Hazeldene Residential Care Home

Hazeldene Residential Care Home is a residential care home providing accommodation and personal care for up to 27 older people many of whom had dementia. At the time of this inspection there were 27 people living at the home.

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

People and their family members gave us very positive feedback about the home and told us staff were kind and caring. We observed positive communication between staff and people.

People were supported to eat a varied and nutritious diet based on their individual preferences. People were complimentary about the food and told us they had enough to eat and drink.

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.

There were appropriate policies and systems in place to protect people from the risk of abuse and the management team and staff understood the actions they should take to keep people safe.

There were enough staff [care and ancillary staff] to support people's needs in a timely and unhurried way. Appropriate recruitment procedures had been followed to help ensure only suitable staff were employed. Staff had received training and support to enable them to carry out their role safely.

Systems were in place so that medicines were administered safely and as prescribed which staff

followed. Infection prevention and control measures were in place and followed government guidance.

Most individual and environmental risks were assessed and managed appropriately. People had access to any necessary equipment where needed, which helped ensure people were safe from harm.

Care plans contained detailed relevant information about people's health and social care support needs. People and, where appropriate family members, were involved in the development of care plans. People were able to access health and social care professionals if needed.

The registered manager and provider’s representative carried out regular checks on the quality and safety of the service and understood their regulatory responsibilities. People, their family members and external professionals said the registered manager was approachable and supportive. Staff were also positive about the registered manager.

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 19 June 2019) and there was a breach of regulations. The provider was required to send us monthly action plans to show us how they were auditing records to ensure these were accurate and up to date. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and a review of the information we held about this service to confirm that they now met legal standards. 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. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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 requires improvement to good based on the findings of this inspection.

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

Follow up

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

People’s experience of using this service:

At this inspection we found improvements had been made in a number of areas. The provider had recruited a new manager who had worked hard with staff to change the culture in the service.

The deployment of staff had changed leading to staff being able to spend more time with people and working in a person centred way, rather than focusing on tasks to be completed.

Risks associated with people’s care were understood by staff and action was taken to reduce these risks. However, the records were inaccurate and did not provide clear direction. As the service were using agency staff on occasions the lack of detail in records posed a risk for people. Risks we had previously found in relation to the environment were no longer present.

The management of medicines had improved. Storage was safe and staff had received additional training to ensure they could safely administer all medicines within the home.

Activities were varied and regular and people felt they had plenty to do.

People were supported by staff who were kind and caring in their approaches, who understood their right to make their own decisions and who supported them to make choices and be involved.

Staff spoke positively about the changes that had been made. They felt training and supervision had improved. They said they now felt listened to and valued.

A number of governance systems had been implemented to drive continual improvement in the home. However, not all of these were effective, and they needed more time to fully embed in order to be confident the improvements seen were sustained.

The service no longer met the characteristics of Inadequate and the overall rating had improved to Requires Improvement. As such, the service has been removed from special measures.

Rating at last inspection: Inadequate (Report published 20 February 2019)

Why we inspected: This location has a history of breaching the regulations and was rated as Inadequate following an inspection in September 2018 and was placed in special measures. We imposed conditions on the providers registration as a result which required them to undertaken certain governance processes and report to us monthly. This was a planned inspection to follow up on the previous rating of inadequate and check improvements had been made.

Follow up: We will ask the provider to send us an action plan detailing how they will address the concerns we found in relation to records and governance systems. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Hazeldene Residential Care Home provides residential care for up to 26 people, some of whom are living with dementia. At the time of our inspection there were 20 people living at the service.

At the last comprehensive inspection in May 2018 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches of Regulation 12 because the risk associated with people falling was not managed safely, topical medicine records were not completed consistently and fire emergency checks were not carried out in line with the providers policy; Regulation 17 because there was a lack of effective governance processes. We also found a breach of Regulation 18 of the Care Quality Commissions (Registration) Regulations 2009 because the registered persons had not always notified CQC of significant events that happened at the home.

