Inspection Report - Care Quality Commission

| Inspection Report | Hazel Bank Care Home | July 2014 www.cqc.org.uk 1

Inspection Report

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Hazel Bank Care Home

Daisy Hill Lane, Daisy Hill, Bradford, BD9 6BN Tel: 01274547331

Date of Inspection: 18 June 2014 Date of Publication: July 2014

We inspected the following standards as part of a routine inspection. This is what we found:

Care and welfare of people who use services Met this standard

Management of medicines Met this standard

Safety and suitability of premises Action needed

Staffing Met this standard

Supporting workers Action needed

Assessing and monitoring the quality of service provision

Action needed

Complaints Action needed


Details about this location

Registered Provider Park Homes UK Limited

Registered Managers Mrs Kathleen Bailey

Miss Harvinder Kaur

Overview of the service

Hazel Bank Care Home provides accommodation, personal and/or nursing care for up to 39 residents, who may be livingwith dementia or other mental health problems. Accommodation is provided over three floors, which can be accessed using passenger lifts.

Type of service Care home service with nursing

Regulated activities Accommodation for persons who require nursing or personalcare

Diagnostic and screening procedures

Treatment of disease, disorder or injury


Contents

When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'.

Page

Summary of this inspection:

Why we carried out this inspection 4

How we carried out this inspection 4

What people told us and what we found 4

What we have told the provider to do 7

More information about the provider 7

Our judgements for each standard inspected:

Care and welfare of people who use services 8

Management of medicines 11

Safety and suitability of premises 13

Staffing 15

Supporting workers 17

Assessing and monitoring the quality of service provision 19

Complaints 22

Information primarily for the provider:

Action we have told the provider to take 24

About CQC Inspections 26

How we define our judgements 27

Glossary of terms we use in this report 29

Contact us 31


Summary of this inspection

Why we carried out this inspection

This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection.

This was an unannounced inspection.

How we carried out this inspection

We looked at the personal care or treatment records of people who use the service, carried out a visit on 18 June 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff, reviewed information sent to us by commissioners of services and talked with commissioners of services. We were accompanied by a specialist advisor.

What people told us and what we found

The inspection visit was carried out by one inspector and a specialist advisor in mental health. During the inspection, they spoke with the home manager, operational manager, quality assurance manager, one of the company directors, three care staff (two care workers and one registered nurse), ten people who lived at the home (four of whom were being nursed in bed and one who chose to remain in their room), six relatives who were regular visitors and the community matron.

Before the inspection we reviewed all the information we held about the home and contacted the local authority Adult Protection Unit and Contracts and Commissioning Team. On the day of the inspection we looked around the premises, observed staff interactions with people who lived at the home and looked at records. There were 33 people living at the home on the day of the visit; 14 of whom required nursing care and 19 required residential care. Five people living at the home were living there on a temporary basis following a fire at their sheltered housing accommodation.

At the last inspection in September 2013 the service was found to be meeting the regulations we looked at.

Before this visit we had received information of concern about how the home dealt with complaints. We found evidence which supported this information.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive?Is the service well led?


This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

There were some systems in place to protect people who lived at the home from abuse and avoidable harm. For example people's medicines were stored safely and administeredas prescribed and care was planned and delivered in a way that ensured people's safety and welfare. There were sufficient numbers of suitably qualified staff to meet the needs of the people who lived at the home.

However we found care staff had not had appraisals or first aid training. The lack of qualified first aiders at the home meant people who lived at the home may be at risk in the event of an emergency. We have asked the provider to make improvements.

We also found the premises and grounds at the home were not adequately maintained. This meant people who lived there were not living in safe surroundings that promoted their wellbeing. We were particularly concerned that the temperature of the hot water at the home was not adequately controlled; this meant vulnerable people were at risk of scalding.We have asked the provider to make improvements.

Is the service effective?

Peoples' care, treatment and support at the home achieved good outcomes and promoted a good quality of life for the people that lived there. People told us they were happy with the care provided at the home and their care and support needs were being met. One person said, "I've been here for about 12 months, I was in another home before but I like it much better here. I'm happy here."

From our observations and from speaking with staff, people who lived at the home and relatives we found staff knew people well and were aware of peoples care and support needs. We also found staff had received appropriate training to meet peoples' needs.

We saw there was equipment such as adapted baths and grab rails in place. These enabled people to maintain their independence.

