Archived: Hazelroyd Nursing Home

Hazelroyd Nursing Home is a nursing home providing personal and nursing care to 23 people aged 65 and over at the time of the inspection. The service can support up to 30 people.

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

Since the last inspection a new registered manager had been appointed and had established robust effective systems for improving quality and safety within the service.

Actions taken by the registered manager and the provider meant people lived in a safe, clean environment. A programme of refurbishment and redecoration was being followed. Priority had been given to building work needed to make sure people were safe.

The registered manager recognised that further work was needed to make sure assessments of people’s needs and care planning was effective and completed with a person centred approach.

The provider and registered manager understood these improvements need to be sustained to ensure consistency in how well the service is managed and led, and to ensure continuous improvements in care for people using the service.

Staff knew what to do if they thought somebody was at risk and people told us they felt safe. Risks to people’s health and safety were assessed and plans put in place to mitigate risks. Medicines were managed safely.

The registered manager analysed accidents, incidents and issues that happened in the home and put plans in place to mitigate the risk of reoccurrence.

Staff were recruited safely and followed a programme of induction, training and training updates. Staff said the training was appropriate to their needs and had improved since the appointment of the new manager.

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. The registered manager planned to increase staffing to improve the opportunities people had to engage in activities.

People enjoyed the food and their nutritional needs were met.

People were supported by staff who respected their individuality and privacy and dignity needs. Staff worked with health and social care professionals to make sure people’s needs were met.

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 inadequate (report published 30 August 2019) and there were multiple 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since August 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

People were not safe. There were not enough staff to give people the care and support they needed or to keep the home clean. Standards of building maintenance and cleanliness were poor and infection control procedures were not always followed.

Risks were not assessed or managed appropriately. There were no processes in place to learn lessons when things went wrong.

People were protected from abuse, but consideration had not been given to the isolation many people were experiencing due to having to stay in their rooms because of the broken lift.

Medicines were managed safely.

Systems were in place to support people to have choice and control of their lives, but this was minimised for some people because the lift did not work. The provider had not adequately assessed or minimised the impact of this on people’s freedom to get to the lounge, dining room and outside areas. There was also impact on visitors who needed to use the lift to visit their relatives.

Staff did not receive the training they needed to equip them with the skills and competencies to do their job. Staff were recruited safely.

People had access to healthcare professionals within the home, but some healthcare appointments had been missed due to the lift not working.

People’s nutritional needs were met.

People and relatives gave mixed feedback about the care people experienced. People’s privacy and dignity was not always maintained.

Care was not always planned with a person-centred approach. Some people were restricted in accessing activities due to not being able to leave their rooms.

The service was not well-led. The registered manager had left the service and the interim manager was absent from the service for several weeks. The provider’s quality assurance systems were not effective in identify and addressing issues.

Following this inspection, we contacted the infection control team and building control team to make them aware of our concerns.

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 December 2018).

Why we inspected

The inspection was brought forward because of concerns shared with us by the local authority and the infection control team.

We have found evidence that the provider needs to make significant improvements. Please see all sections of this full report.

Enforcement

We have identified 5 breaches in relation to safe care and treatment, staffing, person centred care, premises and equipment and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will continue to work with the local authority and clinical commissioning group to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Following the last inspection we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions asking if the service was safe, effective, responsive and well led to at least good. The registered provider sent us an action plan, detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of the Regulations.

Hazelroyd Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Accommodation is provided for up to 30 people, across three floors. At the time of the inspection, there were 27 people living in the home.

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.

People said they felt safe living at Hazelroyd Nursing Home and we found there were systems and processes in place for people's needs to be safely met. Staffing levels were supportive of people's individual care needs. People received their medicines on time and staff understood each person's abilities and health needs.

People were supported to have maximum control and choice over their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice and staff understood legislation around people's mental capacity.

Staff had a kind and caring approach and showed respect when interacting with people and good regard for people's privacy and dignity.

