Hazelmere House Care Home

About the service

Hazelmere House a nursing and residential care home providing personal and nursing care to 40 people at the time of the inspection. The service can support up to 56 people in purpose-built accommodation over two floors.

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

Care and nursing plans were comprehensive, detailed and up to date that detailed people’s current care needs and included how to safely manage any identified risks. Medicines were managed safely by trained staff and people received their medicines as prescribed. The home was very clean and used stringent infection control measures to reduce the risk of COVID-19. Staff were aware of individual risks to people and were knowledgeable about how to safeguard people from abuse. Staff had undergone comprehensive induction, training and safe recruitment checks before providing care.

The home had a manager and clinical lead who were both dynamic, knowledgeable and aspired to provide the best care possible. Feedback from staff, people and relatives about the quality of the service was sought out and valued by the manager and used to drive improvements. Staff told us they felt very supported by an approachable management team and were kept up to date through regular meetings and supervisions. Staff felt they could raise any concerns or ideas for improvement and their comments would be listened to and acted upon. Effective quality assurance and clinical governance systems were in place to ensure oversight of the operations of the home. The manager carried out a comprehensive set of audits and checks to ensure the safety and 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 29 May 2019).

Why we inspected

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 received concerns in relation to infection control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 remained good. This is based on the findings at this inspection.

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.

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

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.

Hazelmere House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during the inspection. Hazelmere House has the capacity to support up to 60 people; at the time of the inspection 36 people were living at the care home.

People’s experience of using this service:

The quality of safe care and treatment people received had improved since the last inspection. We saw that people’s level of risk was determined from the outset and measures were in place to keep people safe.

Effective quality assurance measures were in place. Processes and systems to assess and monitor the provision of care had improved since the last inspection. Audits and checks were routinely completed; these helped to maintain a good level of high-quality, person-centred care.

People told us they felt safe. The registered provider had measures in place to ensure people were protected from harm and abuse. Safeguarding procedures were clearly in place and staff were familiar with the processes that needed to be followed.

Staffing levels were analysed and reviewed in relation to the dependency needs of people who were living at Hazelmere House. Staffing levels were appropriately managed and staff were effectively deployed across the home.

People received care and support from staff who had been appropriately vetted and had undergone the necessary pre-employment recruitment checks.

Medicine management procedures were safely in place. Staff were appropriately trained, had their competency levels checked and were familiar with best practice guidance and the up to date medication administration policy.

Robust health and safety checks were in place and regulatory compliance was maintained. Up to date certificates were in place for gas, electricity, legionella and fire safety.

The registered provider was complying with the principles of the Mental Capacity Act 2005. People were appropriately assessed from the outset and measures were in place to ensure people were not unlawfully restricted.

Staff were supported with training, learning and development opportunities. Training was up to date, staff were regularly supervised and told us they felt supported on a day to day basis.

People’s nutrition and hydration support needs were assessed from the outset. People had access to external healthcare professionals and guidance was incorporated within people’s care records.

We observed kind, compassionate and caring interactions between staff and people receiving support. We received positive feedback about the dignified and respectful approach of staff and it was clear that staff were familiar with people’s preferences and wishes.

People were encouraged and supported to participate in a range of different activities. There was a dedicated activities co-ordinator in post; they arranged a variety of activities based around people’s enjoyments and interests.

The registered provider had formal complaints process in place. Complaints were regularly reviewed, discussed and responded to in line with company policy.

Rating at last inspection: At the last inspection the service was rated ‘Requires Improvement’ (Report published May 2018). Following the last inspection, the registered provider submitted an improvement plan which we checked during the inspection. We found that improvements had been made.

Why we inspected: This was a scheduled inspection based on previous ratings.

Follow up: We will continue to monitor the quality and safety of care being provided and return to inspect the service as per inspection schedule.

Hazelmere House Care Home Nursing Home provides accommodation for up to 56 people who have nursing needs. At the time of our inspection there were 38 people living at the home, two of whom were in hospital. The home provides a wide range of long and short term nursing and residential care for older people. All bedrooms in the home are en-suite and communal facilities include a large conservatory and bar area. There is wheelchair access and a secure keypad entrance. Car parking is available to the front and side of the building.

