Hazel Bank Care Home

Hazel Bank Care Home is a residential care home providing personal and nursing care to up to 39 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 20 people using the service.

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

The provider had taken positive action to address the issues from the last inspection. They had made improvements to the way the quality and safety of the home was monitored. This meant people’s experiences of the care and support provided had improved.

Improvements were required to how staff were recruited. We have made a recommendation the provider reviews their systems for monitoring checks in line with good practise guidance. There were enough staff to keep people safe and they had the skills and experience to support people appropriately. Staff were kind and caring and they demonstrated commitment to providing person-centred care for people. We saw people and staff had warm and trusting relationships.

Care plans contained person-centred information and risks relating to people’s health, safety and welfare were assessed. Medicines were generally administered safely but improvements were required to how some topical medicines were managed. We have made a recommendation the provider reviews how this is monitored. The home worked in partnership with health and social care professionals to ensure people’s needs were met. Staff supported people with their nutritional needs .

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. We found improvements were required to ensure where capacity assessments and best interest decisions were required, they were completed robustly. We have made a recommendation the provider reviews the guidance and training for staff in relation to the Mental Capacity Act.

The registered manager was approachable and visible. They had initiated changes which had led to a range of improvements for people and staff. There were a range of audits and quality checks in place, which included increased oversight from the provider. People, relatives, and staff provided consistent positive feedback about the improvements at the service since the last inspection. The provider was responsive to feedback throughout the inspection and demonstrated their commitment to ongoing improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 2 June 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended the provider reviewed systems and processes to monitor the deployment of staff and how people’s nutrition and hydration intake was monitored. At this inspection we found the provider had acted on the recommendations and made improvements in both these areas.

This service has been in Special Measures since 2 June 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. 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 changed from inadequate to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Hazel Bank Care Home on our website at www.cqc.org.uk.

Recommendations

We have made recommendations the provider reviews the guidance and training for staff in relation to the Mental Capacity Act and improves their staff recruitment checks. We have also made a recommendation they review how they monitor the safe use of topical medicines.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hazel Bank Care Home is a residential care home providing personal and nursing care to up 39 older people and people living with dementia. The service provides support to older people and people living with dementia. At the time of our inspection there were 32 people using the service. Hazel Bank Care Home accommodates people in one adapted building.

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

Serious shortfalls were identified which impacted on the safety and quality of care people received. Specific issues we raised at the last inspection in relation to the management of risk and good governance had not been addressed. The registered manager had left since the last inspection and a new manager had recently started in post. There was a lack of effective leadership at provider level and governance arrangements had failed to identify the significant issues we found at this inspection.

People were at risk of harm as systems were not in place to assess, monitor and review risks relating to people’s health, safety, and welfare. Medicines were not managed safely which exposed people to the risk of harm. Accidents and incidents were recorded but there was not always a clear overview and action was not always taken to mitigate future risk. Care plans were inconsistent and monitoring records were not routinely completed. Where new people were admitted to the service detailed information was not always available to staff to ensure they were able to provide safe care and treatment.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Feedback from people and relatives was generally positive and we observed some warm and caring interactions between staff and people. However, we also observed multiple occasions where people were not treated with respect and dignity. We saw staff were sometimes rushed and task orientated. The provider had a dependency tool in place to assess the number of staff required. We have made a recommendation about reviewing this to ensure enough staff are deployed effectively across the day.

The service worked closely with other health and social care professionals. People’s nutritional and hydration needs were generally met although people’s dining experiences were varied and monitoring records were not always clear. We have made a recommendation the provider reviews the meal’s service and how this is monitored.

Staff received the training and support they required to carry out their role. They had recently undertaken refresher training in a range of subjects. Improvements had been made to how staff were recruited to ensure this was coordinated and monitored safely. Systems were in place to control infection.

The provider was responsive to inspection findings and provided assurances they would make the required improvements to improve the safety and quality of care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was requires improvement (published 10 January 2023) and there were breaches of regulation.