Following the last inspection in May 2018, we issued two warning notices requiring the provider to take action to mitigate the risks to people's health, welfare and safety and improve the systems to monitor the quality and safety of the service. The provider subsequently told us they had put measures in place to ensure the safety of people.

We undertook this focused inspection to check that they had followed their plan. The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led? This is because the service was not meeting some legal requirements. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

You can read the report from our last inspections, by selecting the 'all reports' link for 'Hazeldene Residential Care Home’ on our website at www.cqc.org.uk.

There was a registered manager in post. 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 last inspection we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks involved in the use of the stairs were not always appropriately managed. In September 2018 we received further information of concern around a safety incident Our inspection did not examine the specifics of this incident. However, we used the information to plan areas we would inspect and to judge the safety and quality of the service

At this inspection we identified risks were still not managed safely around the use of the stairs. Risks associated with falls had not been mitigated. We also found other areas of concern in relation to risks associated with health conditions and the environment. Risk assessments lacked the guidance for staff to follow, to mitigate risks to people which meant people were placed at risk of harm.

Accidents, incidents and falls were not analysed to prevent further accidents from happening and the registered persons had not taken appropriate action in response to safety concerns.

There was not an effective quality assurance process in place. Audits to assess the quality and safety of service provision were ineffective in identifying improvements needed.

Expert advice was not sought to help make improvements in the home, however people were assisted to access health and social care professionals to maintain good health.

The provider had taken sufficient action into addressing the concerns regarding the recording of topical medicines. However, staff had not received training regarding the administration of some medicines and staff’s competency to manage medicines was not regularly checked. The storage of medicines required improvement.

Staff had not always notified CQC of significant events that occurred in the home. Neither had they followed legislation that required them to act in an open and transparent way when people came to harm.

Staff were not always effectively deployed to meet people’s needs or keep them safe. We have made a recommendation about the strategic oversight of the deployment of staff

Improvements had been made to staff recruitment and staff were recruited safely.

The home was visibly clean and staff used protective equipment when needed. However, because kitchen staff left personal items in food areas there was a risk of cross infection.

Staff told us the approach of the registered manager had improved and they felt able to contribute to the running of the service.

Due to the concerns identified during the inspection, a referral was made to the Local Authority to ensure the safety of people. Assurances were also sought from the provider about the immediate action they would take to address the concerns identified. Following the inspection, the provider sent us an action plan detailing how they would address the immediate risks to people.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

During our inspection we found a number breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

At our last inspection in November 2016 we had found the provider had been in breach of Regulation 11 - need for consent, Regulation 12 - safe care and treatment, and Regulation 17 - good governance. The service had been rated ‘Requires Improvement’ at that time. The registered provider had not always acted in line with the Mental Capacity Act 2005. Risks people had faced had not always been adequately assessed. The registered manager and the registered provider had not ensured clear actions had been set out in care plans to protect people against those risks. 'When required' (PRN) medicines and prescribed creams had not always been administered properly or safely. Information included in people's care records had not always been accurate or up-to-date. Auditing and quality assurance processes in place had not identified these errors. Following that inspection, the registered manager had sent in an action plan stating what action would be taken to address the breach of the regulations. At this inspection we found sufficient action had not been taken in relation to the concerns identified at the previous inspection. We also identified new areas of concern.

This is the second time the home has been rated ‘Requires Improvement’.

Hazeldene Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hazeldene Residential Care Home is a residential home in Gosport providing accommodation and personal care for up to 26 elderly people. There were 23 people using the service at the time of our inspection.

There was a registered manager in post. 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.

Risks to people were not sufficiently assessed and managed. Using stairs was not taken into account in care plans where people were at risk of harm. In addition, the service did not do all that was reasonably practicable to reduce such risks. Incident and accident records did not always evidence that remedial action had been taken and followed up by the registered manager. Checks on fire alarms and emergency lighting had not been completed in accordance with the provider’s policy.

Recruitment practices were not always safe. Gaps identified in the employment history of staff had not been fully examined and explained.

