The Care Quality Commission
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Archived: Hazel House Care Home

Overall: Inadequate read more about inspection ratings

30 Paradise Lane, Moss Side, Leyland, Lancashire, PR26 7ST (01772) 452750

Provided and run by:
Hazel House Nursing Home Limited

All Inspections

14 & 15 July 2015

During a routine inspection

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.

28 and 31 October 2014

During a routine inspection

This inspection took place over two days on 28 and 31 October 2014.  The first day was unannounced.  The second day was announced.

The last inspection of this service took place on 06 March 2013 when no breaches of regulations 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 37 people lived at Hazel House Care Home. The home is required as a condition of its registration to have a registered manager in place. 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.  At the time of our inspection the registered manager had left when the home changed its registration from a care home with nursing to a care home without nursing   providing personal care only and the new manager was in the process of applying to the Care Quality Commission (CQC) to register.

All the people we spoke with told us they or their relative felt safe and well cared for at Hazel House Care Home. We were told relationships between staff and people who lived there were positive. Procedures were in place to deal with the protection of adults and ‘whistleblowing’. Staff had received training about abuse and were able to tell us how they would respond to and report abuse. 

We observed that there were sufficient numbers of staff on duty to keep people safe. The home had robust recruitment processes in place and all staff received induction training which gave them the required skills to perform their role.

Policies and procedures were in place for medication. We looked at medication records, storage and checks. We were satisfied that people received their medication in a safe manner.

People we spoke with all felt that staff had sufficient knowledge to provide effective care. Training records we looked at confirmed that staff had received regular training. Staff told us they received regular formal and informal supervision which included observations of their practice.

We saw peoples’ health was monitored on an on-going basis and we found that changes to peoples care needs were communicated to staff and documented in care plans when needed.  People we spoke and their relatives told us they had been involved in arranging their or their relative’s care.

We found that the manager and staff at Hazel House had all received training in the Mental Capacity Act 2005 (MCA) and Deprivation of liberty Safeguards (DoLS). We saw evidence that this learning had been put into practice.

We saw from care plans we looked at that people were monitored closely and had their weight regularly recorded. Where concerns were noted, appropriate referrals were made to health and social care professionals.

People were asked about the food they received. Questionnaires were sent out on a regular basis and those we looked at were all positive. However, we found on the first day of our inspection not all people were happy with the food. We ate lunch with the residents in the dining room and were able to confirm what we were told.

The interactions we saw between staff and people who lived at Hazel House were very good. The care plans we looked at included information about people’s preferences, such as how they preferred to be spoken with as well as their personal history.

The home had recently changed from being registered as a nursing home to a care home without nursing. The home and staff had responded well to this change and staff we spoke with enjoyed the new challenges from this transition.

We looked at the care plans for three people who lived at Hazel House.  We found them to be personalised and had been regularly reviewed.

There were no restrictions on visiting and we saw people coming and going throughout our time at Hazel House. People were supported in promoting their independence and community involvement and liked to go out to the local shops with help from staff.

People we spoke knew how to make a complaint and had no complaints regarding the attitude or behaviour of carers.

The manager and her assistant were interested and committed to supporting people who lived at the home and staff to make a success of the transition from being a nursing home to a residential care home. A visiting health and social care professional confirmed with us that the management was good and staff were responsive and acted on advice they gave.

The home had systems and checks in place to monitor the quality of the care and service provided. We were shown a range of surveys, and questionnaires which were sent out to people each year and covered a variety of areas of the service provision.

We saw from care plans and other records we looked at that the home worked well with other agencies and partner homes. The home was open to scrutiny and had undergone accreditation with a number of  external organisations.

5 December 2013

During a routine inspection

The residents and relatives we spoke with were generally complimentary about the standard of care and treatment. Comments included; 'I am kept well informed. Everything is explained to me.' 'I get the care that I need.' And 'The staff are very good.'

There were systems in place to check, monitor and address the on-going maintenance of the building. Records confirmed fire safety equipment was regularly checked. These checks helped to protect the health and safety of people living and working at the home.

