Hazlemere Lodge is a care home that provides nursing care for up to 64 older people. The home is divided into four units. At the time of our inspection there were 62 people who used the service.

The service has a registered manager in place.

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.

During this inspection we found the provider had made improvements in the areas identified.

We received positive feedback from people and their relatives during our visit. One person told us,

“The staff are ever so kind and respectful to us. I can’t complain.”

People were kept safe at the service. Recruitment processes ensured only suitable staff were appointed. There were sufficient staff to support people. We observed staff treated people with kindness and respect. Relatives told us they were happy with the care their loved one received. Comments included, “The staff never have a cross word” and “[My relative] is safe and the staff are pleasant”. One relative told us they had viewed three other homes and that Hazlemere Lodge was by far the ‘best’ one.

Staff received supervision from their line manager and received training to ensure they were able to support people effectively. We saw evidence of training records to confirm this.

Medicines were administered in line with policy and procedures. Where people required their medicines to be given covertly, this was discussed with the relevant professionals involved in the person’s care and best interest decisions were made in accordance with legislation.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People’s nutritional needs were met and appropriate measures put in place to address any weight loss. People received healthcare support they required. Staff told us, “We are able to support people at the end of their life with additional support from specialist nurses”.

People had their needs assessed and this was recorded in care plans. These outlined the support required and people’s preferences. Relatives provided specific life history information to ensure staff provided individualised care. Staff responded to people’s changing needs. Appropriate action was taken in the event of someone becoming unwell.

Activities were arranged for people to join in as a group or on an individual basis. The service had two activity coordinators to provide stimulation, enjoyment and social contact. We saw an exercise therapist attend on the second day of our inspection. People participated in their chairs. Those who were unable to join in observed and enjoyed the social contact.

The service monitored the quality of people’s care. Issues identified were addressed with action plans. Records were maintained effectively and staff had access to policies and procedures to guide their practice.

The service had informed us of incidents and notifications such as when a person died or safeguarding concerns.

We spoke with people and observed care. We saw staff were attentive to people, treated people with respect and provided guidance and support when it was needed. People had access to a safe garden. People we spoke with expressed a positive view of the service. One person told us their general health had improved since moving there. Another said the staff provided the support they needed. We saw care plans included the information required to meet people's needs although we found weaknesses in some plans in recording some psychological and social aspects of care. Those may lead to some needs not being fully addressed.

We found the service’s practice with regard to the control, storage and administration of medicines had improved since our last inspection. Our concerns which led us to a finding of non-compliance on that occasion had been addressed and we found the service complaint on this inspection. The service had arrangements to identify weaknesses in procedure and to minimise risk to people.

We looked at the safety and suitability of the premises. The service had four care areas and provided a service to older people needing nursing care, people with dementia, and general care and support to people. All bedrooms had en-suite facilities and each care area had a lounge, kitchenette/dining room and assisted bathroom. People had access to safe garden. We found the building to be well maintained and all areas we looked at were in good order, tidy and clean.

People who used the service told us that staff respected them and treated them with dignity.

A carer visiting a person new to the home said that all their questions had been answered. They were given written information including on how to complain.

One person told us that the home “…was everything it said in the brochure” and they felt they had made the right decision to move there.

A number of people expressed praise for the staff telling us that they found them caring, attentive and supportive.

Some people in the dementia unit said there were not enough activities which interested them. At the same time, however, they also said they enjoyed going out into the garden.

The inspection took place on 11 and 12 November 2015.

This was an unannounced inspection. The last inspection for Hazlemere Lodge was conducted on 6 June 2013 and the service was found to be fully compliant at that time.

Hazlemere Lodge is a care home that provides nursing for up to 64 older people. The home is divided into four units. At the time of our inspection there were 61 people living in the home.

The service has a registered manager in place. 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 home was in the process of recruiting care staff and was using agency staff to support people who live in the home. One person who lived in the home commented “Agency staff don’t always know what you need; this makes me shout at them.” The same person said they were irritated when they have an agency carer to support them.

We received positive feedback from relatives during our visit. Relatives we spoke with commented on the kind and caring approach of staff. People said that their privacy and dignity was respected and that staff spoke respectfully to them and relatives.

One person told us; “Staff are very friendly and caring; there’s friendliness and kindness here.” A relative whose loved one had been living in the home for two years said that. “Staff are really caring and there is great nursing care.” Another relative said that. “Care is good; X is very dependant, staff are competent.”

We were told there are no restrictions on relatives visiting people and on the day of our visit staff knew relatives by their personal name. Permanent staff and agency staff who had worked at the home for a while were knowledgeable about people’s histories and what was important to them such as family members.

We have made a recommendation about people’s life history and to explore likes and dislikes in relation to activities.

We identified breaches in relation to management of medication, records and infection control.

People did not have their medicine administered in line with the provider’s policy and procedures. People did not receive care that reflected their current needs and the providers infection control policy was not adhered to.

These constituted to breaches of the regulations 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.