People enjoyed meaningful activities and there were appropriate opportunities to engage with the activities coordinator in groups or on a one to one basis. There were many resources to support people's activities and we made a recommendation the provider extends these to include resources such as audio books, for people with impaired vision.

Systems and processes for assessing and monitoring the quality of the provision, including identifying risk, were robustly implemented. Audits were thorough and there was clear evidence of management oversight of the service. People, relatives and staff spoke highly of the registered manager and the way the service was run.

Hazelroyd Nursing Home provides residential and nursing care for up to 30 older people some of who may be living with dementia.

The last inspection was in August 2015. At that time we gave the service a rating of ‘Good’ but found breaches relating to consent and management of Deprivation of Liberty Safeguards (DoLS). We found improvements had been made in this area but recommend care files are updated to make sure people’s consent to sharing information with family is sought and clearly recorded.

Since the last inspection the registered manager retired and a new manager was appointed. The new manager was currently going through application to CQC to become the 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who used the service told us they felt safe and staff knew how to recognise and report abuse.

Systems were in place to promote safety within the home. This included checks on the environment and review of accidents and incidents. However more work was needed on plans for supporting people in the event of an emergency.

Improvements were needed to make sure the home was clean and the risk of cross infection was minimised.

We recommended the provider addressed specific areas we had identified, and ensured their refurbishment programme was put into immediate action so that good infection control measures were in place.

People’s medicines were for the most part managed safely. However, procedures for use and storage of prescribed thickening agents needed to be improved. We made a recommendation in relation to this.

Risks to people’s personal safety were assessed and plans put in place to mitigate the risk.

People spoke very highly of the staff but we found there were not always enough staff available to meet people’s needs safely.

We found staff were being recruited safely. Staff received appropriate training and they told us the training was good. Staff told us they enjoyed working at the home, felt supported by the manager and received supervision and appraisals.

We heard staff asking people for consent and giving explanations before supporting them. We found the service had made improvements to make sure they were working in line with the requirements of the Mental Capacity Act 2005 and the requirements relating to Deprivation of Liberty Safeguards (DoLS). However staff needed to be sure about people’s consent to share information with families.

People told us they enjoyed the food and we saw people were offered a choice of food and drinks which took account of their likes, dislikes and nutritional needs. However, clearer actions needed to be recorded when people’s dietary intake was not sufficient to maintain their health.

We saw people were supported to maintain their health and had access to the full range of NHS services.

People told us staff treated them with dignity and respect and whilst we observed some good practice, we also observed some examples of where improvements were needed.

People told us their family and friends were made welcome in the home and were offered refreshments during their visits. We saw staff encouraged the involvement of people’s families and friends in the home.

Staff knew people well and we saw some good examples of care and consideration of people’s privacy and dignity. However we also noted some examples of where better practice was needed to make sure people were cared for in a way that met their privacy and dignity needs.

People were supported to take part in a variety of in house activities but there was little interaction for those who were unable or chose not to take part in the activities.

There was a complaints procedure in place and we saw action was taken in response to complaints or concerns.

People who used the service and their relatives had the opportunity to share their views by means of meetings and surveys.

Systems were in place to monitor, assess and improve the quality of the services and a comprehensive refurbishment plan was in place.

We found the provider was in breach of Regulation 18 (Staffing).

You can see what action we told the provider to take at the back of the full version of the report.

We spoke with six people living in the home and five staff. These were some of the things they told us:

'The staff are very nice.'

'I get all of the help I need.'

'I think the food is very good.'

'I enjoy working here; we have a good staff team.'

We found that people's care was being planned and delivered in the way they preferred. The medication system was being managed safely and people received their medication at the correct times.

There were enough staff on duty to meet people's needs and all of the staff had a qualification in care.

There was a complaints procedure in place and people told us that they would feel able to raise any concerns.

Two of the people we spoke with said that the care they received was good and that they liked the staff. One person said that they "couldn't wish for any better" and that staff help them "just as I need".

One person said that some staff are better than others but that they get the support they need.