We carried out an unannounced inspection of Hazeldene Care Home on 1 and 2 May 2018. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and we looked at both during this inspection. The service is registered to provide accommodation and personal care for up to 60 people. Nursing care is not provided. Accommodation is provided over three units, with one unit specifically for people living with dementia. At the time of our inspection 45 people were living at the home.

At the last inspection on 22, 23 and 27 February 2017, we did not find any breaches of our regulations. However, we rated the service as Requires Improvement as we found that appropriate action had not always been taken when people experienced a fall and care documentation had not always updated when people’s needs or risks changed. At this inspection we found that improvements had been made and the provider was meeting all regulations reviewed.

The service had a registered manager in post who was responsible for the day to day running of the home. 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.

Most people who lived at the home and their relatives felt there were enough staff available to meet their needs. Following our inspection, the registered manager introduced changes to staffing arrangements at the home, to ensure that staff were available at all times to keep people safe and provide support when people needed it.

Records showed that staff had been recruited safely and the staff we spoke with were aware of how to safeguard adults at risk.

People told us the staff who supported them were kind and caring. They told us staff provided them with support when they needed it.

People told us staff respected their right to privacy and dignity and encouraged them to be as independent as they could be. We saw evidence of this during the inspection.

Staff received an effective induction and appropriate training. People who lived at the service and their relatives felt that staff were competent and had the knowledge and skills to meet their needs.

People received appropriate support with eating and drinking and their healthcare needs were met. Appropriate referrals were made to community healthcare professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice. Where people lacked the capacity to make decisions about their care, the service had taken appropriate action in line with the Mental Capacity Act 2005.

People told us that they received care that reflected their individual needs and preferences and we saw evidence of this. Staff told us they knew people well and gave examples of people’s routines and how people liked to be supported.

People were supported to take part in a variety of activities and events. They told us they were happy with the activities that were available at the home.

Staff communicated effectively with people. They supported people sensitively and did not rush them when providing care. People’s communication needs were identified and appropriate support was provided.

The registered manager regularly sought feedback from people living at the home about the support they received. We saw evidence that the feedback received was used to develop and improve the service.

People living at the service and staff were happy with how the service was being managed. They found the registered manager approachable and supportive.

A variety of audits

We carried out a comprehensive inspection of Hazeldene Care Home on 22, 23 and 27 February 2017. The first day of the inspection was unannounced.

Hazeldene Care Home provides care and accommodation for up to 60 older people. Accommodation at the home is provided on three units, two residential and one for people living with dementia related needs. The majority of the bedrooms are ensuite and there are accessible toilet and bathroom facilities on both floors. The service is situated in Clayton le Dale in Blackburn, East Lancashire. At the time of our inspection there were 46 people living at the home.

At the time of our inspection the service had a registered manager who had been in post since June 2016 and had been registered with the Care Quality Commission (CQC) since 10 February 2017. A registered manager is a person who has registered with the CQC 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.

The service was last inspected on 2, 3 and 7 December 2015, when we found a breach of our regulations relating to staffing. At that time, we also made recommendations about the storage of medicines and meeting the needs of people living with dementia. Following that inspection the provider sent us an action plan detailing the improvements they would make.

During this inspection we found that improvements had been made in relation to staffing, the storage of medicines and meeting the needs of people living with dementia. We did not find any breaches of our regulations.

During our inspection we found that there were appropriate policies and procedures in place for the safe management of medicines. We observed staff administering medicines safely.

People living at the home told us the home environment was safe and they received safe care. Most people we spoke with were happy with staffing levels at the home and felt that staff had the knowledge and skills to meet their needs.

We saw evidence that staff had been recruited safely. The staff we spoke with understood how to safeguard vulnerable adults from abuse and what action to take if they suspected that abusive practice was taking place.

We found that people’s risks, such as a risk of falling, were not always managed appropriately. Accident recording was not completed consistently by staff and care plans and risk assessments were not always updated when people’s needs changed. This meant that it was difficult to ensure that staff were managing people’s needs and risks effectively.

We found that staff received an appropriate induction, effective training and regular supervision. Staff told us they felt well supported by the registered manager.

Staff understood the main principles of the Mental Capacity Act 2005 (MCA) including the importance of gaining people’s consent and their right to refuse care. The service had taken appropriate action where people lacked the capacity to make decisions about their care and needed to be deprived of their liberty to keep them safe. We found evidence that where people lacked the capacity to make decisions about their care, their relatives had been consulted.

People living at the home were happy with quality of the food provided. They told us they had lots of choice at mealtimes and we saw evidence of this during our inspection.

People received support with their healthcare needs and we received positive feedback from community health and social care professionals about standards of care at the home.

We observed staff communicating with people in a kind and respectful way. People told us staff respected their privacy and dignity and encouraged them to be independent.

People were supported to take part in a variety of activities inside and outside the home. Most people living at the home and relatives were happy with the activi

We carried out this inspection because we had received concerns about the home. These concerns included, some staff treating residents and a visitor disrespectfully, people not receiving the care and support they needed and not having some medication as prescribed, and a number of recent incidents investigated as safeguarding.

We spoke with four people living in the home (residents) and five relatives and mixed with people living in the dementia unit. We also spoke with the (new) manager and three members of staff.

Comments from residents and relatives indicated they were satisfied with the care they received and included: "The staff are very caring; they are lovely with them", "Without a doubt I am well looked after", "Staff are very attentive" and "They are courteous and obliging".

