This inspection took place on 16 May 2017 and was unannounced. At our last inspection in March 2015 the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

Hazelwood Lodge is a care home for people with learning disabilities. The maximum number of people they can accommodate is ten. At the time of this inspection there were ten people living at the home.

People told us they liked the staff at the home. Friendly and supportive relationships had developed between staff and people using the service.

Risks to peoples’ safety had been identified and staff were aware of the actions they needed to take to mitigate these risks.

People told us the service was very homely and relaxed and the registered manager encouraged and supported a sense of community between people and staff which had a positive effect on everyone’s well-being.

Staff were aware that the people they supported were vulnerable and understood their responsibilities to keep people safe from potential abuse.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were positive about working at the home and told us they appreciated the support and encouragement they received from the registered manager.

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 told us they enjoyed the food provided and that they were offered choices of what they wanted to eat.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals and understood that people’s diverse backgrounds and cultures needed to be valued and respected.

Both people using the service and their relatives told us they were happy to raise any concerns they had with any of the staff and management of the home.

People were included in monitoring the quality of the service and we saw that their suggestions for improvements and preferences about how they wanted to live their lives were respected and acted on.

This inspection took place on 24 March 2015 and was unannounced.

After our last inspection of 7 July 2014 the provider wrote to us to say what they would do to meet legal requirements for the breaches we found. As part of this unannounced comprehensive inspection we checked that the breaches of legal requirements had been addressed. These breaches related to care and welfare, risk and quality monitoring, consent to care and treatment, and respecting and involving people who use services. At this inspection we found that the service was now meeting all of these standards.

Hazelwood Lodge Limited is a care home providing accommodation and support with personal care for up to ten people with learning disabilities, physical disabilities or mental ill-health. The service is provided in a large detached house in the residential area of Southgate in the London Borough of Enfield. There were nine people living there at the time of our inspection, eight of whom have learning disabilities.

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.

People told us they felt safe at the home and safe with the staff who supported them. We observed that staff were patient, kind and respectful.

People said they were satisfied with the numbers of staff and we saw that they didn’t have to wait too long for assistance.

The registered manager and staff at the home had identified and highlighted potential risks to people’s safety and had thought about and recorded how these risks could be reduced.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and told us they would presume a person could make their own decisions about their care and treatment in the first instance. They told us that if the person could not make certain decisions then they would have to think about what was in that person’s “best interests” which would involve asking people close to the person as well as other professionals.

People said they had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

People told us they liked the staff who supported them and staff listened to them and respected their choices and decisions.

People using the service and staff were positive about the registered manager and management of the home. They confirmed that they were asked about the quality of the service and had made comments about this. People felt the management took their views into account in order to improve service delivery.

We carried out this unannounced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

Hazelwood Lodge is a care home providing accommodation and support with personal care for up to ten people with learning disabilities, physical disabilities or mental ill-health. The service is provided in a large detached house in the residential area of Southgate in the London Borough of Enfield. There were nine people living there at the time of our inspection, eight of whom have learning disabilities.

Our last inspection was in May 2013. At that inspection, the service was found to have met required regulations for consent to care and treatment, care and welfare of people who use services, staff recruitment, and records.

The service had a registered manager in place. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

During our visit, people told us, and we observed, that the care and support they received from individual care staff was caring and compassionate, and that generally they felt safe. However, we found several areas in which people’s safety was compromised. The registered manager did not understand the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS), and we found that people may have been deprived of their liberty unlawfully. While risks relating to people’s support were assessed, risk assessments and guidelines did not always include appropriate strategies for staff to ensure people’s safety.

The service premises were not always cleaned to a high standard, and equipment was not always properly maintained. However, staff were aware of the principles of infection control when providing personal care and preparing food, and followed these.

People’s health needs were met, and they were supported to access health and medical services quickly when they needed to. However, people were not always empowered to make decisions about their own health and well-being, and at times the service actively discouraged people from taking control over their own health and support.

People did not always agree to their care and support in ways that met the requirements of the Mental Capacity Act 2005, and we found little evidence that information was presented to people in ways they could understand so they could make informed decisions. Assistive and augmentative communication tools were not routinely used by the service to ensure people with complex communication needs could express their feelings, however staff were aware of people’s individual communication styles and interacted well with them.

Staff were appropriately vetted to ensure they were suitable people to work with vulnerable adults. The provider had a good system in place to ensure they were appropriately supported through training, supervision meetings and appraisal of their work. However, we found that the culture of the service meant good work was not always recognised.

The provider had a number of mechanisms in place in order to seek feedback from people, however people told us these were not always effective and we saw evidence that showed they were not always listened to, nor changes made to the service as a result of their feedback.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, and one of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

One person's view was representative of others when they spoke with us about staff. They said "this is like my family and I love it here." Other people we spoke with told us that staff were respectful and involved them in making decisions in relation to the care provided, using verbal and non-verbal communication. Another said “I am on top of my care needs and we work together as a team for my choices."

Care planning and reviews took place regularly with involvement from people, and relatives were regularly involved in this process. We found that the staff understood people's care needs. We also reviewed the recruitment processes. Evidence from staff files showed that appropriate checks were in place before care staff commenced working with people who use the service. The provider had systems in place to ensure that the records were appropriately maintained.

People told us that staff were respectful towards them and always spoke to them appropriately.

People said staff understood their needs. One person said, “They do everything I ask them to do.”

People said they were involved in decisions about their care. A person said, they had asked for swimming to be one of their chosen activities. They and had visited the pool to view it for themselves before they attended their first swimming session.”

People expressed their views about meals provided by the home. Comments were “I think the food is very good”.

People told us they could choose how they wish to be cared for. A person said,” You can do things when you like. If I want to go to the shops they assisted me onto the bus and take me shopping.

We observed that people were sitting interacting with staff playing board games.

People spent most of the day at the day centre. A particular person attends a day centre which caters for their particular cultural needs. However a number of people do not attend daycare. They were seen to be involved in the running of the home such as washing and wiping up the dishes and laying the table for dinner.

A number of people spoke about choosing the colour of their bedrooms which had been redecorated.

One person spoke about the recent holiday to Butlin’s and said “I had such a lovely time I did not want to come back.”

We were told “people are helpful and kind”. Another person said,” they are lovely people they make me feel at home”. A person who uses the service confirmed they had a copy of the care plan in their room which they had signed. A person said, “staff asked if they are carrying out personal care in the right way they ask is this how you want it done”.

People expressed their views about the meals provided by the home. Comments were, " I think that the food nice". A person said, “The food is alright. We have a take away on a Friday it was chicken and chips last time."

People said they were able to talk with staff and felt they were listened to.