Hazelgrove Court Care Home

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

People were living in a service where the cleanliness needed improving. Areas of the home remained cluttered and untidy. Staff told us there weren’t enough domestic staff. People told us they felt the untidiness of the home impacted on their wellbeing.

Governance and management systems were not fully effective in identifying and addressing some of the concerns identified. This included issues around cleanliness, staff training and accuracy of daily records. Improvements had been made from the last inspection however, there were still actions that had not been fully addressed.

People were protected from risk of harm. Accidents and incidents were recorded, and actions were taken to mitigate risk of reoccurrence. Staff were recruited safely, and appropriate checks were completed prior to employment. Agency staff were being used; a recent recruitment drive had taken place which had slightly reduced the ongoing use of agency staff. People told us they felt safe. One person told us, “I feel very safe here, it’s like home from home. Once you come in, you don’t want to go.”

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. Risks to people were managed and systems were in place

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 21 March 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulation 17 (Good governance). The service remains rated as requires improvement.

Why we inspected

We carried out an unannounced focused inspection of the service on 7 February 2022.

We undertook this focused inspection of the safe and well-led key questions to check the service had followed their action plan from the last inspection and to confirm legal requirements were now met.

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.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has remained rated requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified a breach in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hazelgrove Court Care Home is a care home providing personal and nursing care to older people, some of whom are living with a dementia type illness or cognitive impairment. At the time of our inspection there were 42 people using the service. The service can support 48 people.

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

People and relatives told us there was not always enough staff to meet people’s needs. Relatives told us people were spending longer periods of time in bed and were not always being offered baths or showers because there wasn’t enough regular staff. Staffing rotas showed there had been shortages in the service due to staff leaving or needing to isolate due to COVID-19. The provider was using high levels of agency staff to support staffing levels and increased staffing numbers during the inspection. Deployment of agency staff needed improving to ensure they were following people’s care and support plans. An ongoing recruitment campaign was taking place. One relative said, “There isn’t enough staff. [person] is not getting shaved, permanent staff are great but there’s too many agency staff.”

People were not always protected from the risk of harm due to care records not being kept up to date. Staff were not always able to identify people’s current needs. Changes to people’s health needs were not always reported, recorded accurately or identified in a timely manner to allow action to be taken.

The provider's quality assurance checks had not been effective in highlighting the areas of concern found during the inspection. Risks to people's health needs, care records, management of agency staff and analysis of accidents and incidents had not been undertaken recently.

Records to evidence building cleanliness, safety and staff training were not well organised to provide the relevant information in a timely manner. The service had appropriate maintenance systems in place to ensure the building was safe for people living at the service.

The provider acknowledged their monitoring of the service was not to their expected standards and took steps to address this immediately. An action plan was implemented, leadership team was strengthened, staffing levels increased and a review of quality assurance measures commenced. The provider was working closely with the local authority and other partners to ensure standards were raised and maintained.

Overall medicines were being managed safely. The service was in the process of changing over to an electronic system and still had some paper records which needed to be reviewed. The service was following national guidance for infection prevention and control and visiting. The provider had a safe recruitment system in place

People and most relatives told us staff worked hard to help support people and genuinely cared about them. One relative said, “Carers are lovely and friendly but they are always busy. I phone up and they always make me feel they have all the time in the world for me when I really know they haven’t.” People, their relatives and staff were complimentary of the new manager. Staff stated they felt the new manager ‘was trying their best’ and told us they felt supported.

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 25 August 2018)

Why we inspected

We received concerns in relation to staffing levels and the management of people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the care people received, management of risk to people’s health and, the overall governance and monitoring of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hazelgrove Court 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. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides personal care to a maximum of 48 people, some of whom are living with a dementia and/or a physical disability. At the time of the inspection there were 46 people who used the service.

At the last comprehensive inspection in May 2016 we found the service was meeting requirements and was awarded a rating of Good. At this inspection we found the safe domain needed some improvement and rated this as Requires Improvement. However, we found the evidence continued to support the rating of good overall. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Systems were in place to ensure people received their prescribed medicines safely, however some improvement was needed with record keeping to ensure staff had up to date guidance to keep people safe.

During the inspection we looked at some bedrooms, bathrooms, and communal areas and found that generally the environment was clean and staff followed safe infection control practices. However, there were some areas in need of improvement. There was a malodour on the first floor that was coming from a carpet. This carpet had been cleaned and the malodour had improved but not fully eliminated. We were informed new flooring was to be purchased.

On our arrival we noted boxes and equipment stored under the stairwell next to the fire escape and near to the registered managers office. We informed the registered manager that this posed a tripping hazard, in addition to obstructing the route in and out of the service and needed to be moved to a more permanent place. The registered manager took action to address this during our visit.

Staff had received safeguarding training and were confident they knew how to recognise and report potential abuse. Staff were recruited carefully and appropriate checks had been completed to ensure they were safe to work with people.