Why we inspected

We undertook a targeted inspection to check whether the Warning Notices we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

During the inspection we found other areas of concern, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective, caring, and well-led.

Enforcement and Recommendations

We have identified repeat breaches in relation to safe care and treatment, dignity and respect and good governance. We also identified new breaches in relation to person-centred care, medicines management and compliance with the Mental Capacity Act.

We have made recommendations about staffing levels and people’s nutrition and hydration.

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.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Hazel Bank Care Home is a residential care home providing personal and nursing care to up to 39 people. The service provides support to older people and people living with dementia. On the first day of the inspection there were 31 people using the service. On the second day of the inspection there were 29 people using the service.

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

Risks to people’s health, safety and well-being had not been effectively assessed and reviewed. This included risks relating to moving and handling, skin integrity and people’s mental health. Specific issues we had raised at the last inspection had not been addressed. The provider was unable to demonstrate robust governance arrangements and evidence of lessons being learned. Systems and processes were in place but they had failed to identify shortfalls and drive improvements.

Safe recruitment practises were not followed, as the required background checks had not been undertaken before staff started work at the home. Medicines were handled safely but records relating to topical medicines and prescribed fluid thickeners required some improvement.

People’s dignity was not always maintained. Staff did not consistently treat people with compassion and respect. Staff were task orientated which meant people did not always receive the support and reassurance they needed.

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.

At our last inspection we recommended cleaning schedules were reviewed. At this inspection we found the provider had increased oversight of this and there was a dedicated housekeeper in post. Effective infection prevention and control measures were in place.

Most people and relatives told us they felt safe and there were enough staff to meet people’s needs. Staff and people spoke positively about how the home was managed and said the manager was visible and approachable.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 August 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced focused inspection of this service on 23 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led.

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 changed remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hazel Bank Care Home on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staff recruitment, dignity and respect and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hazel Bank is a residential care home providing personal and nursing care for people aged 65 and over. The care home accommodates 39 people in one adapted building. At the time of the inspection there were 29 people living at the home.

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

People were not always safe. Risks to people were not always appropriately assessed and managed. Systems to monitor and check the service were in place but these needed to be more thorough to ensure the service consistently met the required standards.

Medicines were not always managed safely. The systems in place to ensure people were administered prescribed topical medicines were not effective. The home was generally well maintained but cleaning records were incomplete.

We have made a recommendation the provider reviews how cleaning schedules are managed and monitored.

Recruitment was managed safely. The staff team were consistent and experienced and had the skills to support people safely. There were links with health professionals and other agencies to ensure people’s health needs were met and changes responded to promptly.

The home and garden were accessible and well maintained.

People who used the service, relatives and staff provided good feedback about their experience. People said they felt safe and staff were caring and kind. We observed a warm and welcoming atmosphere in the communal areas of the home. There had been a lack of consistent leadership in the home, but a new manager had recently been appointed. They were working closely with the provider, staff team and people living at the home to make improvements and were committed to enhancing the quality of 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 good (published 22 December 2017).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding concerns and reduced staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report. The provider took immediate action to mitigate the risk to people.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hazel Bank on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk and medicines management and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

The designated area is a separate self-contained unit within the home. It was clean and well ventilated.

All the bedrooms within the designated area are single rooms with ensuite facilities.

PPE stations were located throughout the designated area and signage was available to ensure staff knew how to apply and remove their PPE safely.

The home is currently closed to non-essential visitors due to national lockdown restrictions. People are supported to keep in touch with family and friends through regular telephone and video calls.

We were assured that this service met good infection prevention and control guidelines as a designated care setting

Further information is in the detailed findings below.

Hazel Bank provides accommodation, personal and/or nursing care to up to 39 people who may be living with dementia or other mental health issues. At the time of our inspection there were 33 people living at the service.

A registered manager was in post who was planning to step down and deregister with the Care Quality Commission (CQC). An acting manager had recently been employed who was planning to register with the Care Quality Commission. 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.

