Hazell Court

Hazell Court is a residential care home providing accommodation and nursing and personal care to up to 55 people. The service provides support to adults and people living with dementia. At the time of our inspection there were 46 people using the service.

Hazell Court is an adapted building over 4 floors and has 2 units. In the long-term unit people received personal care support without nursing. In the rehabilitation unit people received nursing care. The rehabilitation unit was commissioned by the NHS. People used the rehabilitation unit after a stay in hospital and were supported to return home.

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

There were systems in place to keep people safe from avoidable harm and abuse. 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 received their medicines when required and monitoring ensured discrepancies were identified and addressed. Staff were available when people needed them, and staff were recruited safely. The service was visibly clean, and monitoring reduced the risks of cross infection risks. People were supported to have visitors when they wanted them.

There were systems in place to monitor and assess the service provision. This supported the registered manager and provider to identify shortfalls and address them. We received positive feedback about the registered manager, the provider and how the service was led. People received person centred care which achieved good outcomes. Lessons were learned when things went wrong, for example, accidents, such as falls, and concerns were used to drive improvement to reduce them happening again.

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 good (published 30 November 2018).

Why we inspected

The inspection was prompted in part due to a concern received about the safe care provided. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good, based on the findings of this inspection.

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

During our comprehensive inspection on 16 and 17 October 2018, there were 41 people living in the main service and 12 people in the rehabilitation unit, 53 overall.

At our previous inspection of 20 October 2016, this service was rated Good overall. However, safe was rated requires improvement, this was because there were some improvements being made relating to how the service recorded when people received their medicines, which had not yet been fully implemented. At this inspection of 16 and 17 October 2018 we found improvements had been made in safe. We found the evidence continued to support the rating of Good overall. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. We found that people were provided with a very caring service and caring is now rated as outstanding.

Improvements had been made in safe and people received a safe service. There were systems in place designed to reduce the risks of abuse and avoidable harm. Where incidents had happened, the service learned from these and used the learning to drive improvement. Risks to people continued to be managed well. People were supported with their medicines in a safe way. Staff were available to support people and the systems to recruit staff safely were robust. There were infection control procedures in place which reduced the risks of cross contamination.

People continued to receive an effective service. People were supported by staff who were trained and supported to meet their needs. People had access to health professionals when needed. Staff worked with other professionals involved in people’s care. People’s nutritional needs were assessed and met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The environment was well maintained and suitable for the people using the service.

Without exception, people were provided with an exceptionally caring service. People's diversity was respected and all people were treated equally regardless of their specific needs. People shared very positive relationships with staff. Staff interacted with people in an extremely compassionate and caring way which had a positive impact on people’s wellbeing. People’s privacy, independence and dignity was respected. People were listened to in relation to their choices, and they and their relatives, where appropriate, were involved in their care planning. Staff knew people well and their care was tailor made to meet their preferences. People were valued and the service provided showed people that they mattered.

People continued to receive a responsive service. There were systems in place to assess, plan and meet people’s individual needs and preferences. People had access to social activities to reduce the risks of isolation and boredom. There was a complaints procedure in place and people’s complaints were addressed. People’s end of life decisions were documented to reduce the risks of people’s preferences about how they wanted to be cared for at the end of their lives not being met.

People continued to receive a service which was well-led. The registered manager had a programme of audits which demonstrated that they assessed and monitored the service provided. Where shortfalls were identified actions were taken to improve. People were asked for their views about the service and these were valued and listened to. As a result, the service continued to improve.

There were 55 people living in the service when we inspected on 20 October 2016. This was an unannounced inspection.

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.

Improvements were required to evidence that people had received their prescribed medicines. The registered manager was fully aware of the improvements required and was taking action to reduce the risks to people. These improvements were ongoing and not fully implemented and embedded in practice.

People received care that was personalised to them and met their individual needs and wishes. People were encouraged to be as independent as possible by a staff team who knew them well and where additional support was needed this was provided in a kind, caring, respectful manner.

