Archived: Hazelwood

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.

Hazelwood provides residential care for up to four people with learning disabilities. Accommodation is provided from a large terraced house which has 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 independently of each other. 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; we observed that they were happy and relaxed with staff.

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

This is the third time the home has been rated requires improvement. At the last inspection in December 2016, two breaches of regulations were identified. A requirement notice was issued in relation to Regulation 15 and a warning notice was also issued in relation to Regulation 17. Breaches were in relation to a lack of cleanliness and good governance. Following the inspection we met with the provider to discuss their report. We asked the provider to complete an action plan to show improvements they would make, what they would do, and by when, to improve the key questions in safe, effective, responsive and well led to at least good.

At this inspection the building was clean and had been maintained regularly. Areas identified at the last inspection had been addressed. However, breaches in relation to good governance remained an issue. There continued to be a lack of effective managerial oversight at Hazelwood. The registered manager was not present in the home often enough and had not delegated his responsibilities sufficiently well to ensure 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.

There was no PRN (as required) protocol for one person’s medicine and the homely remedies list was out of date (medicines bought over the counter rather than prescribed). There were not enough staff employed to ensure there were always two staff on duty throughout the day when all three people were in the main house and to support activities. Although people’s weights were monitored there was no analysis of the findings or professional assistance sought when weight was lost. One staff member’s training was not up to date in most areas and this had not been addressed.

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 acutely aware of people’s individual needs in relation to activities and supported people in a way that suited them. People were treated with dignity and respect. Staff had a good understanding of the care and support needs of people and had developed positive relationships with people. People responded warmly to this.

Staff meetings were used to ensure that staff were kept up to date on the running of the home and to hear their views on day to day issues. Staff attended regular training to ensure they could meet people’s needs.

People had enough to eat and drink and the menus were varied and well balanced. Appropriate referrals were made to health care professionals when needed and people were supported to attend health appointments.

People were encouraged to be involved in decisions and choices when it was appropriate. Mental Capacity Act 2005 (MCA) assessments were completed as required and in line with legal requirements. Staff had attended MCA and Deprivation of Liberty Safeguards (DoLS) training. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk.

We found two breaches of the Regulations 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. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Hazelwood provides residential care for up to four people with learning disabilities. Accommodation is provided from a large terraced house which has 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. There is very limited cross over between the two parts; staff told us that the two staff teams operated independently of each other. 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; we observed that they were happy and relaxed with staff.

There was a registered manager in post; the registered manager was also the provider. 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 could communicate with us told us they liked living at the service. However, we found areas of the service were not clean and effective systems to maintain the basement flat had not been established.

The provider had not taken steps to check and assure themselves that all staff were suitable to work with people in a social care setting.

The provider had not established robust incident and accident documentation to support staff. This meant it was not clear if staff had consistently reported incidents which required reporting to the local authority. The deputy manager took steps to address the shortfalls in these systems during our inspection.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff understood when an application should be made and how to submit one. However, we found examples where the provider had not sought clarification from people’s families in relation to advocacy. In addition, advocacy best practice was not being followed in respect to the management of some people’s finances. Where people lacked the mental capacity to make specific 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.

Although staff were seen to manage situations appropriately, and in line with their care plans, where people demonstrated behaviours that challenged. Not all staff had received the same training in areas related to positive behaviour training. These staff said they would welcome additional knowledge in this area and would feel more confident with training in areas related to positive behaviour.

The shortfalls we identified during our inspection were directly related to the provider’s leadership. The provider’s oversight of the service was compromised by their day to day operational commitments. They had created a culture whereby they were completing routine tasks such as grocery shopping and transporting people to day care service and not making timely strategic decisions about the running of the service. There was a loyal and long serving staff team who displayed frustration regarding the provider’s urgency to address improvements related to areas such as the décor and physical environment of the building.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems to ensure medicines had been ordered, stored and administered, appropriately.

There were sufficient numbers of staff deployed to meet people’s needs. It was evident these staff had spent time with people, getting to know them, gaining an understanding of their personal history and building rapport with them. People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. Most staff had worked in the home a long time and had a good understanding of people as individuals, their needs and interests.

People’s needs had been assessed and detailed care plans developed. Care plans contained risk assessments for a wide range of daily living needs. Areas included eating, falls and seizures. People consistently received the care they required because staff were clear on people’s individual needs. Care was provided with kindness and compassion. Staff members were responsive to people’s changing needs. People’s health and well-being was continually monitored and the staff regularly liaised with healthcare professionals for advice and guidance.

Since our last inspection there had been improvements in some aspects of the providers quality assurance systems and staff told us these had been helpful in identifying where improvements were required.

We found 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 this report.

We found people indicated that they liked living in the home and that they had regular activities. We saw that their care needs had been assessed and reviewed with support provided that reflected each individual's needs. Safeguarding processes were in place and staff had received appropriate training.

We saw that people's bedrooms were personalised and that staff worked together to keep the environment pleasant. All safety checks had been carried out and maintenance plans were in place. There were processes in place to monitor the quality of the service provided and record keeping was up to date.

We observed staff speaking with people in a respectful and appropriate manner at all times. Staff demonstrated an understanding of people's needs and their individual methods of communication.

We found that people were supported to personalise their rooms, depending on their interests and hobbies. People had access to all parts of the home and we saw that some areas of the premises were not well maintained, which may put people at risk.

We spoke with staff and checked their records to ensure appropriate training and support was in place. Staff had attended training and demonstrated a good understanding of protecting vulnerable people. Appropriate recording and referral systems were not in place with regard to safeguarding people living in Hazelwood, which may put people at risk.

We found that record keeping was not robust. and some of the information and guidance to assist staff was not up to date. Which may put people at risk.