The care plan for one person (who was cared for in bed) identified they were at risk of developing pressure sores. We saw this person was regularly turned from side to side and these actions were consistently recorded. After a prolonged period of bed rest the person had not developed tissue damage; this demonstrated the effectiveness of care given.

Other people's care plans where the potential for tissue damage had been identified showed effective care delivery. No pressures sores had developed and one person admitted with a pressure sore had seen their pressure areas restored to full health.

Is the service caring?

We saw staff treated people with dignity and respect and maintained their privacy and dignity. We heard care staff speaking courteously and kindly with people, asking permission before helping to support them and explaining what was happening.


We observed people who lived at the home were supported by caring and attentive staff who were patient and encouraging when they were supporting them. We observed how staff interacted with people whilst medicines were administered. Staff were respectful when they spoke with people and enabled people to take their medicines in an unhurried manner. We also observed lunchtime in the dining room and saw it was a sociable experience for people.

During our visit we saw the atmosphere was calm and relaxed. Some people were relaxingin their own rooms. Others were chatting in the lounges or watching television. People appeared comfortable and were well dressed and clean, which demonstrated staff took time to assist people with their personal care needs. One person told us, "They help me with washing and dressing and are very kind."

This showed us staff treated people who lived at the home with compassion and respect and encouraged them to retain their independence here where possible.

Is the service responsive?

Care and support was provided in accordance with peoples' preferences, interests and diverse needs. Records we looked at, discussion with staff and observations showed that people's wishes were respected and acted upon.

People had access to activities and were supported to maintain relationships with their friends and relatives. We also saw care staff regularly visited people cared for within their own rooms. Published research evidence suggests that keeping people regularly occupiedand stimulated can improve the quality of life for people with dementia.

There was a full activities programme in the home which included organised games, quizzes and musical entertainment. The home employed activity coordinators to organise the programme. One person, who was sat in the lounge, told us, "I'm not bothered about joining in with the quiz; they are always doing things here though."

This meant the home was organised so that it met peoples' social and emotional care needs, in addition to their physical care needs.

Is the service well-led?

We found people were not protected against the risks of inappropriate or unsafe care because the provider did not have effective systems to assess and monitor the quality of service people received. We have asked the provider to make improvements.

We also found the complaints system at the home was not effective. Comments and complaints people made were not responded to appropriately. We have asked the providerto make improvements.

In this report the name of registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still registered managers on our register at the time.

The home manager told us they had been in post since March 2014. They told us they hadapplied to the Care Quality Commission to become the registered manager at the home. People and their relatives we spoke with gave positive feedback about the new manager.


A relative said, "We have had issues in the past but things appear to be improving."

You can see our judgements on the front page of this report.

What we have told the provider to do

We have asked the provider to send us a report by 02 August 2014, setting out the action they will take to meet the standards. We will check to make sure that this action is taken.

Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service(and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.

More information about the provider

Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions.

There is a glossary at the back of this report which has definitions for words and phrases we use in the report.


Our judgements for each standard inspected

Care and welfare of people who use services Met this standard

People should get safe and appropriate care that meets their needs and supports their rights

Our judgement

The provider was meeting this standard.

People experienced care, treatment and support that met their needs and protected their rights.

Reasons for our judgement

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

During our visit we looked at the care files of four people who lived at the home. We saw their care records were clearly indexed and individually tailored to meet people's needs. They all contained a comprehensive pre-admission assessment. Each person who lived atthe home was assigned a 'named nurse' and a key worker. The home manager explained the named nurse was responsible for the person's care planning and the key worker was responsible for the person's daily living needs, such as shopping for toiletries or clothing. This demonstrated the home was aware of the importance of providing consistent and stable staff interactions for people with dementia.

The four care files we looked at all had relevant individual care plans and risk assessments in place, along with the actions staff needed to take in order to meet people'sneeds. These included care plans for communication (including problems with sight or hearing), mobility, nutrition, tissue viability and psychological aspects of care (such as mood). Records showed care plans and risk assessments were reviewed on a monthly basis. This showed us care planning accounted for people's changing care needs.

Where care plans or assessments indicated a risk assessment was required, we saw these had been carried out. These included assessing the risk of people who could potentially develop pressure sores, risks associated with poor mobility needs such as falling and risks associated with poor nutrition. This was to reduce the likelihood of injury orharm. We saw one person's 'sleeping and rest' care plan showed the person had bed rails and bumpers on their bed. We saw a bed rails risk assessment was in place which had been agreed with the person's family. This showed us care and treatment was planned and delivered to ensure people's safety and welfare.