There were sufficient numbers of staff who had been recruited safely and who had the skills and knowledge to provide care and support to people in the way they preferred, ensuring that they obtained consent before providing care.

Systems were in place which safeguarded the people who used the service from the potential risk of abuse and staff understood the various types of abuse and knew who to report any concerns to.

Staff knew how to minimise risks and provide people with safe care and there were procedures and processes which guided staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised.

People were encouraged to attend appointments with other health care professionals to maintain their health and well-being and people’s nutritional needs were assessed and people had a balanced diet.

There was an open and transparent culture in the service and staff were very motivated. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. Processes were in place that encouraged feedback from people who used the service and their relatives. An effective quality assurance system was in place and as a result the service continued to develop and improve.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service the administrator checked our identification and asked us to sign in the visitors book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service. One person said, 'I never thought I would need a home such as this but they do look after me well.'

We saw that all staff had received training in safeguarding of vulnerable adults from abuse. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

We found that people who used the service were protected against the risks associated with the unsafe use and management of medicines.

We reviewed staffing records regarding The Mental Capacity Act (MCA) 2005 in relation to Deprivation of Liberty Safeguards (DoLS) and saw this training was up to date. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The service had submitted DoLS applications properly using the correct policies and procedures.

Is the service effective?

There were systems in place to audit medication and care plans which ensured there were effective systems in place for monitoring the safe delivery of care.

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that staff had signed records to show they had been reviewed monthly and updated appropriately. The registered manager had arranged for recording times at the end of each shift for staff to update people's records. This meant that staff were provided with up to date information about how people's needs were to be met.

One person felt that the service did not provide sufficient drinks through the day particularly during hot weather. We saw in people's notes that their weight and fluid balance charts were recorded appropriately.

Is the service caring?

People told us that they received the care they needed. People living in the service told us that they were happy living there. Our observations showed that care and support was provided in a timely manner.

People who used the service had a care plan in place detailing their specific care needs and the support to be provided by staff.

Two people who used the service said they enjoyed the meals. One person said that they found the menu was not that well varied, but the food was well cooked.

Is the service responsive?

People's preferences and diverse needs had been recorded in accordance with people's wishes.

One person felt that they had to remind the staff to assist them to move from a wheelchair to a lounge chair. When they did the staff did move them using a hoist and they thought this was done correctly, respecting their dignity.

We saw people's care plans contained their chosen activities. During our inspection we saw the activities co-ordinator engaged in activities with people who used the service.

We found that there were appropriate arrangements in place pertaining to complaints management.

It was reported to us that the service used urine bottles to empty catheter bags which were old and discoloured. The service had replaced these with disposable bottles.

Is the service well-led?

The provider was able to demonstrate that there were systems in place to assess and monitor the quality of the service provided. The views of the people who used the service and staff had been sought. People's views about the service were noted to be positive.

Our observations suggested that people living at the service were happy, that they felt safe and were well cared for. It was evident that people who used the service had a good relationship and rapport with the staff who supported them.

People's health and personal care needs were assessed and there were detailed care plans in place for care staff to follow so as to ensure that people were supported safely and in accordance with people's individual preferences and wishes. Staff spoken with demonstrated a good understanding of people's health and personal care needs and how each person wished to be supported.

The provider was able to demonstrate that a robust staff recruitment policy and procedure was in place and followed to ensure that people living at the service were kept safe. Staff received appropriate professional development. We found that medication practices and procedures required improvement.

We looked at the personalised care and support people received and found this met essential standards. One person told that the staff were "Wonderful, caring and do what you ask of them".

We examined the environment and looked at procedures in place for cleanliness and infection control. Systems in place for infection control did protect people who used the service. In the process of looking at all bathrooms we took the temperature of two showers and recorded very high temperature that posed a risk of scalding. We have made a compliance action to protect people from this risk.

We examined a number of records and found that these were well kept.