At the time of our visit we found overall people were looked after to a satisfactory standard and saw staff treating residents with respect. However we saw the care and services in the dementia unit could be improved. This was highlighted by the local authority at a recent visit. The manager had produced an improvement plan which was being implemented. We also found there had been recent safeguarding incidents that had been upheld. The manager had dealt with these properly and taken action to ensure residents were not at risk, and that they received their medication as prescribed.

Staff felt there were sufficient training opportunities and felt well supported by the manager.

During our inspection we saw that people were given information and choices about the care they received. People were treated in a dignified way. The people we spoke with confirmed this.

We saw that all areas of the home were clean and there were no offensive odours. Regular audits were completed for the prevention and control of infection.

Appropriate checks were undertaken before staff began work. We did not see anyone waiting for support during our inspection. People confirmed that they did not need to wait for staff assistance when support was required. Staff told us they were able to access additional staff when required, such as if a staff member was off sick.

The manager had held a meeting for people and their relatives to discuss their views of the home. They carried out regular checks throughout the home to assess the quality of the service provided. We also saw the home had carried out a satisfaction survey carried out in June 2013.

We spoke with five people who used the service and two visitors. All the people spoken with told us they were happy with the care provided by the home. One family member commented they were happy with the home and the care and treatment the home provided for their relative.

We reviewed the care files of three people who used the service and found evidence that there were procedures in place to ensure their consent was gained in relation to the care provided for them.

We saw that care plans identified the needs of the person and included information on managing identified risk issues.

We spoke with five members of staff, three of whom told us they felt supported in their work and the manager was very supportive and accessible. All staff we spoke with told us they were confident in carrying out their responsibilities and one staff member told us they worked as part of a team. We saw evidence that staff were appropriately qualified to support the needs of people living at Hazeldene.

We found the food provided a nutritionally balanced meal with fresh ingredients being used. People were provided with a choice of meals and systems were in place to address issues around the risks of inadequate nutrition.

We found that there were effective systems in place for complaints to be identified, received and handled.

People who used the service felt they were respected and treated with dignity. People thought care was good and they were able to be kept up to date with their health issues. People felt safe and could voice their concerns if they wished. People thought their medication was given in a safe and timely manner. People thought they were looked after by sufficient numbers of a well trained staff team. Quality assurance systems allowed people to have a voice in the running of the home.

We carried out an inspection of Hazeldene Care Home on 2, 3 and 7 December 2015. The first day of the inspection was unannounced.

Hazeldene Care Home provides accommodation and personal care for up to 60 older people, including people living with dementia. At the time of the inspection there were 46 people living at the service.

Accommodation at the home is provided over three units, one of which is specifically for people

living with dementia. Bedrooms are located over two floors and a lift is available. There is a lounge and dining room on each unit and all rooms have wheelchair access. Of the 60 bedrooms, 43 have ensuite facilities and there are suitably equipped toilet and bathroom facilities on each unit.

At the time of our inspection, the service did not have 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. An acting manager was in post and had been managing the service for nine weeks. The acting manager told us she planned to submit an application to the Commission in the near future to become the registered manager for the service.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to staffing. You can see what action we told the provider to take at the back of the full version of the report.

As part of this inspection we have made recommendations about the storage of medicines and meeting the needs of people with dementia.

The people we spoke with at the service told us they felt safe. One person told us, “I feel safe here. There’s always help when you need it”.

We saw evidence that staff had been recruited safely and the staff we spoke with had a good understanding of how to safeguard vulnerable adults from abuse and what action to take if they suspected abuse was taking place.

Some people living at the service, their relatives and staff told us that staffing levels were sufficient. However, others felt that more staff were needed to meet people’s needs. During our inspection we observed that there were occasions when staff were not available on the dementia unit to support people appropriately.

There were appropriate policies and procedures in place for managing medicines and people told us they received their medicines when they needed them.

The people we spoke with and their relatives were happy with the care provided at the home. One person told us, “The staff look after me well. They’re all excellent”.

We found that staff were well supported. They received an appropriate induction, regular supervision and could access training if they needed it.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and the service had taken appropriate action where people lacked the capacity to make decisions about their care.

People told us they had been involved in decisions about their care and we saw evidence of this in people’s care records. Where people lacked the capacity to make decisions about their care, we saw evidence that their relatives had been consulted.

Everyone we spoke with was happy with the food at the home and felt their nutritional needs were being met. We observed that staff did not always engage with people when they were supporting them with their meals.

People were supported with their healthcare needs and were referred appropriately to a variety of health care services. A visiting district nurse and a local optician and pharmacist were happy with the care being provided at the service.

The people we spoke with told us the staff at the service were caring and we saw most staff treating people with kindness, compassion and respect. However, we observed one member of staff being inpatient when providing support and we raised this with the manager who took appropriate action. People and their relatives told us staff respected their privacy and dignity and they were encouraged to be independent.

We observed that people’s needs were responded to in a timely manner and saw evidence that their needs were reviewed regularly.

A variety of activities were available if people wished to take part in them.

We saw evidence that the manager requested feedback about the service from the people living there and their relatives. The manager told us she planned to use the recently received feedback to develop the service.

People living at the home and their relatives told us they felt the service was well managed and they felt able to raise any concerns.

We saw that the service had a clear statement of purpose which focused on the importance of providing people with high quality, individualised care.

The staff and the manager communicated with people, their visitors and each other in a polite and respectful manner.

The people we spoke with told us the staff and the management at the home were approachable.

We saw evidence that a variety of audits were completed regularly. However, some of the audits had not been effective in ensuring that appropriate levels of safety at the home were being maintained.