People with dementia with or without another mental illness may develop non-cognitive


symptoms that cause them distress or may develop behaviour that challenges. In one of the care files looked at in detail we saw an individual care plan derived from good risk assessments which would help carers address behaviour problems. For example, the person concerned had little insight into the dangers of smoking in bed; this posed a threat to themselves and others. This person's care plan helped staff deal with this risk and told staff how to deal with the person's non-compliance to adhere to reasonable requests. We judged this to be of benefit to all concerned.

We saw records which required completion within the care files and in peoples' bedrooms were generally up to date and completed as required. These included daily reports, weight monitoring, medication administration records, food intake charts and fluid intake charts. This provided evidence which showed people were receiving care in line with the requirements set out in their care plan.

Each care record we looked at contained details of other healthcare professionals involvedin the person's care. These included physiotherapists, chiropodists, district nurses, tissue viability nurses, community psychiatric nurses and social workers. We also saw records of multidisciplinary team (MDT) meetings and best interests meetings. We saw one person with a diagnosed mental illness was posing a risk to themselves by their own actions. An MDT meeting comprising, a psychiatrist, a GP, a community psychiatric nurse, a social worker and a community matron had met with staff at the service to collectively plan care. Our discussion with the community matron confirmed the meeting had been of benefit and future care planning was on-going.

The home manager told us the community matron visited the home twice a week to deal with any medical issues people had. This showed people who lived at the home had appropriate additional support in order to meet their care and treatment needs.

People, relatives and staff all told us the care at the home was good. One person who lived at the home told us, "I like living here; they're all nice people here." One relative said, "I am really pleased with the care here, the staff are so caring".

We saw the home offered a range of activities on a daily basis including dancing, singing and quizzes. We saw people enjoying music and taking part in a quiz during our visit. Our discussions with a visiting healthcare professional indicated that organised activities were a regular feature at the home. This showed the home promoted people's wellbeing by taking account of their social and emotional needs and providing meaningful activities.

We spoke with two members of staff about the use of restraint. They were able to describede-escalation techniques to minimise the use of restraint. They also demonstrated their understanding that restraint should only be used in a way which respected dignity and protected human rights. They described to us the value of providing a stimulating environment and effective communication to prevent behaviour that may be of risk to individuals. This meant that staff had a good understanding of the people who lived at the home and how they could deliver care respectfully and within the law.

Prior to our inspection visit we had received information of concern which suggested people's call bells at the home were not being answered in a timely manner. We looked at this as part of our inspection and we observed staff responded promptly when we heard call bells going off during our visit. We were also shown evidence which confirmed the call bell system had been serviced by an outside contractor.


The provider may find it useful to note that we saw several call bells which were either out of reach and/or the cord was of poor quality in some of the bedrooms and bathrooms we looked in. This meant people may not be able to access the call bell system which had been put in place to help them to summon assistance. We discussed this with the home manager during the inspection. We will check whether the necessary improvements have been put in place during our next inspection.


Management of medicines Met this standard

People should be given the medicines they need when they need them, and in a safe way

Our judgement


People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.


We looked at how medicines were managed and found appropriate arrangements for obtaining, administering and disposal. Medicines were administered by trained nurses or care staff with the appropriate training.

We inspected medication storage and administration procedures at the home. We found medicine trolleys and storage cupboards were secure, clean and well organised. We saw the drug refrigerator and controlled drugs cupboard provided appropriate storage for the amount and type of items in use. The treatment room was locked when not in use.

Drug refrigerator temperatures were checked and recorded to ensure medicines were being stored at the required temperatures. This confirmed that medication was being stored safely. However, the provider may find it useful to note, we saw eye drops stored in the refrigerator which should have been stored at normal room temperature. The nurse immediately removed these eye drops and replaced them with new stock. The provider may find it useful to note that the storage of eye drops was not part of the home's regular audit of medicines.

Most peoples' medication was administered via a monitored dosage system (MDS) supplied directly from a pharmacy. This meant the medicines for each person for each time of day had been dispensed by the pharmacist into individual trays in separate compartments. We saw staff maintained records when medication was not taken and the reasons why. For example, if the person had refused to take it or had dropped it on the floor. A record was kept which showed medicines which had been destroyed. This showedus reliable records were maintained to check medication accuracy.

We saw one person was taking medication prescribed and supplied by the local mental health services. These medicines required regular blood tests to lessen the risk of side-effects developing. Staff administering this medicine had a competent understanding of why the medicine required care in its administration.

