The Care Quality Commission
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Archived: Hazelbrook Specialist Care At Home

Overall: Requires improvement read more about inspection ratings

Willow Burn Hospice, Maiden Law Hospital, Lanchester, County Durham, DH7 0QS (01207) 529224

Provided and run by:
Hazelbrook Specialist Care At Home Limited

All Inspections

18 October 2017

During a routine inspection

This inspection took place on 18 October 2017. The inspection was announced which meant that we gave notice of our visit. This was because the location provides a domiciliary care service and we needed to be sure the manager would be available.

Hazelbrook Specialist Care at Home is a care agency providing palliative and end of life care to people in their own homes and works closely with a local hospice to give additional support to families and carers. At the time of inspection they were providing personal care to 25 people.

There was a manager in place who was in the process of becoming registered with the Care Quality Commission (CQC). 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 found that accurate records were not kept of administration of medicines. Medication administration records (MAR) had gaps where staff should sign to say the medicine was administered, no records or guidance for applying creams and care plans did not fully document people’s individual medicine needs.

Risks to people were not all recorded and action plans were not in place for staff to follow to minimise the risk.

Staff understood safeguarding issues, and felt confident to raise any concerns they had in order to keep people safe. Staff were able to tell us about different types of abuse and were aware of the action they should take if they suspected abuse was taking place. Staff were aware of whistle blowing procedures and all said they felt confident to report any concerns without fear of recrimination. However, not all staff were aware of how to raise a concern outside the organisation.

A number of recruitment checks were carried out before staff were employed to ensure they were suitable. However, not all the recruitment records were completed.

Staff had not received all the training they needed to carry out their roles effectively. Staff were not fully supported from supervisions.

Staff had a working knowledge of the principles of consent and the Mental Capacity Act and understood how this applied to supporting people in their own homes. Evidence of consent was not sought.

The service was set up specifically to provide palliative and end of life care to people; however they did not ensure appropriate care plans were in place for this.

We found there was sufficient staff employed to support people with their assessed needs .We were told that staff were kind and respectful; and staff we spoke with were aware of how to respect people’s privacy and dignity

We found care plans were confusing, repetitive and unorganised. There was no initial assessment, no record of care calls required or what care was needed at each call. Where someone had a care need this was documented as a problem.

The service had a complaints policy that was due for review in December 2016. Complaints were not fully documented.

There were no audit systems in place to monitor and improve the quality of the service provided.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

24 and 27 August 2015

During a routine inspection

The inspection took place on 24 and 27 August 2015 and was announced. This meant we gave the provider 24 hours’ notice of our intended visit to ensure someone would be available in the office to meet us.

The service was last inspected on 21 January 2014. The service was meeting all our regulatory standards at that time.

Hazelbrook is a domiciliary care provider based in Lanchester providing personal care and support to people in their own homes. Hazelbrook specialises in delivering palliative and end of life care to people with life limiting illnesses. There were 18 people using the service at the time of our inspection.

The service had 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.

We found that risks were managed and mitigated well through pre-assessment and ongoing assessment. People using the service felt safe and we saw that the service operated an out-of-hours phone line in case of unforeseen circumstances.

We saw that adequate numbers of staff were on duty to meet the needs of people who used the service. Staff underwent a range of pre-employment checks and, when we spoke with them, they were clear about their safeguarding responsibilities, having received safeguarding training recently.

We saw that no medicines errors had been made on the Medication Administration Records (MAR) we sampled and, whilst the service did not undertake internal audits of these records, we saw that they had identified this as an area of responsibility for a newly created role.

We found that staff received an induction that included mandatory training and shadowing of experienced staff, both attending to people who used the service but also at a local hospice to gain a fuller understanding of palliative care provision. Training included safeguarding awareness, moving and handling, infection control, health and safety, first aid and handling medication.

We saw that new members of staff underwent the Care Certificate.

People told us that that consent was sought both at the initial care planning stage when care staff visited people who used the service.

We saw that staff supervisions, appraisals and staff meetings all happened regularly and that staff felt supported to perform their role.

People told us staff were caring, personable, compassionate and warm in their care. External healthcare professionals also told us that people who used the service felt comfortable with the carers from the service.

We saw that people were encouraged and supported to contribute to their own care planning and review, with family members similarly involved. We saw that end of life care was compassionate and always supported by the views of people who used the service, family members and relevant healthcare professionals.

We saw that personal sensitive information was stored securely.

Care plans were reviewed regularly and, where people’s needs changed, these reviews were brought forward and care provision amended accordingly. People told us the service was accommodating to their changing needs and preferences.

People’s hobbies and interests were encouraged both at home and through attendance at a day centre run by the nearby hospice.

The service had a complaints policy in place. We saw evidence that one complaint had not been formally responded to but that other comments had been promptly and satisfactorily dealt with. People who used the service were made aware of the complaints procedure and told us they knew how to complain and who to, should the need arise.

People who used the service told us the registered manager and senior carer were approachable and knew them well. We saw that, whilst having recently undergone a change of staffing structure, the service maintained high levels of care for people who used the service.

The principles of the service, as set outing the Statement of Purpose and the Service User Guide, were communicated strongly by members of staff we spoke with and evident in the care practices we saw evidence of.

21 January 2014

During a routine inspection

People who used the service, their families and representatives were treated with respect and courtesy by all staff at the agency. The relative of one person who used the service told us 'My (relative) looked forward to them coming'.

Where people's medical conditions prevented them from expressing their views the agency asked people who knew them well, like family members, about their care, beliefs or personal requirements they might have.

We saw people who used the service benefited from some of the services provided by the hospice. One relative told us 'The physio from the hospice came to see us and carried out an assessment. That meant my (relative) could get out of bed and sit in a chair for a little while.'

People we spoke with said they felt their relative was safe with the people providing care and spoke very highly of the agency and the staff employed. One person told us 'I feel very privileged to have had them caring for my relative'; another person told us 'They were the light at the end of a very dark tunnel'.

Staff who worked at the agency were supported to carry out their work and benefited from the close relationship between the agency and a local hospice.