We undertook an unannounced focused inspection of Hazeldene Residential Care Home on 24 September 2018. Hazeldene Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hazeldene Residential Care Home provides residential care for up to 26 people, some of whom are living with dementia. At the time of our inspection there were 20 people living at the service.

At the last comprehensive inspection in May 2018 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches of Regulation 12 because the risk associated with people falling was not managed safely, topical medicine records were not completed consistently and fire emergency checks were not carried out in line with the providers policy; Regulation 17 because there was a lack of effective governance processes. We also found a breach of Regulation 18 of the Care Quality Commissions (Registration) Regulations 2009 because the registered persons had not always notified CQC of significant events that happened at the home.

Following the last inspection in May 2018, we issued two warning notices requiring the provider to take action to mitigate the risks to people's health, welfare and safety and improve the systems to monitor the quality and safety of the service. The provider subsequently told us they had put measures in place to ensure the safety of people.

We undertook this focused inspection to check that they had followed their plan. The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led? This is because the service was not meeting some legal requirements. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

You can read the report from our last inspections, by selecting the 'all reports' link for 'Hazeldene Residential Care Home’ on our website at www.cqc.org.uk.

There was 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.’

At the last inspection we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks involved in the use of the stairs were not always appropriately managed. In September 2018 we received further information of concern around a safety incident Our inspection did not examine the specifics of this incident. However, we used the information to plan areas we would inspect and to judge the safety and quality of the service

At this inspection we identified risks were still not managed safely around the use of the stairs. Risks associated with falls had not been mitigated. We also found other areas of concern in relation to risks associated with health conditions and the environment. Risk assessments lacked the guidance for staff to follow, to mitigate risks to people which meant people were placed at risk of harm.

Accidents, incidents and falls were not analysed to prevent further accidents from happening and the registered persons had not taken appropriate action in response to safety concerns.

There was not an effective quality assurance process in place. Audits to assess the quality and safety of service provision were ineffective

This unannounced inspection took place on 10 and 11 May 2018.

At our last inspection in November 2016 we had found the provider had been in breach of Regulation 11 - need for consent, Regulation 12 - safe care and treatment, and Regulation 17 - good governance. The service had been rated ‘Requires Improvement’ at that time. The registered provider had not always acted in line with the Mental Capacity Act 2005. Risks people had faced had not always been adequately assessed. The registered manager and the registered provider had not ensured clear actions had been set out in care plans to protect people against those risks. 'When required' (PRN) medicines and prescribed creams had not always been administered properly or safely. Information included in people's care records had not always been accurate or up-to-date. Auditing and quality assurance processes in place had not identified these errors. Following that inspection, the registered manager had sent in an action plan stating what action would be taken to address the breach of the regulations. At this inspection we found sufficient action had not been taken in relation to the concerns identified at the previous inspection. We also identified new areas of concern.

This is the second time the home has been rated ‘Requires Improvement’.

Hazeldene Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hazeldene Residential Care Home is a residential home in Gosport providing accommodation and personal care for up to 26 elderly people. There were 23 people using the service at the time of our inspection.

There was 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.

Risks to people were not sufficiently assessed and managed. Using stairs was not taken into account in care plans where people were at risk of harm. In addition, the service did not do all that was reasonably practicable to reduce such risks. Incident and accident records did not always evidence that remedial action had been taken and followed up by the registered manager. Checks on fire alarms and emergency lighting had not been completed in accordance with the provider’s policy.

Recruitment practices were not always safe. Gaps identified in the employment history of staff had not been fully examined and explained.

The home's quality assurance and governance systems were not always effective. Although some systems were effective, others had not identified the concerns we found during this inspection.

The registered provider failed to inform the Care Quality Commission about notifiable incidents and accidents.

People, their relatives and staff provided us with mixed feedback regarding staffing levels.

The home was clean, well-maintained, and people were protected from the risk of cross contamination and the spread of infection. Staff had access to personal protective equipment (PPE) and received training in infection control.

People's needs were effectively met because staff had been provided with relevant training and had the skills they needed to do so. Staff were supported with training, supervision and appraisal.

Principles of the Mental Capacity Act (MCA) 2005 legislation were followed and Deprivation of Liberty Safeguards (DoLS) applications were completed in line with current legislation. Staff showed a basic knowledge and understanding of both the MCA and DoLS. Best interest decisions were made appropriately. People were supported to have maximum choice and control of their

The inspection took place on 23 and 24 November 2016 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We previously inspected Hazeldene Residential Care Home in May 2014, at which time the service was compliant with all regulatory standards.

Hazeldene Residential Care Home is a residential home in Gosport providing accommodation and personal care for up to 26 older people. There were 25 people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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.

We found people’s topical medicines (creams) and people’s ‘when required’ medicines were not always managed properly or safely.

We found some examples of good practice with regard to other medicines and senior carers demonstrated a good knowledge of people’s medical needs.

We found risk assessments were not sufficiently detailed or clear about how staff were to minimise the risks people faced, particularly with regard to the use of bed rails, fluid intake and repositioning.

We found that there were sufficient numbers of staff on duty in order to meet the needs of people using the service, as well as to ensure premises were clean and well maintained. Two bathrooms were clean and well equipped, whilst one was in need of refurbishment, as was the laundry room. We saw both these rooms were included in the registered provider’s refurbishment plan. People’s bedrooms, communal areas and the kitchen were found to be clean and well maintained.

Staff displayed a good knowledge of safeguarding principles and indicators of abuse. They were clear what to do should they have any concerns. People we spoke with, their relatives and healthcare professionals consistently told us the service maintained people’s safety.