Some prescription medicines contain drugs that are controlled under the Misuse of Drugs legislation. These medicines are called controlled medicines or controlled drugs. We saw


the controlled drug records were accurately maintained. The administration of controlled drugs and the balance remaining was checked by two appropriately trained staff.

Creams and ointments were prescribed and dispensed on an individual basis. The creamsand ointments were dated upon opening. All medication was found to be in date. We observed some creams and lotions in use were kept in people's en-suite toilet areas, this was not an appropriate location for these to be stored. When toilets are flushed aerosols are produced; which presents an infection risk. The provider may wish to seek advice fromtheir pharmacist to find a more suitable environment in which to store these items.

We looked at medication administration record (MAR) sheets. The MAR sheets identified whether the person had any allergies. We saw MAR sheets had been signed by staff and there were two signatures where these were needed. We saw the medication records did not have any gaps in the signatures. This showed us that medication had been given correctly and meant people received the medication they needed at the correct times.


Safety and suitability of premises Action needed

People should be cared for in safe and accessible surroundings that support their health and welfare

Our judgement

The provider was not meeting this standard.

People who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises.

We have judged that this has a moderate impact on people who use the service, and havetold the provider to take action. Please see the 'Action' section within this report.


The provider had not taken action to provide care in an environment that was adequately maintained. This meant people who lived at the home were not living in safe surroundings that promoted their wellbeing.

The home manager accompanied us on a tour of the building. We looked in nine people's bedrooms, the linen room, two bathrooms, lounge areas, the dining room, hairdressing salon and attendant circulation areas. We saw door frames and architraves, skirting boards, doors and walls were damaged with areas worn away. We saw damage to suspended ceiling panels through repeated access to one area. Lighting panels were cracked and hanging below the ceiling frame. Whilst all fire doors were held open with automatic door release mechanisms we saw some units were damaged.

We found all floor coverings were appropriate to the environment in which they were used.However, carpets in general circulation areas in many parts of the home were poorly fittingand showed signs of wear which posed a trip hazard. On one staircase we saw some of the protective strips on the leading edge of the stair tread were loose. We also saw the flooring strip across the door to the dining area and the carpeted around a floor access hatch immediately outside the hairdressing room presented trip hazards.

The home manager told us, and we saw, that redecoration had taken place in some parts of the home. There were several other areas in need of refurbishment. Some door handlesto peoples' bedrooms were broken with face plates missing.

We saw that the home had in place a planned maintenance and refurbishment programmewhich would address our concerns regarding redecoration and replacement of floor coverings.

All radiators in the home were of a low surface temperature design to protect vulnerable people from the risk of injury. We saw fire-fighting equipment was available, emergency lighting was in place and fire escapes were all kept clear of obstructions. We saw upstairs


windows all had opening restrictors in place to comply with the Health and Safety Executive guidance relating to falls from windows. Records of lift and hoist maintenance were examined and found to be correctly inspected by a competent person. Portable electrical equipment had also been tested. This showed us the provider had some systemsin place to ensure the safety of the people who lived at the home, staff and visitors.

We took the temperature of water from several taps in areas which people could access. We found the water temperatures were very hot; this meant there was a high risk of peoplebeing scalded. We asked the home manager if hot water temperatures were taken; we were shown documents which recorded temperatures of between 40 and 50+ degrees centigrade. The upper permitted limit for hot water is 41 degrees centigrade, as defined within the Health and Safety Executive guidance on safety in care homes. Further scrutiny of records showed hot water tap temperatures exceeding 41 degrees centigrade had beenregularly recorded since at least April 2014. The maintenance engineer had recommendedreplacement of the thermostatic mixing valves. We found no action had been taken to replace the valves nor had a risk assessment been conducted to minimise risk of scalds toa vulnerable care group whist repairs were awaited. There was also no signage next to taps to warn people that the water was very hot. We judged this to constitute a significant risk of harm by scalding for the people who lived at the home. We discussed our concerns with the management team during our inspection and at feedback.

The provider had appropriate security arrangements in place to protect people who lived atthe home. We found the entrance door was secure from outside and visitors could only enter the building with the knowledge of the staff. All visitors to the service were asked to sign in to the visitor's book, both on arrival and when departing. All ground floor windows were found to be secure. However, the provider may find it useful to note, the Care QualityCommission had been notified of three separate incidents where people living at the homehad gone missing or left the home, unobserved by staff, since the beginning of 2014. Security arrangements at the home should be kept under review and preventive actions put in place to minimise the risks to people.

