Hazeldown Care Home

Hazeldown care home is a residential care home, at the time of the inspection personal and nursing care was being provided to 13 people living with a mental health condition. The service can support up to 18 people. People living in the home are accommodated on two floors in one period building adapted for the use as a care home.

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

Governance systems required further development to inform and drive improvements in the service. People’s risk assessments did not always identify risk or provide enough guidance on how to manage identified risks. Systems to ensure staffing levels were adequate needed further work.

People felt safe living in the service. Risks to people, including from the environment, were managed in practice. People received their medicines safely.

People were supported to eat a balanced diet. Staff were competent and received training in how to meet people’s needs. People’s health care and needs relating to their living environment were met. 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.

People were supported by kind and caring staff who knew them well and encouraged their independence. People were supported to express their views and be involved in decisions about their support.

People received individualised and person-centred care that met their needs and preferences, this included the provision of appropriate activities. Information on the service was provided to people. People’s concerns or complaints were addressed and resolved.

People and staff spoke positively of the management team and their leadership in the service. There was a positive open and person-centred culture in 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 requires improvement (published 3 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Following the inspection, the provider sent us their action plan telling us how they were going to address our concerns and comply with regulation. At our inspection on 13 November 2018 we found vast improvements in the way the service was managed with regular input and support from the registered provider. We found one repeated breach of regulation.

Hazeldown is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The care home can accommodate up to 18 people in one adapted building. There were 12 people at the time of our inspection. The service is situated in the high street in a small village with some amenities. People have their own room and shared amenities including two lounge areas a main kitchen and a separate resident’s kitchen and dining area.

There is a 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.

The previous breach in relation to staffing had been addressed. There were now enough staff to meet the assessed needs of people using the service. Staff recruitment processes were sufficiently robust and staff once employed were well supported. They received the training necessary for their job role.

The service had improved with strong leadership and provider oversight which helped ensure good outcomes of care for people. However, there were still a number of issues regarding the safety and upkeep of the service. These had not been identified by the registered provider and could result in avoidable harm for people using the service.

The registered manager had since the last inspection familiarised themselves with what needed to be notified to the CQC. The service had very few incidents and people all reported feeling safe and well supported by staff. Staff spoken with were aware of their responsibilities to support people and had undertaken training to help them recognise abuse and knew what actions to take.

Staff supported people to take their medicines safety and as intended. They supported people to maintain good health and see health care professionals when appropriate to do so. People were offered a balanced diet and encouraged to think about their food choices in line with their assessed needs and food preferences. There was guidance for staff about people’s health needs and staff undertook specific training when appropriate. Most people had been supported to see the dentist and there were oral hygiene assessments in place.

We have made a recommendation about implementing The National institute of Clinical Excellence, (NICE) guidance in relation to oral hygiene.

Everyone apart from one person was deemed to have capacity and there were no unnecessary restrictions for people. Staff asked people for their consent before providing support and this was clearly documented in people’s care plans. There was information in people’s care plans about their personal information and how it might be shared in line with the updated General Data Protection Regulation (GDPR.)

People’s needs were assessed and reviewed and details of this were recorded in people’s care plans. Staff knew people well but further detail in care plans would help ensure people received greater continuity of care should they go into another setting such as hospital. The service was not currently supporting people at the end of their lives but further thought needed to be given to what people might wish to happen and staff needed appropriate training.

Staff were caring and demonstrated a real commitment to people they were supporting. They helped people feel safe and encouraged people to retain their independence and learn new skills. They had seen people grow in confidence and self-sufficiency.

Since the last inspection improvements had been made in terms of people’s access to the community and opportunity to embrace new things. A record of people’s achievements showed the service was more progressive in supporting people with positive mental health.

The service acted on feedback to improve the service. There had been no formal complaints because staff were responsive which helped ensure people received a suitable service. Audits documented how the service was being well managed and ensured the service was safe and clean for those using it. We found some anomalies to this.

Overall improvements had been made and we had confidence in the registered manager to continue to improve the service and make changes as required.

The service is registered to provide residential accommodation for up to eighteen people with a recognised mental health need. The service is not fully occupied and had ten people using the service when we visited with one person in hospital.