There were effective pre-employment checks of staff in place, including Disclosure and Barring Service checks, references and identity checks.

We saw that, whilst staff consistently asked people for their consent on a day-to-day basis, care files contained conflicting information about whether people had capacity to make specific decisions, meaning the service did not always act in line with the Mental Capacity Act 2005 (MCA).

External professionals had confidence in the experience and knowledge of staff and we saw there was regular liaison with GPs, nurses and specialists to ensure people received the treatment they needed.

Staff completed a range of training the registered provider considered mandatory, such as safeguarding, health and safety, moving and handling and dignity. Staff displayed a good knowledge of the subjects they had received training in and had a good knowledge of people’s likes and dislikes.

We saw people had choices at each meal as well as being offered alternatives. People spoke positively about the food and drinks they had and we observed people experiencing a relaxed lunchtime in the dining room. We observed staff supporting people patiently to eat and drink and offering people drinks throughout the day.

Staff were regularly supported through supervision and appraisal processes as well as ad hoc support from management when required.

The premises benefitted from some aspects of dementia-friendly design, such as bold signage and contrasting hand rails in the two completed bathrooms and communal areas. Dementia care-planning was detailed although we found activities were focussed on group activities and could be improved by focussing on people’s individual preferences more.

The atmosphere at the home was welcoming. People who used the service, relatives and external stakeholders agreed that staff were caring and comp

We spoke with six of the twenty six people who lived at Hazeldene. We also spoke with the registered manager, four members of staff, two relatives of people who lived at the home and one visiting professional.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well led?

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

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

We saw systems were in place to help ensure managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted since the last inspection in May 2013. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant people were safeguarded as required.

The registered manager was responsible for arranging staff rotas and took people's care needs into account when making decisions about the numbers, qualifications, skills and experience of staff required. This helped to ensure that people's needs were always met.

Policies and procedures were in place to help make sure unsafe practice could be identified and people were protected.

Is the service effective?

There was an advocacy service available if people needed it, this meant people could access additional support when they required it.

People's health and care needs were assessed with them and they were involved in the development of their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said they had been involved in the planning of their care and care plans reflected their current needs and wishes.

People's needs were taken into account with appropriate signage. The layout of the service enabled people to move freely and safely around the home. The premises had been sensitively adapted to meet the needs of people who lived at the home.

Visitors confirmed they were able to see people in private and visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw staff were patient and gave encouragement when they supported people. One person said; "I like to do things myself, but the staff are marvellous if I can't quite manage something". We spoke to a visiting professional who told us, "From what I have seen, the staff here are very kind to people".

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People had access to a range of daily activities both inside and outside of the home.

People knew how to make a complaint if they were unhappy and details of the complaints procedure was easily accessible on the notice board in the hallway. People we spoke with told us they had no complaints to make. We saw there was a complaints log, but no entries had been made since the last inspection in May 2013. The manager told us there had been no complaints during this time. This showed us people were happy with the service they received. We saw there was a comments and suggestions book freely available for people to use in the hallway. We saw only positive comments about the service had been made.

Is the service well led?

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Comments and ideas were listened to and acted upon in a timely manner.

The service worked well with other agencies and services to help make sure people received their care in a cohesive manner.

The service had a quality assurance system and records showed notes for action were addressed promptly. As a result, the quality of the service continued to improve.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes which were in place. This helped to ensure people received a good quality service at all times.

We carried out an inspection on 13 May 2013 to review the progress the provider had made in taking action to be compliant in the areas where we had previously assessed them as non compliant.

On the day we inspected there were 25 people living at the Hazeldene Residential care Home, some of whom had memory impairment and or a physical health problem. During our inspection we spoke with four staff members, one relative and four people who use the service.

We saw that the home was clean and well maintained and was undergoing some refurbishment with the minimum disruption to people.

People had personalised their rooms with their own possessions including their own furniture.

We saw that the home had in place risk assessments for people using equipment to support their independent living safely. We saw that people had their care discussed and agreed with them although we could not identify formal agreement to these care plans.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. We observed people at a mealtime have positive experiences. Staff were observed assisting people in a calm, friendly and polite manner.

During this visit we spoke with the acting Home Manager, the Head of Care and all care staff that were on duty. We also spoke with five people that used the service and three relatives. We spent time during our visit observing the care and support being given and how staff interacted with people.

People told us that "staff are very nice" and "this is my home now". People told us about alternative menu choices that they would like offered which we passed onto the acting Home Manager. Relatives told us that they were happy and had no concerns with the home.

We saw care plans for five people who used the service, however, we noted that one needed reviewing, one was not complete and another one did not give specific guidance for staff on how to support a persons specific needs.

One person showed us how they kept themselves busy with making blankets for the Salvation Army.

During our visit we spoke with five people who live at the home, two visitors, and four staff. Following the visit we received calls from six relatives and we were able to talk with them about their thoughts and experiences of Hazeldene.

People told us that they were happy at the home; it was easy for them to move about the home if they are able and they can choose where they sit in the lounge and conservatory. They like the interaction with the staff and like having their hair done.

They said they are able to give their opinion for example about the food and they feel respected and heard. They are able to have visitors at any time. Many people need a lot of support so activities usually take place in the afternoon.

Staff told us that they receive regular training from the senior staff and from external sources. They said they are very well supported to apply for and complete NVQ training. Staff are supported by the management of the home and they can speak with senior staff about any concerns they have about the running of the home.

Relatives we spoke with told us that the home was ‘homely’ and they felt they could speak freely with staff. The staff always conduct themselves in a caring and professional manner. There was some concern expressed that when it was busy, quiet people could be over looked or assumptions made.