Archived: Hazel House Care Home

Updated 2 September 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place across two dates 14 & 15 July 2015 and was unannounced.  We returned to the service at 23.00hrs on 14 July 2015 and undertook an unannounced night visit, our visit completed at 03.00am.

The inspection team consisted of two adult social care inspectors, a specialist advisor in dementia care and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience had personal experience of caring for someone who has lived with dementia.

Prior to this inspection we looked at all the information we held about this service. We reviewed notifications of incidents that the provider had sent us since our last inspection and we asked local commissioners for their views about the service provided. We also requested feedback from community professionals, such as district nurses, the local Commissioning Group and social work professionals from adult safe guarding. Comments about this service are included throughout the report.

We have received on going communications from the provider, new manager and professionals within Lancashire County Council.  We were told that the service was under continual contractual monitoring by Lancashire County Council since April 2015 and we received minutes from safe guarding strategy meetings held to discuss organisational concern. Minutes from a safeguarding meeting in July 2015 showed that the service was making improvements in line with the action plan set by the local authority.

The day before the inspection we received information of concern that we have communicated to the local authority safeguarding team for investigation. We used the information from this concern to focus on some specific areas during this inspection.

We engaged with all the people who lived at the service, however feedback was variable due to some people living with dementia being unable to reliably communicate. We spoke with five relatives, seven care assistants, one domestic, two senior care assistants, training and governance manager, the manager, a representative of the provider and the nominated individual.

The nominated individual is employed as a director, manager or secretary of the organisation (i.e. they should be a senior person, with authority to speak on behalf of the organisation). They must also be in a position which carries responsibility for supervising the management of the carrying on of the regulated activity (i.e. they must be in a position to speak, authoritatively, on behalf of the organisation, about the way that the regulated activity is provided).

We looked at ten people’s care records, staff duty rosters, three recruitment files, training records, management audits, medication records and quality assurance documents.

Updated 2 September 2015

This inspection took place across two dates 14 & 15 July 2015 and was unannounced.

The last inspection of Hazel House Care Home was 28 October 2014 and the service was rated as good, with a requires improvement rating in place for 'is the service effective'. No regulatory breaches were found.

Hazel House is set in its own grounds and is located on the outskirts of Leyland town centre. The home has two floors with a passenger lift. The home provides personal care for up to 43 people. At the time of our inspection 27 people lived at Hazel House Care Home.

The manager was available throughout our visits and received feedback during, and at the end of the inspection. The manager was employed by the provider in June 2015, the manager told us that they intended to apply to 'The Commission' for registered manager status.

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.

We engaged with all people living at the home, feedback varied due to some people having limited communication skills. We spent time observing care delivery and spoke with people who visited the service.

We received mixed feedback when we asked people if they felt safe living at Hazel House Care Home. 

We found that people were not always protected against avoidable harm and quality assurance systems at the home failed to identify or resolve associated risk, therefore placing people at significant risk of harm and neglect.

We found that people’s safety was being compromised in a number of areas. This included how people were assisted to eat and drink, unsafe moving procedures, how well medicines were administered, infection prevention, staff knowledge of essential care standards and suitability of pre-employment checks for staff prior to recruitment.

We found a number of premises issues that compromised peoples safety, these included; garden security, lighting in bathrooms, unsecure hand rails and failure to undertake monthly maintenance checks.  The home had a distinctive malodour throughout communal living areas.

The principles of the Mental Capacity Act 2005 (MCA) had not been embedded into practice and we identified concerns relating to how people’s mental capacity had been assessed prior to depriving them of their liberty. 

We found insufficient evidence of staff training and development. Staff told us that they felt supported by the new manager, however explained that they have not felt confident to disclose their concerns to previous managers at the service and they felt this had contributed to a deterioration in care standards.

We found that people's dignity was not always considered.  People were not responded to in a timely manner and we observed people to have unmet needs, such as calling out in pain, asking for the bathroom and requesting support.  Staff did not seem to acknowledge non-verbal signs of communication for people living with dementia and we observed care to be task focused.

We found that people’s health care needs were not appropriately assessed therefore individual risk factors had not been fully considered, placing people at risk of avoidable harm.  We looked at care records and found significant gaps in reviews of people's needs.  Care planning was not person centred.

We received variable feedback from relatives; some expressed positive comments about the care provided whilst others were concerned about the lack of responsiveness from the provider when they raised concerns.

We did not find evidence of robust management systems in the home and quality assurance was not effective in order to protect people living at the service from risk.

Staff were not provided with effective support, induction, supervision, appraisal or training. The home did not have effective governance systems in place to ensure that improvements can be made.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to peoples safety,  staffing, the safe administration of medicines, nutrition and hydration, premises safety, governance, person centred care and dignity and respect.  We have deemed that the overall rating for this service is inadequate.

We found people living at the service experienced inadequate care which in some cases had a imminent risk to their health and wellbeing.

We want to ensure that services found to be providing inadequate care do not continue to do so. Therefore we have introduced special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to cancel their registration.

Services rated as inadequate overall will be placed straight into special measures. You can see what action we have taken at the end of this report.