Archived: Hazelgrove Nursing Home

As part of this inspection we spoke with four people who lived at the home, eight visiting relatives, the acting manager, the care consultant, a registered nurse, a clinical assistant and four care workers.

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

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

This is a summary of what we found

Is the service safe?

People were treated with respect and dignity by the staff. People who lived at the home told us they felt safe. A person told us "I am treated well and I feel safe".

Systems were in place to make sure that management and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the home to continually improve.

The acting manager compiled the staff rotas, they took people's care needs into account when they made decisions about the numbers, qualifications, skills and experience required. This helped ensure that people's needs were always met.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were safeguarded as required.

Recruitment practices were safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

People's health and care needs were assessed with them, and, as far as practicable, they were involved in developing and reviewing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

The home had systems in place to assess and manage risks and to provide safe and effective care.

There was an advocacy service available if people needed it, this meant that when required people could access additional support. We also found evidence of staff seeking advice, where appropriate, from the GP or social services.

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

Staff were appropriately trained and training was refreshed and updated regularly. However, systems of formal supervision for staff had not been implemented or carried out.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to staff supervision.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Staff took time interacting patiently and sensitively with people throughout the home. We observed that people were treated with consideration, dignity and respect.

People, their relatives, friends and other professionals involved with the home had completed a recent satisfaction survey. Where shortfalls or concerns were raised these were being addressed.

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

Is the service responsive?

People told us they were asked for their feedback on the home, and their feedback was heard and changes were made as a result. People were also confident that their concerns would be listened to and acted upon.

We saw evidence that the home worked with key organisations, including the local authority and safeguarding teams, to support help care provision and service development.

There were limited activities on offer in the service. Our own observations and feedback from relatives and staff confirmed this.

Is the service well-led?

The home did not have a registered manager in post at the time of our inspection. A registered manager is a person who has registered with CQC to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

The home did not have established quality assurance systems in place which identified shortfalls within the service. As a result, the quality of the home provision and improvement could not be monitored.

Staff told us they were clear about their roles and responsibilities. Staff showed an awareness of the ethos of the service and good understanding of the care and support needs of people. They told us that they felt valued and supported by the acting manager and were happy and confident in their individual roles.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law, in relation to having robust quality assurance and governance systems in place to drive continuous improvement.

As part of this inspection we spoke with three people who used the service and five visiting relatives. We also spoke with the manager and eight care workers.

Is the service safe?

People who used the service, their relatives and staff all told us that at times there were not enough staff on duty to make sure that people were cared for safely. Our own observations and the records we saw confirmed this.

We saw examples of unsafe and inappropriate care practices being carried out by staff, especially in the area of manual handling.

Some staff did not know about the risk management plans that had been written for some people with particular needs. This was putting these people at unnecessary risk of harm.

The service had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), although no applications had needed to be submitted. Relevant staff had an understanding of when an application should be made, and how to submit one. However no current staff had received formal training in respect to the Mental Capacity Act 2005.

Risk assessments were not updated often enough, or written in enough detail to ensure people were protected from the risk of harm.

We looked at the recruitment of new staff. We found that some staff required checks into gaps in employment and the take up of appropriate references were not being followed. This was putting people at risk of being supported by staff who did not have appropriate experience, or were not of good character.

Some systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints and concerns, which helped reduce the risks to people and helped the service to improve. However, concerns were raised in respect to the effectiveness of these systems.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to the care and welfare of people and staffing requirements.

Is the service effective?

People had their needs assessed, however we saw examples of staff being unaware of people's assessed care needs and care plans not being followed.

We saw that some care plans contained gaps and were not updated often enough. Although staff had received some relevant training, we saw that induction for several new staff was inadequate, which meant people were at risk of not having their needs met.

Staff told us that they did not receive adequate support from their managers and that there were not appropriate mechanisms in place to raise concerns about the service.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to the delivery of care and support of staff.

Is the service caring?

People told us that staff were generally kind and thoughtful. Most people said that staff asked them how they wanted to receive their care and were respectful. However, feedback received from people, their relatives and staff stated that staff did not always have the time to give to people living in the home. Our own observations supported this.