This service was last inspected in June 2016 where we rated the service as requiring improvement. We identified breaches of regulations 11 (Need for consent), and 17 (good governance). After our inspection June 2016, the provider submitted an action plan to the Commission outlining the action they would take to improve the service.

The care home had a registered manager. 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.

There had been a change in registered manager since our last inspection in 2016. The new manager successfully registered with the Care Quality Commission in September 2017.

At this inspection we found that the new registered manager was working diligently and was making significant improvements in the management of the home and staff. On taking up their new position they had carried out their own assessment of the home’s compliance with the requirements of the Health and Social Care Act 2008 and associated Regulations and had identified that significant improvement was required to ensure the safety and wellbeing of the people who lived at the home.

On this inspection we identified further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 on safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of this report.

The atmosphere in the home was welcoming and sociable. People told us that they were well cared for and spoke highly on the manager and staff.

People told us that they felt safe living in the home and staff were committed to providing good standards of care.

Measures designed to reduce risk were not always put into practice so some people remained at risk of harm or their needs not being met.

Safeguarding systems, processes and practices protected people form abuse, neglect, harassment and breaches of their dignity and respect.

There was an adequate number of suitably trained and experienced staff on duty to meet the needs of the people who lived at the home.

Staff recruitment procedures and process were thorough, with all appropriate checks being made to make sure new employees were suitable to work with vulnerable people.

Staff were well trained and well supported. They told us that they appreciated the support, direction and leadership provided by the management team and their morale was good.

We could see that people were involved in decisions about their care. They told us that staff listened to them and acted on what they said. However, staff needed further training on gaining consent to care and did not always complete assessment in accordance with the Mental Capacity Act 2005 (MCA), Code of practice to ensure people receive the right support to assist them with their decision making.

People enjoyed a varied and nutritious diet, which catered for their individual needs and preferences. They were fully engaged in assessing the quality and presentation of meals served, via residents and relatives meeting and were able to give direct feedback given to the manager and staff.

Social activities were organised in the home which were tailored to peoples’ individual needs. They told us that they enjoyed them and the activities coordinator who organised them was excellent at their job.

Staff were aware of the need to support people approaching the end of their life but care planning arrangements were not always person-centred to ensure their wishes and needs were understood, met and respected.

The home had an effective complaints procedure. People’s concerns and complaints were taken seriously and responded to and used to improve the quality of care.

The home had an established quality assurance system in place but some checks and audits undertaken by the management team were not always effective because they failed to identify the areas of concern we identified during our inspection.

People, their relatives’ friends and staff praised the manager for their leadership, guidance and the way they had involved them in the day to day running of the home.

The registered manager was aware of incidents in the home that required the Care Quality Commission to be notified of. Since the day they started work in the home they had been open and candid with us and had submitted statutory notifications as required.

Hazelmere House Nursing Home is owned and operated by Bupa Care homes (GL) Limited. It is a purpose built 56 bedded home set in a residential area of Wilmslow. The home provides a wide range of long and short term nursing and residential care for older people including 8 bedrooms set aside for intermediate care. Intermediate care is supported by a team of health care professionals employed by the local authority. They work closely with other health and social care providers offering assessment, treatment, rehabilitation and support for older people and adults with long term conditions at times of transition in their health and support needs.

All bedrooms in the home are en-suite and communal facilities include a large conservatory and bar area. There is wheelchair access and a secure keypad entrance. Car parking is available to the front and side of the building.

This service was last inspected in August 2015 where we rated the service as requiring improvement. We found that the provider was not meeting all the regulations in relation to safe care and treatment, safeguarding people, staffing, consent, person centred care, handling of complaints and assessing and monitoring the quality of care.

We judged that most areas had a minor impact on people, but some had a more significant impact. We served two warning notices and six requirement notices and we asked the provider to take action. Following our inspection in August 2015, the provider sent us an improvement plan and told us that all the necessary improvements would be made by 31 December 2015. During this inspection we saw that improvements had been made within the service in relation to people’s safety, staffing, staff support, person centred care, dealing with complaints and reporting safeguarding concerns. However there remained concerns in relation to following the principles of the Mental Capacity Act, keeping accurate, complete records and quality assurance. You can see what action we told the provider to take at the back of the full version of the report.

The home has a registered manager. 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 there were 49 people living in the home.

We found that the manager and clinical services manager had started to implement many changes and staff and people living in the home and their relatives felt that there had been a significant improvement in the standards in the home since they had been in post; however there remained some areas for improvement.