Safeguarding processes were in place. Staff had been trained in recognising and reporting signs of abuse. Accidents and incidents were appropriately reported and investigated with actions taken to protect people. Assessments were in place to mitigate risk to people and these were updated to reflect changing need.

Medicines were managed safely. People received medicines appropriately from staff trained in the safe administration of medicines.

The service was clean and mostly well maintained. Staff had access to equipment designed to prevent the spread of infection such as gloves, aprons, hand sanitising gels and wipes. The provider took immediate actions to address concerns we raised with heating and hot water on the top floor.

Staff were recruited safely and had received appropriate training to offer safe and effective care and support. Safe numbers of staff were deployed at the service and staff were able to spend quality time with people. Staff received regular supervision and appraisal and felt supported by the management team.

The service was compliant with the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Best interest decisions were evident in people's care records. People were consulted about their choices/preferences and their consent sought prior to care and support tasks. People and/or their relatives were involved in the planning of their care. Care records were individualised, up to date and relevant to people's needs. People's end of life wishes were documented and advanced care planning in place where appropriate.

People received a varied and nutritious diet. People at nutritional risk had their weight and food/fluid intake monitored. However, better documentation was required to reflect people were receiving sufficient fluid intake.

We saw good evidence of staff providing compassionate and caring care. People's privacy and dignity was respected. People with specific needs such as sensory loss or cultural requirements were supported to ensure they were involved with the day to day life of the service. Information about people was displayed in their bedrooms as a quick guide for staff. This helped staff understand people's likes, dislikes and care needs.

An activities programme was on offer, according to people's wishes which included regular activities within the home and trips out.

People's health care needs were met through good communication with the multi-disciplinary team such as GPs, district nurses, opticians, community matron and dentists. The service used video links to aid further access to a telemedicine service which meant some people required less visits to hospitals.

A robust complaints procedure was in place. Minor concerns were also documented and investigated with actions taken as a result. people told us they were happy with the service and were able to approach the management team if they had any concerns.

A range of quality assurance tools were in place to monitor and drive improvements to the service. People's opinion of the service was sought through regular meetings, surveys and informal discussion. The provider and management team were a visible presence within the service and led by example.

Staff were well motivated and morale at the service was good. Staff felt supported by the management team and their opinions were sought through annual questionnaires and regular staff meetings, during which updates, concerns and feedback was shared.

Before the inspection we reviewed all the information we held about the home and contacted the local authority Adult Protection Unit and Contracts and Commissioning Team. On the day of the inspection we looked around the premises, observed staff interactions with people who lived at the home and looked at records. There were 33 people living at the home on the day of the visit; 14 of whom required nursing care and 19 required residential care. Five people living at the home were living there on a temporary basis following a fire at their sheltered housing accommodation.

At the last inspection in September 2013 the service was found to be meeting the regulations we looked at.

Before this visit we had received information of concern about how the home dealt with complaints. We found evidence which supported this information.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key 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. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

There were some systems in place to protect people who lived at the home from abuse and avoidable harm. For example people's medicines were stored safely and administered as prescribed and care was planned and delivered in a way that ensured people's safety and welfare. There were sufficient numbers of suitably qualified staff to meet the needs of the people who lived at the home.

However we found care staff had not had appraisals or first aid training. The lack of qualified first aiders at the home meant people who lived at the home may be at risk in the event of an emergency. We have asked the provider to make improvements.

We also found the premises and grounds at the home were not adequately maintained. This meant people who lived there were not living in safe surroundings that promoted their wellbeing. We were particularly concerned that the temperature of the hot water at the home was not adequately controlled; this meant vulnerable people were at risk of scalding. We have asked the provider to make improvements.

Is the service effective?

Peoples' care, treatment and support at the home achieved good outcomes and promoted a good quality of life for the people that lived there. People told us they were happy with the care provided at the home and their care and support needs were being met. One person said, 'I've been here for about 12 months, I was in another home before but I like it much better here. I'm happy here.'