We saw the home's outside area was a valuable resource which was not currently fully available for people. Outdoor facilities for people were in need of attention, for example, plants had overgrown the pathways. We saw the access ramps from the dining room to the patio and from the car park to the lower grassed area were of poor construction and were not suitable for wheelchair users. This meant people who lived at the home may be at risk, as the home's surrounding grounds had not been adequately maintained.


Staffing Met this standard

There should be enough members of staff to keep people safe and meet their health and welfare needs

Our judgement


There were enough qualified, skilled and experienced staff to meet people's needs.


The home manager told us the home had a registered nurse on duty 24 hours a day. Theysaid the nurse was supported by six care workers in the morning, five care workers in the afternoon and two care workers at night. The care team was supported by three domestic staff, two for cleaning and one for laundry, and two kitchen staff. The home manager told us the activities co-ordinator worked five hours a day, Monday to Friday. They said as this post was currently vacant so they had assigned a care worker to carry out the activities for five hours a day until the position was filled.

When we asked about vacancies the operations manager told us the administrator post at the home was currently also vacant, interviews had been held and they were waiting for recruitment checks to be completed. The provider was also recruiting to vacancies for bank staff, these were care worker positions.

The home manager explained to us that they were quite new in post and that they were a Registered General Nurse. We saw that all of the nursing staff working at the home had current registration with the Nursing and Midwifery Council (NMC). The NMC aims to protect the public, and helps those on the NMC's register to meet the standards required ofthem. This assured us that the nurses working at the home were fit to practise and appropriately qualified for their role.

We asked to see the duty rotas and we saw these confirmed the staffing levels which had been explained to us. On the day of our visit the laundry person had phoned in sick so oneof the domestic staff was doing the laundry when we carried out our tour of the building. During the morning a domestic from one of the provider's neighbouring homes came to thehome to cover the vacant cleaning shift.

We asked the managers about cover for absences. They told us staff at Hazel Bank and the two neighbouring homes owned by the same provider would be asked whether they wanted to cover unfilled shifts. The operational manager said, "There are quite a lot of staffthat want extra hours." They told us the provider had their own bank staff and the homes never used agency staff. This meant people who lived at the home were cared for by consistent care staff.


During our inspection we observed a relaxed and homely atmosphere where staff obviously knew people well. We observed care staff supporting people where needed in a calm and unhurried manner. One person we spoke with told us, "The staff are really nice here" and another person told us, "They're very good here; I've no complaints at all. They care for me and look after me." When the nurse came into this person's bedroom they said(about the nurse), "They're a damn good worker!"


Supporting workers Action needed

Staff should be properly trained and supervised, and have the chance to develop and improve their skills

Our judgement


Staff were not receiving appropriate support, training and appraisal to monitor their performance and development needs and ensure they had the skills and competencies to meet people's needs.

Staff meetings were infrequent and communication systems for ensuring staff were updated about changes were not robust.



Staff did not receive appropriate professional development.

We saw records were kept of all those attending learning and development activities. We looked at the staff training matrix and saw the provider's mandatory training was generally up to date. We noted the training matrix did not include training in first aid. We asked the operations manager about this and they told us there were plans in place to introduce first aid training for staff. We asked the managers how many staff at the home had first aid training. They were unable to confirm which staff had received first aid training or show us certificates to confirm that first aid training was up to date for any of the staff. The home manager showed us a 'First Aiders' notice in the staff room with five staff names on it. Oneof these was the previous manager at the home and two other staff names had been crossed out. The home manager told us there was one care worker and one nurse currently working at the home who had received first aid training; however we did not see any evidence to confirm this.

People who use services should receive care treatment and support from staff who have undertaken appropriate training and qualifications, as advised by Skills for Care. Skills for Care recommends that the First Aid at Work course, which lasts for three days, is appropriate for most care staff; although the Emergency First Aid at Work course, which lasts one day, may be suitable for some members of staff. These formal training courses should be delivered by suitably qualified First Aid learning providers. Re-qualification training is required within three years and it is recommended that refresher training in undertaken on an annual basis. The apparent lack of first aid training for staff who worked at the home meant the safety and welfare of people who there may be put at risk in the event of a medical emergency.


We asked the staff we spoke with about their training. They told us they got training and, as far as they were aware, it was up to date. They also confirmed staff could undertake further qualifications if they wanted to. However, the provider may find it useful to note, staff indicated their need for further training to cope with people who became disruptive and at risk of harming themselves and others around them.

