About the service:Hazelmere is registered to provide nursing, care and accommodation for up to 23 people. There were 21 people living in the service when we visited. People cared for were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Some people were also living with dementia. Most people needed support with their personal care, eating, drinking or mobility. Accommodation was provided over two floors.
People’s experience of using this service and what we found:
At the last comprehensive inspection in July 2018, we told the provider they needed to improve the oversight and governance of the service. The registered manager and provider had made improvements to the governance and oversight arrangements, implementation of systems and processes to safely assess and manage risks to people, including their medicines. However, there were some areas of documentation that needed to be further developed to ensure people received safe and consistent care. This included the clear documentation of best interest decisions and the rationale behind them. The improvements made since the last inspection also needed more time to be sustained, and fully embedded into the culture of the service.
People received safe care and support by staff who had been appropriately recruited, trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “Very safe here, no complaints at all,” and “I came here because I had been ill, it’s clean, good food and considerate staff.” People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by trained and knowledgeable staff, who had been assessed as competent. There were sufficient staff to meet people's needs. The provider used a dependency tool to determine staffing levels. Staffing levels were reviewed following falls or changes in a person's health condition.
Safe recruitment practices had been followed before staff started working at the service. Staff were deployed in a planned way, with the correct training, skills and experience to meet people’s needs. Nursing staff received clinical supervision and training. Staff told us that they had they got to know people and their needs well and received the training they needed to meet people’s needs safely and effectively. One staff member said, “We get lots of training and have regular supervision.” People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals.
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.
Everyone we spoke to was consistent in their views that staff were kind, caring and supportive. People were relaxed, comfortable and happy in the company of staff and engaged in a positive way. People’s independence was considered important by all staff and their privacy and dignity was also promoted.
Activities reflected people’s preferences and interests. People were encouraged to go out and meet family and friends. Staff knew people’s communication needs well and we observed staff communicating with people in an effective way.
Staff were committed to delivering care in a person-centred way based on people's preferences and wishes.
People were involved in their care planning as much as they could be. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives.
People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated. The provider and registered manager were committed to continuously improve, and had developed structures and plans to develop and consistently drive improvement within the service and maintain their care delivery to a good standard.
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 September 2018) and there were three 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.
The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.
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.