Our inspection of Hazeldene EMI Nursing Home was undertaken on 10 and 14 September 2015. The first day of our inspection was unannounced.
The last comprehensive inspection of Hazeldene EMI Nursing Home by the Care Quality Commission (CQC) took place in July 2014. Two breaches of regulations were identified during this inspection. Following the inspection, the provider completed an action plan to say what they would do to meet the legal requirements in relation to the two breaches. Our September 2015 inspection included checks to ensure that the home had followed their plan and to confirm that they now met legal requirements
Hazeldene EMI Nursing Home provides care for up to 60 older people, most of whom are living with dementia. The home was fully occupied at the time of our inspection. Accommodation is provided over two floors, accessed by a lift. All bedrooms are single and have en-suite toilets. Each floor has a separate dining area. There are lounges throughout the home.
The manager in post at the time of our inspection was not the registered manager of Hazeldene EMI Nursing Home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does S & S Healthcare, the provider.
They manager had been at the home for six weeks and was in the process of obtaining the necessary checks in order to then submit their application to become the registered manager of the home. The deputy manager was an established member of staff and had provided management cover pending the recruitment of the new home manager.
People told us that they felt safe living at Hazeldene EMI Nursing Home. Conversations with staff and the manager demonstrated that they were aware of local safeguarding procedures and had the necessary knowledge to ensure that vulnerable adults were safeguarded from abuse.
We found that there were sufficient staff to meet people’s needs and keep them safe. We noted that there was a high use of agency staff and nurses on both days of our inspection and also received comments from staff and relatives about this. Particularly because the agency staff were often unfamiliar with people’s needs. The manager was aware of this and was in the process of recruiting to all vacant posts within the home.
Improvements had been made to medication practices within the home. Our observation of a medication round on each floor of the home together with our review of records provided evidence that medicines were safely administered, recorded and stored. We noted some shortfalls in relation to the recording of as and when required, (PRN) medications. We were reassured that these issues would be addressed as part of the improvements the manager was in the process of making to this area of practice.
We found that improvements had been made to records documenting people’s capacity to make decisions. Capacity assessments and best interest decisions were clearly recorded and in line with the Mental Capacity Act Code of Practice. Clear records about the Deprivation of Liberty Safeguards (DoLS) were also maintained.
Staff were provided with an induction and a range of training to help them carry out their roles. Nursing and senior carer had received a recent supervision session and an annual appraisal. However, other members of care and ancillary staff had not received an annual appraisal or a supervision within the providers recommended timescale. The new manager was aware of this and showed us a folder they had prepared to plan supervisions and appraisals for all staff.
People’s physical health needs were monitored and clearly documented. Referrals were made when needed to health professionals.
We received mixed feedback about the food at Hazeldene EMI Nursing Home. We observed the lunchtime meal in both of the dining rooms and noted that the mealtime was well organised. The meals looked appetising and were well presented and there were sufficient staff to ensure people were supported to eat at the same time.
We noted that meals were served on bare tables in both dining rooms, some of which were scuffed and worn. There were also few examples of staff interacting with people during our observation of lunchtime in the first floor dining room. We fed back our observations to the manager and were reassured that they had identified the need for meal times to be improved, and how they proposed to do this within a recent action plan.
The manager’s action plan also reflected our observations that the environment was not always dementia friendly. It stated, “We need to create an enabling environment of care that enhances the resident’s orientation,” and again listed ways of achieving this.
Our observations together with conversations with people and relatives provided evidence that the service was caring. We saw that staff across the home spent time sitting and talking with people. Members of staff spoken with on the day of our inspection had a good understanding of people’s individual needs and preferences and knew how to respect people’s privacy and dignity.
Relatives and members of care staff felt that activities within the home could be improved. Our observations confirmed this. The manager of the home agreed with our findings and said that they had identified activities as an area for development. We noted that this had also been documented within their recent action plan.
People’s needs were assessed and reviewed and care plans were amended in response to any changes in need. However, one of the six care plans reviewed during our inspection did not contain the required records to document an injury we observed and heard a member of care staff discuss during the course of our inspection.
Relatives and staff were positive about the deputy manager and the newly appointed manager and the way in which they led the service. They told us that both individuals were visible and were approachable. Staff told us that the new manager had clearly communicated the improvements they wished to make. One member of staff commented, “I agree with what the things the deputy and manager are changing and how they’re doing it. They’re there for the residents and that’s what we’ve needed.”
A system was in place to continually audit the quality of care provided at the home. We saw that this incorporated a range of weekly and monthly audits relating to differing areas of the service.