden, which was used by the people who used the service during summer and when the weather is better. The provider had a complaints procedure and people felt able to raise concerns if they needed to. The registered manager kept a log of concerns received and addressed them effectively.

People and staff spoke mostly positively about the support they received from the registered manager. People who used the service praised the operations and deputy manager for being supportive and available if they required any help or advice. People who used the service, relatives and staff said that generally there was good leadership in place. They felt that they could approach the operations manager and deputy manager and felt they listened to them and acted on their concerns. The provider had undertaken regular quality assurance audits and any shortfalls had been acted upon. The audits included financial records, care plans, medicines records and the environment. Staff had the opportunity to discuss issues with the management team during team meetings.

During our last comprehensive inspection in June 2015 we rated the service as good.

Hazelwood House is a residential care home registered for 15 older people, some of whom may have dementia and mental health problems.

The registered provider is also the 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.

People who used the service told us they were safe and staff were clear about how and whom to report any allegations of abuse to. However, we found that financial records and procedures were not sufficiently in place, which meant there was a risk of people’s finances not being managed appropriately.

Risks in relation to the treatment or care were appropriately assessed and risk management were available for staff to follow.

Sufficient staff was deployed to meet the needs of people and staff were vetted appropriately, However, on occasions references had not been checked, to assure they were provided by the previous employer.

Medicines were managed safety and procedures were in place for the storage, administration and disposal of medicines.

Staff had access to basic mandatory training and specialist training had been booked for staff to ensure peoples complex needs can be met.

People who lacked capacity to make some decisions in relation to their treatment or care had their capacity assessed and appropriate safeguards had been put into place.

People who used the service were provided with nutritious and well balanced meals and had access to drinks and snacks at any time during the day.

The service ensured that people’s health care needs were met and appropriate support was sought from health care professionals if required.

People told us that they felt comfortable in the presence of care workers and were well cared for and their privacy and dignity was respected.

Care plans reflected people’s assessed needs and were based around the person. People were provided with some activities. However, these were not always meeting people’s needs or reflected people’s expectations.

Appropriate procedures were in place for people to make complaints or raise concerns. Over the past 12 months the service received one complaint which was in process of being resolved.

The service had some systems in place to monitor and assess the quality of care; however these were not always effective. Senior management was present although the leadership of the home was not always effective.

We have made two recommendations; one about involving people more in making decisions about their accommodation and another about seeking advice and support to improve and develop the leadership and management of the service.

We found two 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.

On 21 March 2014 we received an action plan confirming that the provider had taken action to become compliant with Regulation 17(1)(b) of the Health and Social Care Act 2008 (Regulated Activities) 2010.

The purpose of our inspection on 12 September 2014 was to assess compliance with the breach of Regulation 17(1)(b) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2010.

We looked at four care records and spoke to three people who used the service, one relative, two care workers and the registered manager during our inspection on 12 September 2014. We found that the provider had taken appropriate actions and updated all care records. People who used the service and relatives told us that they had been informed and updated of any changes in the care provision and action had been taken to assess peoples consent in line with the requirements of the Mental Capacity Act 2005. People told us, "I am always informed of what is going on" and "The care is excellent, which puts my mind at rest when I am not around."

People's privacy and dignity were respected, however there was no regular consultation with people who used the service and their relatives.

There were processes in place to protect people using services from harm. The staff were trained to recognise the signs of abuse and to report concerns in accordance with the home's procedures.

Staff were supported to provide care and treatment to people who used the service and were being trained, supervised and appraised appropriately.

Records kept were accurate and held securely.

We saw some improvements in relation to the involvement of people and their representatives in planning for their care. However, we saw limited information in the care records to evidence how tpeople were involved in decision making. People told us that staff always asked for their permission before caring out tasks for them and staff confirmed that they always talked to people about the support they were going to provide to gain their agreement.

The care plans viewed took account of people's individual likes, dislikes and preferences, however people's cultural and spiritual needs were not always included in them.

People told us that they felt well cared for by staff. A relative spoken with said when talking about the staff, "they are lovely and very friendly". People told us that there were always enough staff on duty to support them.

The home was clean and free from odours at the time of our visit. We saw staff observing good practice in relation to preventing the spread of infection.

People told us that they would tell the manager if they had a complaint and said they felt their concerns would be listened to.