The home's quality assurance and governance systems were not always effective. Although some systems were effective, others had not identified the concerns we found during this inspection.

The registered provider failed to inform the Care Quality Commission about notifiable incidents and accidents.

People, their relatives and staff provided us with mixed feedback regarding staffing levels.

The home was clean, well-maintained, and people were protected from the risk of cross contamination and the spread of infection. Staff had access to personal protective equipment (PPE) and received training in infection control.

People's needs were effectively met because staff had been provided with relevant training and had the skills they needed to do so. Staff were supported with training, supervision and appraisal.

Principles of the Mental Capacity Act (MCA) 2005 legislation were followed and Deprivation of Liberty Safeguards (DoLS) applications were completed in line with current legislation. Staff showed a basic knowledge and understanding of both the MCA and DoLS. Best interest decisions were made appropriately. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were able to talk to health care professionals about their care and treatment, and they had appointments with a GP arranged when needed. When necessary, people received care and treatment from external health care professionals such as the district nursing team.

People had access to sufficient amounts of adequate food, drinks and snacks. Those who spoke with us were satisfied with the quality of the meals provided.

People were treated with dignity and respect by kind and caring staff. Staff had a good understanding of the care and support needs of people and had developed positive relationships with them.

People's support plans contained detailed information about people's hobbies and interests. People had many different opportunities to socialise and take part in a variety of activities if they wished to do so.

A complaints procedure was in place. People and their relatives knew how to make a complaint and those who spoke with us were pleased with the way any issues they had raised had been dealt with.

The registered provider held regular meetings for people, their relatives and staff, and satisfaction surveys were used to gather feedback. We saw actions had been taken in response to the feedback.

People and relatives knew the registered manager and staff we spoke with found the manager approachable. Staff provided us with mixed feedback regarding the way the service was run.

We recorded three breaches of our regulations. You can see what action we have told the registered persons to take at the end of the full version of this report.

We previously inspected Hazeldene Residential Care Home in May 2014, at which time the service was compliant with all regulatory standards.

Hazeldene Residential Care Home is a residential home in Gosport providing accommodation and personal care for up to 26 older people. There were 25 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 (CQC) to manage the service. Like directors, 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 people’s topical medicines (creams) and people’s ‘when required’ medicines were not always managed properly or safely.

We found some examples of good practice with regard to other medicines and senior carers demonstrated a good knowledge of people’s medical needs.

We found risk assessments were not sufficiently detailed or clear about how staff were to minimise the risks people faced, particularly with regard to the use of bed rails, fluid intake and repositioning.

We found that there were sufficient numbers of staff on duty in order to meet the needs of people using the service, as well as to ensure premises were clean and well maintained. Two bathrooms were clean and well equipped, whilst one was in need of refurbishment, as was the laundry room. We saw both these rooms were included in the registered provider’s refurbishment plan. People’s bedrooms, communal areas and the kitchen were found to be clean and well maintained.

Staff displayed a good knowledge of safeguarding principles and indicators of abuse. They were clear what to do should they have any concerns. People we spoke with, their relatives and healthcare professionals consistently told us the service maintained people’s safety.

There were effective pre-employment checks of staff in place, including Disclosure and Barring Service checks, references and identity checks.

We saw that, whilst staff consistently asked people for their consent on a day-to-day basis, care files contained conflicting information about whether people had capacity to make specific decisions, meaning the service did not always act in line with the Mental Capacity Act 2005 (MCA).

External professionals had confidence in the experience and knowledge of staff and we saw there was regular liaison with GPs, nurses and specialists to ensure people received the treatment they needed.

Staff completed a range of training the registered provider considered mandatory, such as safeguarding, health and safety, moving and handling and dignity. Staff displayed a good knowledge of the subjects they had received training in and had a good knowledge of people’s likes and dislikes.

We saw people had choices at each meal as well as being offered alternatives. People spoke positively about the food and drinks they had and we observed people experiencing a relaxed lunchtime in the dining room. We observed staff supporting people patiently to eat and drink and offering people drinks throughout the day.

