Archived: Hazelhurst Nursing Home

The inspection took place on 22 March 2016 and was unannounced.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 were supported by staff who knew how to keep them safe and how to care for them in a manner which respected their choices and preferences about how their care was provided. People’s consent was sought before assisting people with their personal care, and people were given explanations by staff as they assisted them with their care needs. People were treated with dignity and respect and staff understood people’s right to privacy. People received their medicines safely and only from suitably trained staff. People were told what their medicines were for, and were given the right to refuse them.

People’s health and well-being needs were known by staff and were kept under review. When people’s needs changed, the provider was able to respond to these needs and referred to other health professionals when this was required. People were given choices in the food they ate and were supported and encouraged to keep hydrated and to eat a healthy, balanced diet. People’s individual dietary needs were known by staff and were met appropriately.

People enjoyed the activities they were offered and were involved in deciding what activities and events they would like to do. Activities were tailored to reflect people’s preferences and to prevent social isolation. People knew who the registered manager was and how to voice any complaints, suggestions or concerns. Relatives and health professionals were encouraged to provide feedback on the home and to make suggestions for improvements. Where suggestions were made, the registered manager and provider acted on these, which created a culture of openness and transparency.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. We talked to eight of the 28 people living in the home and two visiting relatives.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

The people we spoke with told us they felt safe in the home. One person told us, 'I don't see any bad practice here.' The provider had taken reasonable steps to protect people from abuse.

Appropriate arrangements were in place to manage medicines. This meant that people were protected against the risks associated with medicines.

Risks to people had been identified, assessed and kept under review. Qualified and care staff were provided with training suitable for their role so they could provide care and treatment safely.

Effective systems were in place to ensure people were living in a building that was well maintained, clean and hygienic.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People told us that they felt the service met their needs. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and worked hard to provide a personalised service.

The care assessment and planning systems were effective in ensuring that needs and issues were identified and followed up. Care and treatment decisions were appropriately discussed with people, their relatives and external professionals to ensure they were in a person's best interest.

Staff told us they felt well trained and supported in their role. We saw that training was planned and qualified staff had the opportunity to continue their professional development.

Effective systems were in place to ensure people had access to the equipment they needed that was in good condition and had been regularly serviced.

Is the service caring?

We spoke with eight people who used the service and two relatives. People told us that they had their care and health needs met and that staff understood what support they required. Comments included, 'They let me still do things for myself' and 'Yes, they are kind and always help you.' One person's relatives told us the care was good. They said, 'You can't fault it."

Staff interactions were supportive and respectful. They responded well to people's needs offering reassurance and guidance where needed. We observed a relaxed, yet respectful atmosphere in the service.

Is the service responsive?

We found that the service had responded to concerns raised at the previous inspection and taken action to improve standards and change the culture within the home. The registered manager and staff felt confident that people using the service were having their needs met in a caring and responsive way.

We found that care was being delivered in a more personalised way with greater consideration given to the needs of people living with dementia. Individual requests had been listened to and arrangements made. For example, one person had their own garden area and was growing plants with long handled tools bought to assist him.

The provider had sought the views of people's representatives formally through the use of annual satisfaction questionnaires and quarterly residents and relatives meetings. People including staff were encouraged to use a suggestion box and these were followed up by the registered manager. Relatives told us that they had not made a complaint, but they knew what to do and felt confident that their concerns would be listened to. The service's complaints records showed that concerns and complaints were responded to.

Is the service well led?

The service had a registered manager in post, who was well supported by a deputy manager who was the clinical lead nurse. The provider was closely involved, they visited twice a week and held meetings regularly to monitor the operation of the service.

The registered manager showed us the improvements made since our last inspection. They had increased the level of supervision of care delivery by senior staff and developed a more open culture where staff could raise issues and make suggestions of how the service could be improved.

The systems to monitor the service had been improved. The registered manager said the provider was forthcoming with funding for environmental improvements and training. Professional support had been commissioned from an external provider for health and safety and human resources advice and associated policies were being reviewed as part of this process. There was scope for more formal auditing and competency monitoring.

Staffing deployment at mealtimes and in the morning meant some people had to wait for their food and for their morning personal care routines. This was raised at the last inspection. The quality assurance systems had not been effective at identifying that outcomes for people still needed to be improved in these areas. The registered manager told us they would take prompt action to address and improve people's experiences.

Staff were kind and caring in the way that they spoke with people and provided their care. Some aspects of people's care had not been assessed or managed appropriately. People sometimes had to wait for staff to attend to their care needs.

People were supported to eat a nutritious and varied diet. Staff provided sensitive support to people who needed assistance with eating and drinking.

The home had effective procedures in place to make sure that only suitable staff were employed. The systems for managing risk and for monitoring the quality of the service were not always effective.

At our previous inspection in May 2012, we found that the home was not managing medicines safely. A pharmacist inspector visited the home to check whether the necessary improvements had been made. We found that the home had made some improvements, but that there were still concerns about the management of medicines.