We did not see evidence that people living in the home, their relatives or friends had been invited to complete a satisfaction survey. Feedback received from relatives also stated that they felt their concerns would not be listened to. This meant people were at risk of not having their concerns and needs properly taken into account.

We found that care and support had not always been provided in accordance with people's wishes, especially around activities and social interaction.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to the delivery of care and support of staff.

Is the service responsive?

People told us there were no activities on offer in the service, and that their personal choices and needs were not being met. Our own observations and feedback from relatives and staff confirmed this.

People knew how to make a complaint if they were unhappy. We looked at how complaints had been dealt with, and found that they had been handled appropriately. However, feedback received indicated that people felt their comments or complaints would not be listened to or dealt with effectively.

We saw evidence that the service worked with key organisations, including the local authority and safeguarding teams, to support help care provision and service development.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to delivering personalised care and having effective systems in place to receive feedback.

Is the service well-led?

Feedback from relatives and comments from staff showed us that the service did not have appropriate leadership or a positive and empowering culture. Staff told us they sometimes felt that they were left to manage with little support. This meant that there was not enough support for staff in their role to ensure they offered effective care.

The service had a quality assurance system. However, records we saw showed that not all of the shortfalls identified had been addressed. The system did not systematically ensure that staff were able to provide feedback to their managers, so their knowledge and experience was not being properly taken into account.

Staff were unclear about their roles and responsibilities. For example, the manager was not present at the service on the first day of our inspection and staff were unaware of who was in charge in their absence.

We saw that staff turnover was high and there were several staff vacancies. The manager told us they had not been able to recruit suitable staff to these posts. When we spoke with staff, they told us that staff commitment to the job had decreased due to the pressures they were under and the lack of support they received.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to quality assurance, staffing requirements and support.

We looked at the care plans, risk assessments and daily records relating to 33 of the 37 people who lived at the service. We found that the documentation used for care planning lacked consistency and detail in respect to people's assessed and on-going care and treatment. We found that regular formal reviews of people's care had not taken place.

Staff we spoke with told us that they felt valued and supported and that their training needs had been met.

The overall appearance of the service was clean and we saw that there were appropriate systems and policies in place in respect to cleanliness and infection control. A person who used the service told us 'I see the cleaners going round a lot'. A member of staff told us 'I think that the home is very clean now'.

Staff told us that they felt valued and supported. They told us that they were able to raise any issues that they may have in their roles, in order to carry out their work to the best of their ability. One member of staff told us 'I feel supported, I'm ok. I can raise issues and I am listened to'. Another member of staff told us 'The culture is changing in the home. It is a happier place to work now'.

We saw that the service had systems in place to gain and review consent to care and treatment from people who used the service. We also saw that the provider had systems in place to monitor, respond and learn from complaints.

The people we spoke with told us they were reasonably happy with the care they or their relative had received and with the majority of the staff team. Although several comments from people related to the feeling that the atmosphere of the service had changed in recent months. It was felt that tensions existed between staff and relatives of people who used the service, which had impacted on the quality of the care provided.

Despite the service having appropriate policies and procedures in place, we saw areas of non-compliance in respect to cleanliness and infection control. We also spoke with several staff members who told us that they felt their training needs were met, but that they did not feel supported adequately in their roles to carry out their work to the best of their ability.

We also took information from other sources to help us understand the views of people who use the service, which included a satisfaction survey and meeting minutes.

The people we spoke with told us they or their relative or friend were generally happy with the care they received and with the staff team.

Staff we spoke with knew the people living at the home well and had a good understanding of their support needs.

One person who used the service told us 'They [the staff] do come pretty quickly when I need them'. A friend of a person who used the service we spoke with told us 'The staff have so much patience and they are very welcoming, he [their friend] is safe here'.

A relative who was visiting on the day of our inspection told us 'The staff are very gentle, they take their time and are caring'.

One member of staff we spoke with told us 'The carers are a happy group, which puts the residents in a good mood'.