The inspection took place on 12 and 14 June 2018 and was unannounced. One inspector carried out the inspection on the first day and two inspectors on the second day.

Hazelwood House 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.

Hazelwood House is a care service which provides accommodation for up to 11 people who have a learning disability or challenging behaviour. At the time of our inspection, there were 10 people living at the service. The service was arranged over three floors connected by three staircases. There were two bathrooms on the middle floor, a toilet on the ground floor, and a separate shower room at the rear of the building. There was a lounge, dining room and large garden that people could easily access. Most people were able to use the kitchen independently or with staff support if required.

There was a registered manager at the service. 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.

The last comprehensive inspection of this service was in February 2016, when the service was rated Good. At this comprehensive inspection, we found the service was not meeting legal requirements and was rated Requires Improvement.

There were quality assurance systems in place based on a range of audits. However, we found these had not been effective in ensuring compliance with the regulations. We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

Staffing levels were not sufficient to ensure that people received safe and person centred care at all times. There was no system in place to ensure staffing levels were assessed in consideration with people’s individual needs.

The provider and registered manager had a lack of understanding around their responsibilities of protecting people’s rights in line with the Mental Capacity Act 2005 and best interest decisions had not been completed appropriately.

People were not always able to access activities within the service or the local community in a way that was individual and person-centred.

People and their families felt the home was safe and staff were aware of their responsibilities to safeguard people from abuse.

People received their medicines safely. Staff who administered medicines had received training and had their competency to administer medicines assessed to ensure their practice was safe.

Procedures were in place to learn from adverse incidents and there were appropriate systems to protect people from the risk of infection.

Effective recruitment procedures were in place. New staff received a robust induction to their roles and existing staff were competent, received regular training and were supported appropriately.

People were treated in a kind and caring manner. We observed positive interactions between people and staff.

The environment was supportive of people’s needs. People’s bedrooms were decorated to each individual’s taste and contained personal possessions and photos.

People’s care plans contained detailed and person-centred information and were updated regularly. Relatives and professionals were considered in people’s care reviews.

Staff built positive relationships with people and their families. They used appropriate techniques to communicate effectively, promoted independence and involved people in decisions about their care.

People were encouraged to make decisions about how their care was provided, and staff supported

We spoke with two people who use the service and observed care given to other people living in the home. One person told us, "the staff are really helpful and help me to do the things I like to do." Another person said, "I get on well with everyone here and I have learned to do more for myself. We saw staff engaging people in a range of activities including a musical afternoon which people told us they really enjoyed.

We looked at care records for four people and saw these contained assessments of need, support plans and risk assessments. Essential information concerning communication, choices and likes were included in people's care records. We observed staff asking people what they would like to do before delivering support and care to them.

We spoke with three members of staff who shared with us their understanding of safeguarding vulnerable adults. They identified different forms of abuse and demonstrated how they would report a safeguarding concern. One person who used the service told us, "I would speak to my key worker or the manager if I was not being treated nicely." This showed people and staff were aware of abuse and how they would report concerns they found.

A member of staff said, "the manager supports me to do my job and I know I can speak to them about any problems in the workplace." Another member of staff said, "the training is excellent and this has helped me to progress in my job." We looked at staff records which showed staff were supported to develop new skills through supervisions, observed practice and team meetings.

The provider carried out regular audits to look at the quality of the service. These highlighted actions which the manager needed to take to improve the quality of the service. The manager recorded the actions they had completed.

During this inspection we spoke with three people who used the service, two members of staff and the manager. People told us staff discussed their care and support with them and said they were happy with the way care was given. One person said that staff were “very respectful”. All the people we spoke with said they felt well cared for.

We observed that staff communicated well with people and promoted a supportive environment. Effective recruitment procedures were in place to ensure staff had undergone the relevant checks before commencing their employment.

The building was fit for purpose and well maintained. We saw that a complaints policy was in place and that complaints received were handled in line with the policy.

We spoke to a number of the residents and the staff. We observed interactions between the staff and people who used the service. People told us that they were treated with respect and that the staff were’ excellent’ People were offered choices and there was no restriction to time when they got up or went to bed. People commented that the staff helped them and that it was very good living at the home.

They said that they would approach the manager and their support workers with any concerns and were confident these would be addressed. People told us that if they had any problems they could talk to the staff. Comments were ‘my support worker helps me and I can discuss things with her.’ Another person said that ‘the girls are smashing’ and the care was ‘excellent.’

People discussed with us how they spent their time. One person said that they liked cooking and helping the staff with the evening meals. Another person told us that they went out with their relative on particular day once a week and enjoyed their time together. One of the residents showed us their room and said that they had everything they needed. They said that they enjoyed spending time in their bedroom watching television and the staff respected their privacy.

This inspection took place on 04 September 2015. This visit was unannounced. At our last inspection on 07 January 2014 we found the provider was meeting all of the expected standards of care.

Hazelwood House is a home which provides accommodation and care for 11people who have a learning disability or an autistic spectrum disorder. The home was fully occupied at the time of our inspection.

The home 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.

People told us they felt safe living at Hazelwood House. Staff received safeguarding training and knew how to recognise and report concerns within their organisation and to appropriate authorities. Risks associated with the delivery of care had been identified and action taken to minimise those risks. People’s needs were assessed and updated along with risk assessments and care plans.

There were sufficient staff to support people with their care and social activities. Staff received suitable training and support to enable them to deliver the care required for people. Specific training was available to meet the identified specialist needs of people.

Medicines were safely administered and were stored in appropriate secure areas within the home. Staff received appropriate training to enable them to give medicines competently. They were observed and assessed to ensure they were safe to administer medicines.

People received effective care as their needs had been assessed prior to admission. Care plans were written to identify needs of people and contained sufficient information for staff to deliver care accordingly. The care plans were personalised and contained information about each person’s likes, dislikes, history and preferences.

People chose their meals and were supported to prepare their own and others meals in safety. The food was nutritious and sufficient. People were supported to maintain good health and had good access to GPs and other healthcare specialists.

There was a good atmosphere in the home and we saw people were happy with the staff who supported them. They told us bout good relationships they had and how they could share their concerns with the registered manager and staff. People and their relatives told us they were involved in planning their care and were able to make changes to their care plans if required.

The registered manager sought the opinions of people and staff regularly on aspects of care and improving service delivery and the environment. People regularly gave feedback and identified things they would like to change or new activities they wanted to try. Staff were encouraged to think of ways in which to enhance people’s lives and told us they were listened to by the registered manager when they made suggestions.

The service was well led and there was a positive culture which placed people at the centre of care they received. Relatives were kept up to date on events in people’s lives and were encouraged to maintain their relationships with people. Auditing systems were in place to ensure high quality care was delivered to people. The registered manager ensured other essential audits were regularly carried out.