We inspected the service on 12 September 2018, and 15 and 16 October 2018. The inspection was unannounced.

Hazeldene House is registered as a domiciliary care service and a care home. A domiciliary care agency provides personal care to people living in their own homes. Under this arrangement people's care and housing are provided under separate contractual agreements. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. In this case the Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Hazeldene House is registered to provide nursing, personal care and accommodation for up to 75 people, and at the time of the inspection there were 74 people living there. Most people were receiving personal care from staff and had rented their accommodation within Hazeldene House. They also received support from nurses who were employed by the registered provider under a separate agreement. Ten people received both accommodation and care as part of one agreement. The service provided support to older people with dementia. It was arranged over three floors, with each floor having its own communal lounge area.

The service had a 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.

Action was not always taken to protect people from risks once they had been identified. Risk management strategies were not always being followed by staff. There was insufficient guidance provided to staff in order to manage the risks. There were not always enough staff available to meet the needs of people at the service. This had an impact on the safety of people living at the service. People were not being protected from abuse. The registered manager had not followed up on all safeguarding concerns reported to them. The registered manager had failed to notify us of a notifiable event in a timely manner.

Some staff were not always able to communicate with people or their relatives in a way they could understand, because the staff did not always understand spoken English. We made a recommendation about this. We saw more positive interactions between other staff and people. People were encouraged to take part in the reviews of their care and relatives had access to up-to-date information about how people were being supported. However, the registered provider was not always providing information to people in a way they could understand. We have made a recommendation about this. People were supported to be independent.

People’s needs were assessed but their care was not always delivered in line with current legislation. When the service was responsible, people were supported to eat and drink enough to maintain a balanced diet. Appropriate referrals were made to health professionals such as speech and language teams. However, staff were not always following guidance when it had been provided. Staff received training which ensured they had the skills and knowledge to deliver effective care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received their medicines safely. People were protected by the prevention and control of infection. The service was clean and smelt fresh.

People received care that was responsive to their needs. Relatives told us they knew how to complain, and would be happy to do so if they had any issues or concerns. However, complaints were not always treated as such, and we made a recommendation about this. There was nobody receiving end of l

Hazeldene House is a nursing home that was purpose built and opened in 2011. It is registered to provide nursing care, personal care, treatment of disease, disorder or injury, and accommodation for people who require nursing or personal care. It caters for up to 80 persons living with dementia. Accommodation is provided over three floors in spacious care suites that people are able to rent or lease-buy. People purchase care packages according to their needs and wishes and although people are able to choose any other registered domiciliary care providers, 99% of the care is currently provided by an in-house team of registered nurses and care workers who are available 24 hours a day.

There were 77 people living in the home at the time of our inspection, 76 of whom lived with dementia. Not all of the people living in the service were able to express themselves verbally and communicate with us.

This inspection was carried out on 19 and 21 January 2016 by two inspectors and an expert by experience. It was an unannounced inspection.

There was a manager in post who was registered with the Care Quality Commission (CQC). 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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. There were thorough recruitment procedures in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

People’s care suites were respected by staff as being their private quarters and these were personalised to reflect people’s individual tastes and personalities.

Staff knew each person well and understood how to meet their support and communication needs. The premises were well maintained and suited people’s needs.

Staff had received essential training and were scheduled for refresher courses. New recruits did not work on their own until they were able to demonstrate the relevant competence. Staff had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions and were scheduled for an annual appraisal. This ensured they were supported to work to the expected standards.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005 requirements. Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed when necessary about particular decisions and meetings were held with appropriate parties to make decisions in people’s best interest.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

Staff communicated effectively with people,

At the time of the inspection there were sixty two people using the service all of whom had a diagnosis of dementia at varying stages.

We spoke with 18 people that used the service and three visitors to the service. We also received six completed comment cards. People told us they were happy with the care provided and felt that their needs were met. We found that people had their needs fully assessed and planned for and they were involved in the planning of their care. Staff knew people well and knew how to meet their needs. We saw that staff provided the care people’s plans said they needed and did so in a way that promoted their independence and rights. One person using the service told us “This is a lovely home, I have no complaints”. We saw that staff were responsive to people’s needs and people were treated with dignity and respect.

we found that the service worked effectively with other health and social care providers to ensure that people’s needs were met. People were supported to access the services they needed.

The provider had effective systems in place for monitoring the quality of the service provided to people with dementia. Risks were assessed and managed and people’s views were taken into account in the ongoing improvement of the service.

At the time of our inspection, there were 37 people living in the service. The service was newly built and replaced one that had been on the same site. The first phase of the building of new premises had been completed and could accommodate up to 40 people. When the second phase of building was complete a maximum of 80 people could be accommodated at the service.

We used a number of different methods to help us understand the experiences of people using the service, because people had complex needs which meant they were not able to tell us their experiences. We observed how people spent their time during the day, how staff met their needs and how people communicated and interacted with staff. The registered manager was not on duty during the inspection so we telephoned them shortly afterwards to check on some information and give feedback on the inspection.

We observed that people were given choices about what to do, what to eat and where to spend their time each day. Their preferences and care and support needs were recorded on their care plans which were kept up to date.

People were comfortable in the presence of staff and staff demonstrated a good understanding of people’s individual needs. Staff respected that people needed to retain their independence as far as was possible.

Relatives who were visiting told us they were satisfied with the service. A relative said they were ““very happy with the home” and another that their relative was happy living there.

The provider had effective systems in place to regularly assess and monitor the quality of the service. This included asking people and their representatives for their views about it.

We spoke individually with seven people using the service. Some people were unable tell us about their experiences of living at the home because they had complex needs, so we used some other methods of to gain information about what it was like to live there. We spoke with four visitors during the visit, spoke with staff, read records including care plans and observed people during the day.

The people using the service that we spoke with told us they were given choices about their daily routines such as when to get up and go to bed, what to eat and what to do each day. They said they had opportunities to take part in activities and enjoyed the events the home arranged.

People told us that staff were kind and caring and when they needed assistance with anything staff responded quickly.

People said they were happy with their rooms and that rooms were always kept clean. We spoke with some people who shared a bedroom with another person, they told us they were happy with sharing and they had been asked if they wanted to share a bedroom before they moved in.

People told us that they liked the meals at the home and there was choice. At lunchtime we saw two choices of main meal were available and other options were offered to a person who did not choose to have either of them.

Some of the comments that people made were,

“They really are nice to us, they do anything they can for you”

“There is enough to do, I join in if I wish to”

“If you don’t like the meals they go and get something else for you”

“They look after me more than well, if you want a cup of tea they go and make it for you”

Comments made by visitors included,

“I can’t praise them enough, the caring and looking after is fantastic”

“They are kindness itself, it is exemplary, excellent”

“They have lots of outings and if I cannot go there are enough staff to accompany my relative”

“Staff are brilliant, there is good communication we chose the home as it is local, we are very satisfied”

“The home is always clean and there are no unpleasant smells”

We did not speak directly to people about this outcome. Relatives told us that staff were kind and caring, they thought there were enough staff on duty and the home was well managed.

We did not speak directly to people during this visit as some were too unwell and others with dementia were not able to engage with the process.

It was not possible to interview many people as some were too poorly and others with dementia were not able to engage with the process. We were able to talk briefly with a relative and six people who live at the home.

Social Services told us there are some concerns about how the service meets people’s needs. Staff at the service said the home had ‘a good atmosphere and was a good place to work’. People living at the home told us the staff were kind. They also told us they felt cold and would like the home to be warmer.