We inspected Hazelwood Nursing Home on 16, 17, 18 and 22 November 2016. The inspection was unannounced. Hazelwood Nursing Home is a nursing home providing support and accommodation for up to 50 older people. At the time of our inspection there were 39 people living at the service. Hazelwood Nursing home is one large purpose built detached building split over two floors.

There was a registered manager in post who was registered with the CQC. 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 our last inspection on 16 November 2015, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to medicines not being effectively managed, there not being sufficient staff deployed to ensure people’s safety and wellbeing, people not receiving personalised care with activities that were designed to stimulate or interest them and poor quality auditing systems. The provider sent us an action plan stating that they would address all of these concerns by 30 January 2016.

At this inspection, we found that the provider had taken action on all these areas and was fully meeting the regulations where breaches were found.

The provider had systems in place to protect people against abuse and harm. The registered provider had effective policies and procedures that gave staff guidance on how to report abuse. The registered manager had robust systems in place to record and investigate any concerns.

Risks to people's safety had been assessed and actions taken to protect people from the risk of harm. The environment was clean and appropriate measures had been taken to reduce the risk of infection. However, there was no recent fire risk assessment in place that was carried out by a trained competent person. This was brought to the attention of the registered manager who took immediate action.

Medicines were managed safely and people had access to their medicines when they needed them.

Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed. Staff met together regularly and felt supported by the manager. Staff were able to meet their line manager on a one to one basis regularly. However, there were no robust records to identify when people were having supervisions or when they were due. We have made a recommendation about this in our report.

There was sufficient staff to provide care to people throughout the day and night. When staff were recruited, they were subject to checks to ensure they were safe to work in the care sector.

The staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout the days of our inspection. Staff knew the people they cared for well and treated them with kindness, compassion, dignity and respect.

The principles of the Mental Capacity Act 2005 (MCA) were adhered to. People’s mental capacity was being assessed appropriately and meetings took place to make decisions on people’s behalf and in their best interests, when they were unable to do so.. Staff had training on MCA and had good relevant knowledge.

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.

The registered manager had started to implement a dementia friendly environment but this had not been completed. We have made a recommendation about this in our report.

People had freedom of choice at the service. People could decorate their rooms to their own taste

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Information was given to people or their representative about the service before they moved in.

We observed people using the Short Observational Framework Inspection methodology (SOFI). We saw that people were relaxed and well cared for.

We spoke to relatives of people living at the home and staff. People told us that they were happy with the care and support being delivered at the home. One person told us “Staff are like an extended family to me” another said, “My Mum’s room is always immaculately clean and staff in the home are always smiling.”

We found that the premises and grounds were well maintained and clean.

Staff told us they felt supported in their roles and that they have supervision and regular opportunities for training. The manager of the home told us they were planning on introducing appraisals for staff and formalising continuing professional development for nursing staff.

We looked at the provider’s quality assurance system and found that there was a range of monitoring processes in place that enabled the provider to respond to issues of quality.

We had meaningful conversations with three people living in the home during the visit. We spent time with other people on the first floor, who had dementia, and were unable to communicate clearly verbally. We saw that staff interacted well with them, and did not rush them. There was a relaxed atmosphere and we saw people smiling and laughing at different things during the day.

Comments from people included (written with their permission):

“My health has improved dramatically since I have been here. I was very ill, but now I am much better and can walk again. This place cannot be faulted. The staff are excellent, and the home is run very well. Staff come instantly if I ring my buzzer.”

“All the staff have got time for us”.

“It is wonderful here, excellent. We couldn’t have picked a better home”.

A relative said:

“I am very happy with the care that is given here. Nothing seems to be too much trouble for the staff. I am pleased I am allowed to help my relative in some small ways”.

We inspected Hazelwood Nursing Home on 16 and 17 September 2015 and the inspection was unannounced. Hazelwood Nursing Home is located in Longfield near Gravesend and provides accommodation, personal care and nursing for up to 50 older people. The home is set over two floors and has a lift to bedrooms and communal areas between both floors. At the time of our inspection there were 47 people living at the home, with 18 people on the ground floor and 29 people on the upper floor. Everyone at the home was living with dementia, some people had mobility difficulties and sensory impairments and some people displayed behaviours that challenged others. Many people were receiving care in bed.

The service did not have 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. The previous registered manager had left at the end of August and interim management arrangements were in place to cover the service whilst recruitment to the post was in progress.

We found four 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 this report.

Relatives said they felt people were safe living in the home, however we found that staffing levels were not based on people’s support needs and there were insufficient numbers of staff to provide the support and supervision people required.

People received their prescribed medicines, however medicines were not effectively audited and guidance was not always robust enough to ensure people received their medicines when they required them and in a way that ensured their efficacy.

People who required the most care and support were not always given the support they needed to ensure they had meaningful occupation during the day and were not socially isolated.

Although there were some systems to assess quality and safety of the services provided, not all were effective in identifying concerns and ensuring improvement.

Staff were confident in how to protect people from abuse and harm. They were aware of the procedures to follow and were clear about their responsibilities.

Risk assessments were person centred and gave staff clear concise guidance regarding people’s individual needs. They included both measures to reduce identified risks and guidance for staff to follow to ensure people were protected from harm.

Staff knew people well and provided effective care that was based on detailed guidelines written in people’s individual care plans. Staff had completed the training they needed to supportpeople in a safe way.

We observed that staff sought people’s consent before providing care and support. Staff and management understood the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and their responsibilities.

People were provided with adequate nutrition and staff were knowledgeable about people’s dietary requirements.

People were referred to health care professionals when needed and there were strong links with a wide range of health professionals including the local GP surgery.

People were treated with respect and dignity by staff who demonstrated kindness and compassion.

People’s individual assessments and care plans were regularly reviewed to ensure they remained appropriate in meeting their needs.

People were supported to maintain their relationships and relatives told us that they felt most welcome.

Relatives knew how to make a complaint and were given opportunities to give their views.