Risks to people's safety and health were assessed, managed and reviewed. People and relatives told us there were sufficient numbers of staff on duty to ensure people’s needs were met.

The registered manager had systems in place for reporting, recording, and monitoring significant events, incidents and accidents. The registered manager told us that lessons were learnt when they reviewed all accidents and incidents to determine any themes or trends.

People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences. A training plan was in place and staff were suitably trained and received all the support they needed to perform their roles.

People were supported to have a good diet which met their needs and preferences. People told us they liked the food that was provided. People were supported to access health professionals to maintain their health and wellbeing.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff understood people's different ways of communicating and how to make people feel valued. The home had a strong person-centred culture. People told us the staff were kind and caring and treated them with dignity and respect. The service recognised the importance for people of maintaining close family relationships and provided the support required to make this happen.

People's care needs were met in a way they liked. Individual care plans included the appropriate information to help ensure care was provided in a person centred and safe way. Information was available to people in a format they could understand.

The service was well led by the registered manager. There were quality assurance systems in place to help monitor the quality of the service, and identify any areas which might require improvement.

Hazelgrove Court Care Home is purpose built and can accommodate up to 48 people. The service provides care and support to people requiring personal and nursing care and people living with dementia. There are two separate units. The ground floor of the service accommodates people who require personal and nursing care. The first floor of the service provides accommodation for people living with dementia. At the time of the inspection the home was providing care to 47 people.

The home has 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.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about the different types of abuse and what action they would take if they suspected abuse was taking place. Safeguarding alerts had been made when needed.

Risk assessments were in place for people who needed them and were specific to people’s individual needs.

Emergency procedures were in place for staff to follow and personal emergency evacuation plans were in place for everyone.

Robust recruitment processes were in place and appropriate checks had been made.

There was sufficient staff on duty. People and relatives told us there was enough staff day and night to meet the needs of people who used the service. A dependency tool was used to determine safe staffing levels.

Medicines were managed appropriately. The service had policies and procedures in place to ensure that medicines were handled safely. Accurate medicine administration records were kept to show when medicine had been administered and disposed of.

Required certificates in areas such as gas safety, electrical testing and hoist maintenance were in place.

Staff had received up to date training to support them to carry out their roles safely. Their performance was monitored and recorded through a regular system of supervisions and appraisals.

People were supported to maintain their health through access to food and drinks. Appropriate tools were used to monitor people’s weight and nutritional health. People spoke positively about the food on offer.

Staff demonstrated good knowledge and understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberties Safeguards. The registered manager had a good system for recognising when DoLS applications needed to be made or reviewed. However best interest decisions were not always recorded in care records.

People were supported to maintain good health and had access to healthcare professionals and services when needed. Staff accompanied people to hospital appointments and we could see people had regular visits from their own G.P.

From our observations, staff demonstrated that they knew the people’s needs very well and could provide the support needed.

People were actively involved in care planning and decision making and this was evident in signed care plans. Information on advocacy was available and had been used in the past.

People and their relatives spoke highly of the service. People said they were treated with dignity and respect.

Personalised care plans were in place which provided staff with the information needed to meet people’s individual needs, wishes and preferences. Care plans had been reviewed regularly.

The service employed an activities coordinator to plan activities and outings for the people who use the service. People told us they were happy with the activities that took place.

The registered provider had a clear process for handling complaints which we could see had been followed; however, this had not been recorded appropriately in the complaints record.

Staff described a positive culture that focused on the people using the service. They felt supported by the registered manager to be able to deliver this and told us the registered manager was approachable and they were confident she would deal with any issues raised.

Staff were kept informed about the operation of the service through regular staff meetings.

Quality assurance processes were in place. The registered provider visited regularly to monitor the quality of the service

Accidents and incidents were monitored to identify any patterns of trends and appropriate action was taken.

Feedback from staff and people who used the service was regularly sought through meetings and surveys but action plans were not always developed.

The service worked with various healthcare and social care agencies and sought professional advice, to ensure that the individual needs of the people were being met. The registered manager attending provider meetings and events held by the local authority.

The registered manager understood her role and responsibilities. Notifications had been submitted to CQC in a timely manner. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales.

During the inspection we spoke with four people who used the service and two relatives. We also spoke with staff in the home. People told us that they were happy with the care and service received. One person said, "The staff are very good and there are enough to help me when I need it." Another person commented, "The meals are very nice, I join in some of the activities, bingo is my favourite." A relative told us, "The staff are lovely and caring, my family member is always clean and smartly dressed." We saw that staff treated people with dignity and respect. Staff were attentive and interacted well with people. We saw that people had their needs assessed and that care plans were in place.

We saw that people were encouraged and supported to receive adequate nutrition and hydration.

The home employed staff with the correct skills experience and qualifications and pre employment checks were carried .

The home had a clear complaints procedure in place.

Some records were not accurately completed therefore people were not protected from the risks of unsafe or inappropriate care and treatment.