Staff we spoke with told us that, whilst they felt supervised in their day-to-day duties, there was no formal structured supervision. Documentary evidence we saw of supervision indicated supervision was taking place although there was no plan to ensure the providers own target of six supervisions per year would be met. The staff also told us that appraisal was not currently carried out, nor had been for some time. When we asked the managers to show us the most recent staff appraisal records they were unable to locate any evidence for us. We were therefore unable to inspect a complete learning and development plan for any of the staff.

We spoke with a recently appointed member of staff. They told us an induction programmetook place and they were not allowed to work unsupervised until the programme was completed. They said the induction had prepared them with the necessary information to care for people, to be aware of emergency procedures and be aware of reporting mechanisms for adverse events. Staff told us they were pursuing studies to attain accredited training which demonstrated the provider was supporting staff in this area.

We asked the home manager how changes were communicated to staff. They told us staffmeetings were held every three months. They showed us the 'Staff and relatives meetings'folder. We saw the most recent staff meetings at the home had been held on the 7 April 2014 and the 17 January 2014. We asked the home manager whether staff who had not attended the meeting were required to show evidence they had read the minutes of the meeting to demonstrate they were aware of changes to the service. The home manager told us they left a copy of the minutes of the meetings in the staff room. They confirmed they did not keep any records of meeting attendance or records of staff reading the minutes after the meeting. This meant there was no record to show whether all staff were informed about changes at the home.

We asked about staff meetings for evening and night staff. The home manager told us they held a separate meeting on the same day with the evening and night staff, following the same agenda. We did not see any minutes for meetings with the evening and night staff for the previous two meetings in the folder. When we asked the home manager whether these had been held they told us they did not hold a meeting with evening and night staff at the most recent meeting in April and the previous meeting was held prior to them coming into post. This meant there was no evidence to show us whether all staff working at the home had been given the opportunity to attend a staff meeting in the six months prior to our visit.

The company director also told us, "All of the staff on duty go into handover; there are two handovers a day and changes are communicated to staff each day in handover." When weasked them what happened about supervision of the people who lived at the home and responding to call bells while handover was in progress they told us, "There is always someone manning the lounges." This meant the system for communication of changes to staff and caring for people during handover was unclear.



Action needed

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care

Our judgement


The provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.



People who lived at the home, their representatives and staff were asked for their views about their care and treatment and they were acted on.

The home held residents and relatives meetings every three months. We saw the dates forthese meetings were on display outside the dining room. We looked at the minutes from a recent meeting, which had been held on 6 June 2014. We saw seven relatives and five people who lived at the home had attended the meeting and items discussed included the plans for redecoration and refurbishment and problems with the laundry. This showed us the provider regularly sought the views of people who lived at the home and their relatives about the care and support provided at the home.

The company director told us the home also sent out quarterly quality assurance questionnaires to relatives. We looked at eight forms which had been completed between February and April 2014. We saw the responses and comments about the home were generally positive. For example, "Care staff are friendly and obliging" and "Sometimes items go missing in the laundry."

We asked the home manager whether they checked how long it took staff to answer people's call bells. They told us they did periodic checks to see how long staff took to answer call bells and it was usually "less than a minute." When we asked to see the records of these checks the home manager told us they did not keep a record. This meant there was no evidence to confirm to us whether these checks had been carried out and wewere unable to see how long it took for call bells took to be answered.

The home manager told us the operational manager did a monthly visit on the behalf of theregistered provider. We looked at the record of the most recent visit, which had been


carried out on the 4 April 2014. We saw several actions had been identified at this visit. When we asked the managers about these actions they were unable to show us any evidence to confirm whether any of these actions had been completed. The operations manager told us actions were checked and signed off at the next visit; however we were not shown any evidence to confirm this.

We looked at the report from the Local Authority Quality Control Audit Report, which had resulted from a visit to the home on 16 April 2014. We saw there were five actions identified which required completion by 18 June 2014. We looked at the home's action plan for this, and saw that none of the actions had been signed off. When we asked the managers whether these actions had been completed they were not able to confirm to us whether the actions had been completed within the required timescale.

When we looked at the minutes of the staff meetings we could not see any evidence to show that actions identified at one meeting were followed up at the next. We asked the managers about this and the company director told us, "Actions from the previous meeting are always followed up. We have a standard agenda." However, the minutes we were shown did not confirm this was happening at the home.