We saw that the service was now following safeguarding procedures and accurately recording and reporting where issues had arisen. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns.

We found that there were sufficient staff deployed to meet the needs of the people living in the home. The home was using a high level of agency staff to maintain staffing levels and there were occasional times when the identified number of staff were not on duty. The manager was proactively managing this on a daily basis to improve the situation.

We looked at staff recruitment files to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

The provider had their own induction training programme which was designed to ensure that any new staff members had the skills they needed to do their jobs effectively and competently. This resulted in staff having the skills and knowledge to carry out their jobs well and provide safe and effective care.

We asked staff members about training and they all confirmed that they received regular training throughout the year and that this was up to date and provided them with knowledge and skills to do their jobs effectively.

People had care plans which were personalised to their needs and wishes. Each care plan contained detailed information to assist support workers to provide care in a manner that respected the relevant person’s individual needs, promoting their personal preferences’.

People living in the home told us that the standard of care they received was good. Comments included, “it’s very nice here”, “everyone is so kind and helpful” and “I’ve never complained, never had anything to complain about”. Relatives spoken with praised the staff team for the quality of care provided. They told us that they had every confidence that their relatives were safe and protected from harm and enjoyed a good quality of life. One person told us, “my wife is very settled and stable at present”.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. We saw that some applications had been made, however we found instances where assessments had not been carried out appropriately and decisions had been taken without considering whether this was in the person’s best interests.

There was a flexible menu in place which provided a good variety of food to people using the service. People living there told us that the food was good and they had a wide variety of food choices as well as where they could eat their meal.

Staff members we spoke with were positive about how the home was being managed since the manager and clinical services manager had been in post. They spoke of feeling that someone listened to them now and they were supported to do their job.

There was an internal quality assurance system in place to review systems and help to ensure compliance with the regulations and to promote the welfare of the people who lived at the home. This included audits on care plans, medication and accidents. Whilst we found that audits were being completed, where issues had been identified, action had not been taken to address these shortfalls.

The home was well-maintained and clean and provided a calm, relaxing atmosphere. There were a number of maintenance checks being carried out weekly and monthly. These included water temperatures as well as safety checks on the fire alarm system and emergency lighting. These were audited regularly.

Following our inspection we were contacted by a number of people who raised concerns about the standard of care in the home and we shared this information with the local safeguarding authority. Quality officers from the local authority's adult safeguarding unit visited the home and identified further inadequacies in the planning and provisioning of care. We attended a meeting with representatives of the local authority, associated health and social care professionals and representatives of the provider in early April 2014. The provider gave assurances that action was being taken to improve the service and safeguards were agreed and put in place to ensure the welfare of the people who lived at the home.

Following our inspection in February the provider sent to us a detailed service improvement plan (SIP). The actions described in the SIP were specific to the areas where improvements were required and we saw that the provider had set realistic timescales by which the improvements would be made. We could see who was responsible for carrying out the required actions and quality assurances process were included so we could see how compliance would be measured and monitored. When the SIP was updated the provider sent us a copy so we could see how the necessary improvements were being made. This showed us that the provider was aware as to what needed to be done and was committed to ensuring that the people who lived at the home received safe and appropriate care that met their needs and protected their rights.

We carried out this inspection to follow up on action taken by the provider to ensure people were receiving safe and appropriate care. As part of this inspection we spoke with a number of representatives of the local authority, the recently deployed home relief manager, eight staff, 19 of the 48 people who lived at the home and eight of their relatives, friends or advocates.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with the people who used the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

We found that the people who lived at the home experienced care, treatment and support that met their needs and protected their rights. However, they were not always protected from the risks of unsafe or inappropriate care because accurate and appropriate records about their care were not always maintained and nurse call bells were not always answered promptly. Compliance actions have been set and the provider must tell us how they plan to make further improvements.

We could see that the action taken by the provider since our previous inspection had significantly improved the standard of care and quality of life for the people who lived at the home. All the people spoken with told us that they had seen significant improvements in the way the home was managed and staffed and whilst some wanted to see further improvements all made positive comments about the quality of care, facilities and services provided. They told us that they were treated with respect and were involved in making decisions about their care and support. One person said 'the home has improved out of all recognition since the beginning of the year, the staff are lovely they make it feel like home, the atmosphere is great now there is more staff and it is more like the Hazelmere we know and love.' We could see that the home provided a positive environment where people were acknowledged, involved and included in the day to day comings and goings of the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to all care homes. The care services manager and a number of nurses spoken with told us that they had been trained on the MCA and DoLS and they understood when an application should be made and how to submit one. While no applications had been submitted, we could see that proper policies procedures and processes were in place.