Staff were regularly supported through supervision and appraisal processes as well as ad hoc support from management when required.

The premises benefitted from some aspects of dementia-friendly design, such as bold signage and contrasting hand rails in the two completed bathrooms and communal areas. Dementia care-planning was detailed although we found activities were focussed on group activities and could be improved by focussing on people’s individual preferences more.

The atmosphere at the home was welcoming. People who used the service, relatives and external stakeholders agreed that staff were caring and compassionate. We saw numerous instances of warm, inclusive interactions.

Group activities were varied, coordinated by a member of staff who demonstrated a good understanding of people’s interests and their communicative abilities.

Reviews of people’s care needs took place, although these were not adequately documented or accessible during the inspection.

Records of people’s care needs had recently been moved to an online care file management system and we found a number of inaccuracies in these care records, as well as previous paper-based recording systems.

We found that auditing of the service needed to improve as, whilst regular audits were conducted by the registered manager and monthly visits by the registered provider, they had not identified a number of issues.

Staff, people who used the service, relatives and external professionals we spoke with expressed confidence in the registered manager as well as care staff.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

We saw systems were in place to help ensure managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted since the last inspection in May 2013. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant people were safeguarded as required.

The registered manager was responsible for arranging staff rotas and took people's care needs into account when making decisions about the numbers, qualifications, skills and experience of staff required. This helped to ensure that people's needs were always met.

Policies and procedures were in place to help make sure unsafe practice could be identified and people were protected.

Is the service effective?

There was an advocacy service available if people needed it, this meant people could access additional support when they required it.

People's health and care needs were assessed with them and they were involved in the development of their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said they had been involved in the planning of their care and care plans reflected their current needs and wishes.

People's needs were taken into account with appropriate signage. The layout of the service enabled people to move freely and safely around the home. The premises had been sensitively adapted to meet the needs of people who lived at the home.

Visitors confirmed they were able to see people in private and visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw staff were patient and gave encouragement when they supported people. One person said; "I like to do things myself, but the staff are marvellous if I can't quite manage something". We spoke to a visiting professional who told us, "From what I have seen, the staff here are very kind to people".

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People had access to a range of daily activities both inside and outside of the home.

People knew how to make a complaint if they were unhappy and details of the complaints procedure was easily accessible on the notice board in the hallway. People we spoke with told us they had no complaints to make. We saw there was a complaints log, but no entries had been made since the last inspection in May 2013. The manager told us there had been no complaints during this time. This showed us people were happy with the service they received. We saw there was a comments and suggestions book freely available for people to use in the hallway. We saw only positive comments about the service had been made.

Is the service well led?

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Comments and ideas were listened to and acted upon in a timely manner.

The service worked well with other agencies and services to help make sure people received their care in a cohesive manner.

The service had a quality assurance system and records showed notes for action were addressed promptly. As a result, the quality of the service continued to improve.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes which were in place. This helped to ensure people received a good quality service at all times.

On the day we inspected there were 25 people living at the Hazeldene Residential care Home, some of whom had memory impairment and or a physical health problem. During our inspection we spoke with four staff members, one relative and four people who use the service.

We saw that the home was clean and well maintained and was undergoing some refurbishment with the minimum disruption to people.

People had personalised their rooms with their own possessions including their own furniture.

We saw that the home had in place risk assessments for people using equipment to support their independent living safely. We saw that people had their care discussed and agreed with them although we could not identify formal agreement to these care plans.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. We observed people at a mealtime have positive experiences. Staff were observed assisting people in a calm, friendly and polite manner.

People told us that "staff are very nice" and "this is my home now". People told us about alternative menu choices that they would like offered which we passed onto the acting Home Manager. Relatives told us that they were happy and had no concerns with the home.

We saw care plans for five people who used the service, however, we noted that one needed reviewing, one was not complete and another one did not give specific guidance for staff on how to support a persons specific needs.

One person showed us how they kept themselves busy with making blankets for the Salvation Army.