We asked what audits and checks were carried out at the home. We were shown folders of audits which included, but were not limited to, infection prevention and control, hand hygiene, mattress checks, catering audits, care plan audits and medication audits. We sawaction plans had been written which identified issues raised in the audits. We did not see any evidence or records to show whether actions had been completed, and by whom. For example, the catering audit from 25 March 2014 identified 14 actions were required; we saw one had been signed off. When we asked the managers about these outstanding actions the operations manager told us, "They are doing the actions but not crossing them off." We also looked at an infection control audit action plan dated 13 May 2014 had a column for 'date completed' which was all blank. This meant there was no evidence to show whether required actions identified during audits and checks had been completed.

We judged that the lack of follow up of actions identified during checks on the quality and safety of the service constituted a significant risk to the people who lived at the home. Thisincluded the significant issues we found during our visit regarding the temperature of the hot water at the home, which had been identified by the maintenance person at least threemonths prior to our visit and had not been followed up.

We saw the audits carried out at the home did not seem to follow any pattern. We asked whether the home had an annual audit schedule, showing which audits were to be carried out each month. The managers told us the home did have a schedule; however they were unable to provide us with a copy. We asked how they knew, for example, that all of the care plans for people who lived at the home were audited within a given time period. We had seen that varying numbers of care plan audits had been carried out each month in 2014; one in January, eight in February, three in March, 14 in April, eight in May and one in June. The managers were unable to confirm whether there was a system in place to record and check which care plans had been audited each month, they were also unable to confirm how often each care plan was audited.

We asked to see the home's records of accidents and incidents; these were kept in a file inthe manager's office. Records showed appropriate changes to the care and treatment had been made, and preventive actions put in place where these were identified.


There was no evidence to show that incidents at the home were being monitored and analysed over time, so that any patterns and trends could be identified. When we asked the operations manager whether the home analysed incident records they said the provider did not currently do this. They showed us a summary table of incidents for each month, which categorised incidents and showed which day of the month they had occurred. The table included times of day for some incidents. We saw the numbers of each type of incident were not totalled up for each month. There were no reports producedto compare the numbers and types of incidents occurring over a given time period.

Trend analysis of incidents that may result in harm to people allows changes to their care and treatment to be made where needed. It is good practice to analyse trends in incidents as part of continuous quality improvement and to share lessons learned with staff. We did not see any evidence, for example in the staff meeting minutes, that accidents, incidents, or complaints were discussed with staff. The operations manager agreed with our observations that trends in incidents occurring at the home should be analysed and reportsproduced.


Complaints Action needed

People should have their complaints listened to and acted on properly

Our judgement


The complaints system at the home was not effective. Comments and complaints people made were not responded to appropriately.

The registered person did not provide people, and those acting on their behalf, with support to bring a compliant or make a comment, where such assistance was necessary.



People's complaints were not fully investigated and resolved, where possible, to their satisfaction.

Prior to our visit we had received a complaint about the home from a relative of a former resident. Their complaint had been submitted to the home some months ago and had not been dealt with appropriately or within the required timescales. The issues raised in this complaint were still ongoing at the time of our inspection.

During our inspection we looked at the home's complaints procedure. We saw the document we were shown was for another care home managed by the same provider. We asked to see what was sent out to people with the home's brochure. We saw this document was not the most recent version of the home's complaints procedure.

We were shown a folder containing written complaints made and the provider's response. We found the file was not indexed and paperwork was disorganised making it difficult to confirm whether the home's complaints process had been followed correctly or not.

We saw, and the home manager confirmed, there had been three complaints logged by the home since the last inspection in September 2013. We looked at the three complaints and saw there was no record of actions taken to address the issues identified and there was no evidence to show how the complaints had been investigated. In two of the three records there was no copy of the original complaint submitted. There was also no evidence to show whether the home had followed up the complaint to check whether the complainant was satisfied with the outcome. This meant people's complaints were not fullyinvestigated and resolved, where possible, to their satisfaction.

We asked whether verbal complaints, comments and concerns made by people who lived at the home and their relatives were logged and acted upon. The manager told us they did


not have any method for recording minor concerns which may be brought to the attention of staff. During our visit we did not see any evidence that verbal complaints and commentsabout issues and concerns were appropriately logged and acted upon. The home managertold us they had an 'open door' policy and dealt with minor issues on a day to day basis as soon as they were more to their attention. However the home manager was unable to show us any evidence to confirm this was happening. We asked what staff would do if a complaint was raised directly with them, rather than the home manager and the managers confirmed there was no recording system in place to log these.

