CQC report explained · a nursing home
What the CQC found at Hazelwood Gardens Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Medicines, staffing, safeguarding and risk assessments were generally managed well. However, staff were not wearing face masks when the inspection began, and inspectors were not assured that infection control guidance was being followed.
- Effective?
- Good
- This key question was not inspected in this focused visit.
- Caring?
- Good
- This key question was not inspected in this focused visit.
- Responsive?
- Good
- This key question was not inspected in this focused visit.
- Well-led?
- Good
- Management checks had improved and were being used to identify shortfalls. Staff felt supported, and inspectors found a positive, person-centred culture.
What inspectors found, January 2023
Rated Good overall; Hazelwood Gardens Nursing Home improved medicines and leadership, but Safe was still Requires Improvement because mask guidance was not followed at first.
This was an unannounced focused inspection on 18 November 2022. One inspector spoke with people, a relative and staff, observed care and reviewed care, medicine, recruitment, maintenance and management records.
The home had improved since the previous inspection in March 2019. Medicines were stored securely and records were complete. There were enough staff, safeguarding arrangements were understood and management checks had become stronger.
Inspectors found a shortfall in infection control because staff were not wearing face masks when the inspector arrived. The manager acted immediately after this was raised. The home was rated Requires Improvement for Safe and Good for Well-led. The overall rating remained Good because this inspection only reassessed Safe and Well-led, while other ratings carried over.
Safer medicines
Medicines were kept in a locked trolley and fridge. Records checked by inspectors were complete and showed medicines had been given as prescribed.
“The charts had all been signed to confirm people had received their medicines as prescribed.” from the report
Enough staff
People and staff told inspectors that staffing levels were safe. The manager and clinical lead also helped cover sickness and leave.
“The deployment of staff helped to meet people's needs and kept them safe.” from the report
Safeguarding
Staff had safeguarding training and understood how to recognise and report possible abuse. Concerns were investigated and referred externally when needed.
“Staff had been trained in safeguarding adults from abuse.” from the report
Stronger management checks
The home had developed regular audits covering care, the building and management. Inspectors found that improvements from the previous inspection had been sustained.
“Improvements had been made to the governance systems that the home had in place.” from the report
Kind and person-centred culture
Inspectors saw staff working as a team and supporting people's individual relationships and communication needs.
“A positive culture was promoted in the home.” from the report
Masks were not being worn at first
needs fixingStaff were not wearing face masks when inspectors arrived. The manager said they thought masks were no longer needed, but introduced mask wearing immediately after this was raised.
“On arrival to the home we found that staff were not wearing masks.” from the report
Fire drill improvements
needs fixingThe local fire brigade had identified that improvements were needed around fire drills and how often they took place.
“The local fire brigade had recently visited the home and identified improvements were needed around fire drills and their frequency.” from the report
- 01How do you make sure staff follow the latest infection prevention and control guidance, including mask wearing?
- 02What changes have you made to fire drills and how often they take place?
- 03How are medicine records checked now, including handwritten entries and medicines that may need to be crushed?
- 04How do you use audits to identify and fix any new shortfalls?
- 05How can residents and relatives give feedback, and when were the quality assurance surveys last sent out?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive were carried over from the previous inspection. This explanation was written from the published report of 17 January 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, April 2021
Hazelwood Gardens Nursing Home was inspected but not rated; inspectors were assured about infection prevention and control.
This was an announced, targeted inspection on 4 March 2021. It looked at how well the home was prepared to prevent and control coronavirus infections.
Inspectors found temperature checks, hand sanitiser, lateral flow testing and regular testing for people and staff. Staff wore masks and had training in using protective equipment. Cleaning focused on frequently touched areas.
The home had a separate visiting area and offered video calls when visits were not possible. Inspectors were assured about the home's infection control arrangements, but the service was not given an overall rating.
Testing and screening
The home checked temperatures on arrival and carried out regular testing for people and staff. It had plans to identify positive cases quickly.
“Regular testing was being undertaken of people in the home and staff to help ensure any positive cases were identified quickly.” from the report
Protective equipment
Staff had been trained to put on and remove protective equipment safely. Inspectors saw staff wearing masks throughout the home.
“Staff had received training in donning and doffing Personal Protective Equipment (PPE).” from the report
Cleaning
The home was cleaned regularly, including areas that people touched often. An infection control audit was also carried out.
“Regular cleaning of the home was taking place, with attention being paid to high touch points such as stair bannisters.” from the report
Visitor arrangements
Visits took place in a separate area with its own entrance. Video calls were arranged when families could not visit.
“If families were unable to visit, arrangements were made for video calling.” from the report
Visiting screen
minorThe screen separating visitors and residents was not the solid perspex screen recommended at the time. Other safety measures, including testing and social distancing, were in place.
“This wasn't a solid perspex screen as is recommended.” from the report
- 01What infection prevention and control arrangements are in place now?
- 02How are people and staff tested, and what happens if someone tests positive?
- 03How are visits arranged now, and what alternatives are available if a family visit is not possible?
- 04How often are high-touch areas cleaned and infection control audits completed?
- 05Can you show us the current arrangements for protective equipment and staff training?
This was a targeted inspection of infection prevention and control, so the other areas and an overall quality rating were not assessed. This explanation was written from the published report of 10 April 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Hazelwood Gardens Nursing Home
4 rated inspections over 6 years: the service has improved, from Requires improvement to Good.
- January 2023Goodcurrent ratingSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Hazelwood Gardens Nursing Home →
- April 2021Inspected but not ratedSafe: Inspected but not rated
Read what inspectors found at Hazelwood Gardens Nursing Home →
- April 2019Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- April 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2017Requires improvementSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- January 2016
Registered with the Care Quality Commission on 5 January 2016.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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