There is 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 service was fully staffed and had the number of staff it said it needed. The staff employed were observed to be extremely caring and compassionate and worked hard to enhance the lives of people they were supporting. They gave up their free time to support people socially. We found there were insufficient staff to meet people’s needs. Staffing levels had remained static for years despite an increase in people’s needs. Staffing levels did not enable people to go out when they wanted when they needed support to do so. Most people did require support to go out because of the remote location of the service. The manager was on shift supporting staff and trying to oversee the overall management of the service and associated upkeep of records and auditing. They did not have a deputy to delegate things to. Care staff were providing care and support as well as doing domestic duties and cooking. This impacted on their ability to take people out according to their expressed needs and wishes.

People received their medicines as intended by staff who were suitably trained to administer medicines but staff would benefit from more specific guidance about the use and when to administer medicines as required. Medication profiles would also help to ensure staff received their medicines according to their preferences.

Risks to people’s safety were mitigated as far as possible because staff were knowledgeable about people’s needs and sought advice when needed. There were individual and generic risk assessments in place. Equipment was regularly checked to ensure it was safe to use. The environment was restrictive for people with physical disabilities due to steep stairs and internal steps.

Staff recruitment was adequate but there were no audits on staff files and there was no evidence of how the interview process was used to determine that staff had the right skills and attributes for the job. Staff felt well supported by the manager who was very knowledgeable and understanding. However formal mechanisms of support were limited. Staff had supervision but they were not regular and staff did not have annual appraisals. Staff training and induction was good when first employed but there was limited evidence of opportunities for continued training and sharing positive practice. Most staff had higher qualifications and, or a care certificate.

People were encouraged to be involved in decision about their care. Everyone was deemed to have capacity. Staff were aware of the requirements of The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. When implemented correctly it ensures that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process.

Staff understood what constituted abuse and how they should respond to any allegations of abuse. However there had been a failure to notify CQC of different events affecting the well-being of people using the service and there was no provider oversight of this.

People were inadequately supported with their dietary needs. Staff involved people in menu planning and staff prepared meals with limited involvement from people. However we were concerned that although staff monitored people’s weights and referred any concerns to the doctor there was little evidence that staff supported people to achieve sensible weight loss or promote healthy eating. A number of people had serious medical conditions and their records did not show us how staff were helping people in trying to mitigate the risks. There was also little information about promoting positive mental health and minimising people’s anxiety. It was clear through our observations that staff were very attentive to people’s needs and told us about things people had achieved but this was not reflected in people’s care plans.

Staff were proactive in taking people to the GP and accessing other health care services. This helped ensure their health care needs were met.

Staff were supporting people to manage their own personal care and to contribute to the upkeep of the household. However no one was currently taking their own medicines and we could not see goals to help people become more self -sufficient. There was limited opportunity and social engagement for people outside the service.

Care plans documented people’s needs and were based on an assessment of people’s needs. Care plans were reviewed but did not record progress against goals. They also did not show clear actions in regards to incidents, change or unmet need and therefore were not sufficiently comprehensive.

There had been no complaints about the service and staff regularly asked people about how they were. There was limited family support so people relied on staff and, or advocates. The provider did not have an overarching quality assurance system and did not regularly seek people’s views about the service. The manager did hold three monthly resident meetings and asked them to complete surveys annually about how they rated the service. Surveys were not used to gauge staff and professional opinion and we could not see how feedback was used to improve the service. People we spoke with were happy with all aspects of their care and did not raise any concerns.

There were no formal audits of quality and standard of care being provided in line with the services business plan and statement of purpose. We could not see how the provider was monitoring its own service to ensure people’s needs were being met.

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

We spoke with four people living at Hazeldown and they all expressed satisfaction with the service. One person told us 'I don't see myself being anywhere else other than here; I think I will live out the rest of my days here.' They further commented that they liked their room and when asked told us that they had no suggestions for improvement to the service. We asked another person if they were happy living at the home and they responded 'Yes.' A third person commented 'I get looked after very well.'

We found that the home had appropriate arrangements in place to manage people's medicines safely.

The home was generally well maintained and safety checks were undertaken on a regular basis. We saw that recent checks had been undertaken from external agencies such as the fire service and an electrical testing company.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

During our initial inspection visit we found that mental capacity assessments and individual risk assessments were not being carried out appropriately.

We also found that quality monitoring processes were not being managed to ensure that staff received appropriate training, that service user feedback was acted upon and that incidents were monitored so improvements could be identified.

Following a request for information, the manager forwarded us documented evidence that action had been taken to address these issues. Upon our review of this evidence we found that improvements had been made.