From our observations and from speaking with staff, people who lived at the home and relatives we found staff knew people well and were aware of peoples care and support needs. We also found staff had received appropriate training to meet peoples' needs.

We saw there was equipment such as adapted baths and grab rails in place. These enabled people to maintain their independence.

The care plan for one person (who was cared for in bed) identified they were at risk of developing pressure sores. We saw this person was regularly turned from side to side and these actions were consistently recorded. After a prolonged period of bed rest the person had not developed tissue damage; this demonstrated the effectiveness of care given.

Other people's care plans where the potential for tissue damage had been identified showed effective care delivery. No pressures sores had developed and one person admitted with a pressure sore had seen their pressure areas restored to full health.

Is the service caring?

We saw staff treated people with dignity and respect and maintained their privacy and dignity. We heard care staff speaking courteously and kindly with people, asking permission before helping to support them and explaining what was happening.

We observed people who lived at the home were supported by caring and attentive staff who were patient and encouraging when they were supporting them. We observed how staff interacted with people whilst medicines were administered. Staff were respectful when they spoke with people and enabled people to take their medicines in an unhurried manner. We also observed lunchtime in the dining room and saw it was a sociable experience for people.

During our visit we saw the atmosphere was calm and relaxed. Some people were relaxing in their own rooms. Others were chatting in the lounges or watching television. People appeared comfortable and were well dressed and clean, which demonstrated staff took time to assist people with their personal care needs. One person told us, "They help me with washing and dressing and are very kind."

This showed us staff treated people who lived at the home with compassion and respect and encouraged them to retain their independence here where possible.

Is the service responsive?

Care and support was provided in accordance with peoples' preferences, interests and diverse needs. Records we looked at, discussion with staff and observations showed that people's wishes were respected and acted upon.

People had access to activities and were supported to maintain relationships with their friends and relatives. We also saw care staff regularly visited people cared for within their own rooms. Published research evidence suggests that keeping people regularly occupied and stimulated can improve the quality of life for people with dementia.

There was a full activities programme in the home which included organised games, quizzes and musical entertainment. The home employed activity coordinators to organise the programme. One person, who was sat in the lounge, told us, 'I'm not bothered about joining in with the quiz; they are always doing things here though.'

This meant the home was organised so that it met peoples' social and emotional care needs, in addition to their physical care needs.

Is the service well-led?

We found people were not protected against the risks of inappropriate or unsafe care because the provider did not have effective systems to assess and monitor the quality of service people received. We have asked the provider to make improvements.

We also found the complaints system at the home was not effective. Comments and complaints people made were not responded to appropriately. We have asked the provider to make improvements.

In this report the name of registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still registered managers on our register at the time.

The home manager told us they had been in post since March 2014. They told us they had applied to the Care Quality Commission to become the registered manager at the home. People and their relatives we spoke with gave positive feedback about the new manager.

A relative said, 'We have had issues in the past but things appear to be improving.'

We found people's risk assessments and care plans were person-centred and the care plans we reviewed clearly set out what the needs of people were including their specific likes and dislikes. We found staff were polite and attentive to people's needs.

We found the environment of the home, in most areas, to be visually clean but some areas required extra attention to detail, for example, underneath lounge tables and the environment in the laundry room. People's rooms were clean and appeared comfortable.

We found staff were effectively trained and supported in order to carry out their duties affectively and received regular one-to-one sessions with the registered manager and annual appraisal. We also found the provider had an effective complaints process and the registered manager was able to manage complaints and follow them through to a satisfactory conclusion.

During the inspection we spoke with four people who used the service and the two visiting relatives. We also spent time observing how staff interacted with people and how care and support was provided. One person who used the service said they liked it at the home and they "got along with all of the staff". Another person said staff were polite and they enjoyed the food. One relative we spoke with said they were happy with the care being provided and their relative "loved the food".