Is the service effective?

We found that Hazelmere House Nursing Home provided effective, caring and compassionate care for people who lived there. We could see that the provider, the relief home manager, and nurses were working closely with the people who lived at the home and their representatives, including associated health and social care professionals to ensure that people's needs were met.

Is the service caring?

We found that the manager and staff provided sensitive and compassionate care, with kindness dignity and respect. People were relaxed and at ease, clean and well-presented. All the people we spoke with made positive comments about the staff and the care provided. One person who described the standard of care as 'excellent' said 'the staff are kind and caring they treat me with respect and I feel safe.'

All visiting relatives spoken with praised the home, the staff and the quality of care provided. Several of them made comments about the recent improvements in the way the home was being managed and staffed. One visitor said 'the staff are carefully selected, they are very kind, caring people and we have a lot of respect for them.'

We observed staff engaging people in conversation frequently, listening to them, acting on their requests and supporting them with their daily activities and hobbies. This provided for a positive environment where people were acknowledged and included in the day to day comings and goings of the home.

Is the service responsive?

Since our last inspection the provider had responded to concerns we raised and had taken effective action to improve the management and staffing of the home and thereby the standard of care provided. This showed us that the service is responsive.

We saw that information about the safety and quality of the service provided was gathered on a continuous and on going basis from feedback from the people who lived at the home and their representatives, including their relative's friends and health and social care professionals, where appropriate.

People told us that the manager spoke with them about the quality of care provided on a regular basis. One of the people spoken with said 'the new manager listens to us, does whatever we ask of her.' Many other people expressed similar views. Visiting relatives told us that they were pleased with the way the new manager had responded to them when they had raised concerns.

We saw the notes of a recent resident and relatives meeting and could see that people's views had been acted upon and taken seriously.

Is the service well led?

We found that Hazelmere House Nursing Home was well led. Following our inspection in February 2014 the provider appointed a suitably qualified and experienced home relief manager.

All the people we spoke with during our inspection including the people who lived at the home, their representatives and staff praised the new manager for her competence, skill and dedication to the effective management of the home. One person said: 'the home is much better now we have the new manager, she is wonderful, she is out there supervising the staff all the time she comes to talk to us and makes you feel you are on her level, and whatever you ask of her is done'.

Staff told us that the new manager was very supportive and that they appreciated the guidance support and leadership she provided.

One person who used the service said the staff: "Are gentle and kind and make sure that I'm safe." Another person said:"Staff sometimes ask me if I'm alright and do I need anything, asking if the care that I have is what I want, which it is." Another person said: "It's not home, but it is the next best thing and I feel safe here, the staff are very gentle and kind." However another person said they felt like: "A product, rather than a person," and their view was: "The place stinks," when reflecting on their opinion of the service.

We found through our observations and the comments received that people's views were not always gained prior to staff providing support and that their dignity was not always maintained. We observed that people's privacy was maintained.

We reviewed three care plans and found that two of the three care plans were incomplete. We saw that the planned communal activities for the week were available for people to read on the notice boards and that a new activities co-ordinator had been recruited.

We reviewed five staff records and the information in these files confirmed that appropriate recruitment checks had been carried out.

We found that when staff were in receipt of training and not available to provide care appropriate staffing levels were not in place.

We spoke with three family members who regularly visit the service. Both family members said that they considered the care to be good. Comments included:'Its very good care' and 'staff are very helpful.'

We also looked at a sample of care records. These contained information regarding the needs and wishes of individuals and the care that they had agreed with the service. We noted that some records required updating and discussed this with the manager at the time of the visit.

We looked at the homes complaints procedures and saw that there was a policy in place to capture concerns and documented timescales for complaints to be investigated and responses given.

We looked at the infection control measures within the home and found that the home was clean with systems in place to ensure this was maintained.

During our visit we also looked at the numbers and skills of staff employed. We found that there were times when the staff were very busy but people's needs were met.