This unannounced inspection took place on the 2 May 2018. During our last inspection on 1 June 2017 we found the provider was in breach of Regulation 13 Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2010. The provider did not ensure that people who used the service were protected from financial abuse due to the lack of effective monitoring systems of people’s finances. The provider was in breach of Regulation 17 HSCA 2008 (Regulated Activities) Regulations 2010. We found that the provider did not have robust and effective systems in place to monitor, assess and improve the quality of care provided to people who used the service. The provider was also in breach of Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2010. We found that staff employed did not receive appropriate training and support to ensure that they had the appropriate skills to meet the needs of all people who used the service.

The provider sent us an action plan in July 2017 telling us that they had taken the appropriate actions to address the breaches found during our inspection in June 2017 and that they were no longer in breach of the regulations.

We found during our inspection in May 2018 that the provider had taken action and had improved the management and auditing of peoples financial records. Staff had been provided with regular training and support to ensure they had the right skill and knowledge to meet people’s needs. The provider had introduced a robust and effective system to monitor and assess the quality of care.

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 in Harrow Northwest London and is registered for 15 older people who may have dementia or a mental illness. During the day of our inspection there were 13 people living at Hazelwood House. Hazelwood House is located close to public transport and local shops.

The registered provider is also the 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.

Staff demonstrated good understanding of their responsibilities in respect to ensuring that people who used the service were safe. Staff told us that they had attended training regarding safeguarding adults and learned about different forms and types of abuse, how to recognise it and how to report it. The provider followed safe recruitment procedures and ensured staff were appropriately checked prior to being offered employment. Medicines were managed safely and staff had received appropriate training and were competent to administer medicines to people who used the service. Any risks associated with people’s care had been assessed and appropriate risk management plans were put into place to ensure risks were managed safely.

Staff spoken with and records confirmed that staff had received appropriate training which gave them the skills and confidence to carry out their responsibilities. Training included moving and handling, first aid, health and safety, fire prevention, safeguarding, and food hygiene. The service was meeting the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff said that they had received training in DoLS and MCA. People were offered a choice of food at each meal, and drinks and snacks were provided throughout the day in line with their preferences and dietary requirements. Appropriate healthcare professionals were involved in the care of people when required.

Staff supporting people were respectful and carin

This inspection was carried out on 1 June 2017 and was unannounced.

During our last comprehensive inspection in June 2015 we rated the service as good.

Hazelwood House is a residential care home registered for 15 older people, some of whom may have dementia and mental health problems.

The registered provider is also the 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 who used the service told us they were safe and staff were clear about how and whom to report any allegations of abuse to. However, we found that financial records and procedures were not sufficiently in place, which meant there was a risk of people’s finances not being managed appropriately.

Risks in relation to the treatment or care were appropriately assessed and risk management were available for staff to follow.

Sufficient staff was deployed to meet the needs of people and staff were vetted appropriately, However, on occasions references had not been checked, to assure they were provided by the previous employer.

Medicines were managed safety and procedures were in place for the storage, administration and disposal of medicines.

Staff had access to basic mandatory training and specialist training had been booked for staff to ensure peoples complex needs can be met.

People who lacked capacity to make some decisions in relation to their treatment or care had their capacity assessed and appropriate safeguards had been put into place.

People who used the service were provided with nutritious and well balanced meals and had access to drinks and snacks at any time during the day.

The service ensured that people’s health care needs were met and appropriate support was sought from health care professionals if required.

People told us that they felt comfortable in the presence of care workers and were well cared for and their privacy and dignity was respected.

Care plans reflected people’s assessed needs and were based around the person. People were provided with some activities. However, these were not always meeting people’s needs or reflected people’s expectations.

Appropriate procedures were in place for people to make complaints or raise concerns. Over the past 12 months the service received one complaint which was in process of being resolved.

The service had some systems in place to monitor and assess the quality of care; however these were not always effective. Senior management was present although the leadership of the home was not always effective.

We have made two recommendations; one about involving people more in making decisions about their accommodation and another about seeking advice and support to improve and develop the leadership and management of the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service on 18 June 2015 at which one breach of legal requirements was found. The registered provider did not ensure that appropriate checks were carried out on care workers to ensure people who used the service were protected from staff unsuitable to work with vulnerable adults.

After the comprehensive inspection, the registered provider contacted us on 2 September 2015 advising us that actions had been taken to meet legal requirements in relation to the breach.

We undertook a focused inspection on the 17 September 2015 to check that the registered provider had met all legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hazelwood House on our website at www.cqc.org.uk.

Hazelwood House provides accommodation and care for a maximum of up to 15 older people some of whom have dementia and mental health needs.

At our focused inspection on the 17 September 2015, we found that the provider had followed their plan and legal requirements had been met.

The home has 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 and associated Regulations about how the service is run.

The provider ensured that appropriate employment checks were carried out to ensure only staff suitable to work with vulnerable adults were employed.