The home had a robust recruitment policy and associated procedures in place to help ensure that people employed were of suitable character and had the necessary skills to perform their duties.

The provider organisation had both internal and external procedures in place to assess and monitor quality.

People living at the home and their relatives were made aware of the formal complaints procedure. The relatives we spoke with confirmed they felt able to speak with senior staff if they had a concern and were confident it would be dealt with.

6 March 2013

During a routine inspection

People told us they were satisfied with the care and support provided at Hazel Hall. They told us, 'They are good here' and 'I have been impressed with the treatment and care'.

We found people experienced some good care and support. They told us they were treated with respect. People were getting support with their healthcare needs and they had ongoing attention from health care professionals.

People were being involved as far as possible in planning their care and were enabled to make decisions about matters which affected them. People were encouraged to maintain and develop their independence skills.

People had no concerns about their care and treatment; they said they felt safe with the staff. They told us they liked the staff.

We found some parts of the home did not effectively promote peoples' well being, dignity and privacy. The provider gave us assurances during the inspection, that these matters would be addressed.

During an inspection looking at part of the service

At our last inspection visit on 9 August 2011 we were concerned that some of the essential standards of quality and safety were not being met. We asked the service to send us a report that explained what action they intended to take to respond to our concerns.

The service recently sent us an up to date copy of their 'improvement plan' as part of this review. This gave us sufficient information to determine that the service had responded promptly and appropriately to our concerns and was compliant, therefore we did not visit the service or speak directly with people who used the service. However their experiences were captured through other information.

At the last inspection we observed staff treating people in a friendly and respectful manner but found that the staffing levels and the routines of the home were affecting peoples' daily choices. Recent changes to the staffing levels and routines of the home ensured that people's needs were being met and they were given more choices and more flexibility in their routines.

An improvement in the way information was recorded had ensured that people received the care and support they needed and that the records reflected this.

At the last inspection visit we saw that systems were in place to obtain peoples' views and opinions and that people were able to influence the way the home was run. However we were concerned that poor communication between management and the staff team could impact on the care that people received. We were told there had been an immediate review of all methods of communication between staff and management and that communication had significantly improved.

9 August 2011

During a routine inspection

People told us they were given choices about how to spend their day although for some who needed assistance it depended on the availability of staff. Comments included "I can go where I like", "people have to wait sometimes as staff are so busy" and "you can do what you want as long as you don't have to wait for staff".

We were told that people were able to influence the way the home was run and that regular meetings were held. One visitor said they had not attended any meetings but enjoyed the newsletter as it was "very interesting" and a 'resident' said "I don't go to meetings but I am invited".

People said "there is plenty to do but you don't need to join in if you don't want to" and "there are different things going on".

People told us they were involved in decisions about their care and visitors told us they were kept up to date.

All the people that we spoke to told us they were happy with the care and support they

received. They all told us that staff worked very hard to make sure they were looked after properly. Comments from visitors included "my relative is looked after very well" and "people are given very good care in difficult circumstances".

People told us they were happy with the meals and that they were always offered an alternative. Comments included "I enjoy the meals", "I like the food, we have a good cook; she knows what I like", "we get lots of drinks through the day" and "the food is very good, there is always plenty to eat".

People said they felt safe; they told us they were confident to speak up if they had concerns and that the manager and staff often asked if they were comfortable and happy. Comments included "the staff are very good with people" and "the staff are very kind to me".

People were happy with the staff team and told us that they worked very hard and were caring, patient and kind. However we were told by various sources that there were not always sufficient staff to meet the needs of the people who used the service.

People who lived at Hazel House told us about the staff; they said "they are always very busy and I sometimes have to wait", "I can get up later if I want but you need to wait for staff", "staff are very busy and not always around" and "there seems to be enough staff".

Visitors told us "that staff don't have the time to do the little things", "people have to wait as staff are so busy", "there are a nice team of staff but there are not enough of them" and "staff always seem rushed".