Archived: Hazelwood

Updated 3 November 2018

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

We visited the home on the 19 and 20 September 2018. When planning the inspection, we took account of the size of the service and that some people at the home could find visitors unsettling. As a result, this inspection was carried out by one inspector. This was an announced inspection. We contacted the home the evening before our visit to let them know we would be coming. We did this because staff were sometimes out of the home supporting people who use the service and we needed to be sure that they would be there.

We did not ask the provider to complete a Provider Information Return as this inspection was brought forward due to its history of repeated breaches of the Regulations. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed other information we held about the service. We considered information which had been shared with us by the local authority and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law.

During the inspection we reviewed the records of the home. This included two staff recruitment files, training and supervision records, medicine records, accidents and incidents, quality audits and policies and procedures along with information in regard to the upkeep of the premises. We looked at three people’s support plans and risk assessments along with other relevant documentation. We spoke with the provider and three members of staff. People were not able to tell us their views of life at Hazelwood so we observed the support delivered in communal areas to get a view of care and support provided. This helped us understand the experiences of people living at Hazelwood.

Updated 3 November 2018

Hazelwood 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 provides residential care for up to four people with learning disabilities. Hazelwood has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Although the building as a whole was one service, accommodation was provided from a large terraced house which had been separated into two distinct parts. Three people live in the main upstairs part of the house and one person lives in a self-contained basement flat. Both units ran completely independent of each other with separate staff teams. There were four people living at the service at the time of our inspection. Most people needed support with communication and were not able to tell us their experiences but we observed that they were happy and relaxed with staff.

There was a registered manager in post. A registered manager provider 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. The provider is also the manager of the home.

This is the fourth time the home has been rated requires improvement. At the last two inspections August 2016 and December 2017, warning notices were issued in relation to Regulation 17. Breaches were in relation to a lack of managerial oversight of the service and poor systems to ensure good governance. Following the August 2016 inspection, we met with the provider to discuss their report. At our last inspection in December 2017 we found that whilst some improvements had been made, the provider continued to be in breach of Regulation 17. The warning notice issued at that time required the provider to have met Regulations by 4 June 2018. At this inspection we found that whilst some improvements had been made the provider continued to be in breach of Regulation 17.

There continued to be a lack of effective managerial oversight at Hazelwood. The provider had not ensured all areas of record keeping were kept up to date and reviewed at regular intervals. Systems for auditing were not effective as shortfalls were rarely identified and they had not picked up the shortfalls we identified during our inspection. The building had not been maintained and there was no effective plan to ensure this was addressed. For example, there were areas in need of painting and there was a carpet that was torn and a trip hazard. There were no meetings held with staff who worked in the basement area of the service, and no systems to assess the quality of care provided in the basement flat. Record keeping relating to aspects of staff recruitment where potential conflicts had been identified, for example staff related to each other working together had been explored but the outcome had not been documented. The home’s fire safety assessor had made recommendations for actions to be taken as part of the home’s fire risk assessment but these had not been addressed and the reasons for this had not been documented.

We made a recommendation to ensure systems improved to enable staff to receive regular training and supervision.

Despite the shortfalls listed above, most of the staff team had worked in the home a long time and had an extremely good understanding of people as individuals, their needs and interests. Some people attended day centres and people were also supported with daily activities both within and outside of the home. Staff were very aware of people’s individual needs in relation to activities and supported people in a way that suited them. People were encouraged to develop and maintain skills in relation to daily living tasks. They were treated with dignity and respect. Staff had a good understanding of the care and support needs of people and had they had a good rapport with people.

People were encouraged to make decisions and choices on a day to day basis. Staff were aware that when complex decisions were required further advice and support was needed. Mental Capacity Act 2005 (MCA) assessments were completed as required and in line with legal requirements. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk.

In the main house staff meetings were used to ensure that staff were kept up to date on the running of the home, to hear staff views on day to day issues and to provide updates on people’s changing needs and support. There were enough staff who had been appropriately recruited, to meet people’s needs.

People were supported to attend health appointments, such as the GP or dentist. People had enough to eat and drink and menus were varied and well balanced. Incidents and accidents were well managed. People’s medicines were managed safely.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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. However, since carrying out our inspection the provider submitted an application to cancel their registration and this has been accepted. Any proposed enforcement would therefore not be concluded within the closure timescale.

Further information is in the detailed findings below.