We conducted an unannounced inspection of Hazelwood House on 18 June 2015. Hazelwood House provides accommodation and care for a maximum up to 15 older people some of whom have dementia and mental health needs.

At our last inspection on 11 October 2014, the service met the regulations inspected.

The service had 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.

The atmosphere of the home was relaxed and welcoming. Throughout our visit we observed caring and supportive relationships between staff and people using the service. Staff interacted with people in a friendly and courteous manner. People told us they were content living in the home.

People were involved in decisions about their care and support, and were not restricted from leaving the home. People told us their privacy was respected and they were supported to maintain good health. People’s health was monitored and they received the advice and treatment they required from a range of health professionals.

People were cared for by staff who understood people’s needs and had the knowledge and skills to provide people with the support and care they wanted and needed. Staff received a range of relevant training and were supported to obtain qualifications related to their work. Staff told us they enjoyed working in the home and received the support they needed from management staff to enable them to carry out their roles and responsibilities. The staffing of the service was organised to make sure people received the care and support they needed. However the provider did not always follow safe recruitment practices.

Staff understood how to safeguard the people they supported. People told us they felt safe. People’s individual needs and risks were assessed and identified as part of their plan of care and support. People’s support plans were personalised and contained the information and guidance staff needed to provide people with the care they needed and wanted.

People had the opportunity to participate in a range of activities, and to participate in the local and wider community. People’s relationships with family and those important to them were supported.

People were provided with a choice of meals and refreshments that met their preferences and dietary needs.

Staff had an understanding of the systems in place to protect people who were unable to make particular decisions about their care, treatment and other aspects of their lives. Staff knew about the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

There were effective systems in place to monitor the care and welfare of people and improve the quality of the service.

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

We carried out an inspection on 17 January 2014 and found the provider in breach with Regulation 17(1)(b) of the Health and Social Care Act 2008 (Regulated Activities) 2010. The provider did not have suitable arrangements to ensure people who used the service were enabled to make, or participate in making decisions relating to their care and treatment.

On 21 March 2014 we received an action plan confirming that the provider had taken action to become compliant with Regulation 17(1)(b) of the Health and Social Care Act 2008 (Regulated Activities) 2010.

The purpose of our inspection on 12 September 2014 was to assess compliance with the breach of Regulation 17(1)(b) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2010.

We looked at four care records and spoke to three people who used the service, one relative, two care workers and the registered manager during our inspection on 12 September 2014. We found that the provider had taken appropriate actions and updated all care records. People who used the service and relatives told us that they had been informed and updated of any changes in the care provision and action had been taken to assess peoples consent in line with the requirements of the Mental Capacity Act 2005. People told us, "I am always informed of what is going on" and "The care is excellent, which puts my mind at rest when I am not around."

At the time of our inspection, the home was providing care for thirteen people.

People’s privacy and dignity were respected, however there was no regular consultation with people who used the service and their relatives.

There were processes in place to protect people using services from harm. The staff were trained to recognise the signs of abuse and to report concerns in accordance with the home's procedures.

Staff were supported to provide care and treatment to people who used the service and were being trained, supervised and appraised appropriately.

Records kept were accurate and held securely.

We spoke with the provider, one member of staff, two relatives and three people who were living in the home. People told us they felt able to express their views about their care and felt listened to by staff. We saw staff speaking with people and offering them choices.

We saw some improvements in relation to the involvement of people and their representatives in planning for their care. However, we saw limited information in the care records to evidence how tpeople were involved in decision making. People told us that staff always asked for their permission before caring out tasks for them and staff confirmed that they always talked to people about the support they were going to provide to gain their agreement.

The care plans viewed took account of people's individual likes, dislikes and preferences, however people's cultural and spiritual needs were not always included in them.

People told us that they felt well cared for by staff. A relative spoken with said when talking about the staff, "they are lovely and very friendly". People told us that there were always enough staff on duty to support them.

The home was clean and free from odours at the time of our visit. We saw staff observing good practice in relation to preventing the spread of infection.

People told us that they would tell the manager if they had a complaint and said they felt their concerns would be listened to.

People told us staff treated them with respect and dignity. We observed staff interactions with people and found that staff listened to and engaged appropriately. People said staff respected their choices when they made these.

We found that people were not given as many opportunities as possible to make choices. Three people told us they did not get to choose their meals and were given these based on what staff knew about their preferences. All people we spoke with said they had not seen their care plans or been asked about these for them to express their views about the care planned for them. One person said they had not been involved when their room was redecorated so that their views could be taken into consideration.

People were satisfied that their personal care needs were being met and that they were receiving support with their healthcare needs. We however found that people’s care plans and risk assessments were not updated when their needs changed to make sure that they continued to receive safe and appropriate care.

People reported that meetings were arranged for them so that they could share their views and make suggestions about the service. The minutes were however not always displayed for people to read about the meetings. Some people told us they had previously completed satisfaction questionnaires to tell the provider their views about the services provided.