People who are living with dementia may need additional support to bring a complaint or make a comment; the provider did not have effective systems for capturing and reporting incidents or near misses involving people with dementia. Adverse verbal comments were treated differently to written complaints even though people living with dementia are far less likely to complain in writing. We discussed with the managers that complaints may notbe received in a formal letter. The company director showed us records on their computer which demonstrated that some complaints received via email or verbally had been recorded and dealt with by the company. However, none of these records related to complaints or comments received at Hazel Bank Care Home.

This section is primarily information for the provider


Action we have told the provider to take

Compliance actions

The table below shows the essential standards of quality and safety that were not being met. The provider must send CQC a report that says what action they are going to take to meet these essential standards.

Regulated activity Regulation

Accommodation for persons who require nursing or personal care

Regulation 15 HSCA 2008 (Regulated Activities) Regulations2010

Safety and suitability of premises

How the regulation was not being met:

The registered person had not made suitable arrangements to ensure that service users and others having access to the premises were protected against the risks associated with unsafe or unsuitable premises, by means of adequate maintenance and operation of the premises and use of any surrounding grounds. Regulation 15 (1) (c) (i) (ii)




Supporting workers


Staff were not receiving appropriate support, training and appraisal to enable them to deliver care and treatment to people who lived at the home safely and to an appropriate standard. Regulation 23, (1a)


Accommodation for Regulation 10 HSCA 2008 (Regulated Activities) Regulations

This section is primarily information for the provider


persons who require nursing or personal care

2010



People were not protected against the risks of inappropriate or unsafe care by effective systems to assess and monitor their care and welfare. This was because the provider did not have aneffective system in place to regularly assess and monitor the quality of service people received. Regulation 10.




Complaints


The registered person did not have an effective complaints system in place for identifying, receiving, handling and responding appropriately to complaints and comments made by service users, or persons acting on their behalf.

The registered person did not ensure that all complaints made were fully investigated.

The registered person did not provide service users and those acting on their behalf with support to bring a compliant or make acomment, where such assistance was necessary.Regulation 19 (1), (2a), (2c)

This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The provider's report should be sent to us by 02 August 2014.

CQC should be informed when compliance actions are complete.

We will check to make sure that action has been taken to meet the standards and will report on our judgements.


About CQC inspections

We are the regulator of health and social care in England.

All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care.

The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "governmentstandards".

We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming.

There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times.

When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place.

We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it.

Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to re-inspect a service if new concerns emerge about it before the next routine inspection.

In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers.

You can tell us about your experience of this provider on our website.


How we define our judgements

The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection.

We reach one of the following judgements for each essential standard inspected.

Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made.

Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action.We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete.

Enforcement action taken

If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range ofactions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecutinga manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people.


How we define our judgements (continued)

Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact.

Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly.

Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly.

Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly

We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards.


Glossary of terms we use in this report

Essential standard

The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant numberof the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe theessential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are:

Respecting and involving people who use services - Outcome 1 (Regulation 17)

Consent to care and treatment - Outcome 2 (Regulation 18)

Care and welfare of people who use services - Outcome 4 (Regulation 9)

Meeting Nutritional Needs - Outcome 5 (Regulation 14)

Cooperating with other providers - Outcome 6 (Regulation 24)

Safeguarding people who use services from abuse - Outcome 7 (Regulation 11)

Cleanliness and infection control - Outcome 8 (Regulation 12)

Management of medicines - Outcome 9 (Regulation 13)

Safety and suitability of premises - Outcome 10 (Regulation 15)

Safety, availability and suitability of equipment - Outcome 11 (Regulation 16)

Requirements relating to workers - Outcome 12 (Regulation 21)

Staffing - Outcome 13 (Regulation 22)

Supporting Staff - Outcome 14 (Regulation 23)

Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10)

Complaints - Outcome 17 (Regulation 19)

Records - Outcome 21 (Regulation 20)

Regulated activity

These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided.


Glossary of terms we use in this report (continued)

(Registered) Provider

There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'.

Regulations

We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009.

Responsive inspection

This is carried out at any time in relation to identified concerns.

Routine inspection

This is planned and could occur at any time. We sometimes describe this as a scheduled inspection.

Themed inspection

This is targeted to look at specific standards, sectors or types of care.


Contact us

Phone: 03000 616161

Email: [email protected]

Write to us at:

Care Quality CommissionCitygateGallowgateNewcastle upon TyneNE1 4PA

Website: www.cqc.org.uk

Copyright Copyright © (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with thetitle and date of publication of the document specified.

Inspection Report - Care Quality Commission

Documents

Transcript of Inspection Report - Care Quality Commission