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Inspection carried out on 7 September 2018

During a routine inspection

Hazel House is a residential care home for eight people of varying ages with learning disabilities and mental health conditions. The house is a converted domestic dwelling set out over two floors. The home has access to a large garden.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection, we found the service remained Good.

The service had a registered manager. At the time of the inspection, the registered manager was on maternity leave and the home was being managed on a day to day basis by a team leader with support from the providers management team. 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

People were safe living at Hazel House. Risks associated with people's care had been appropriately assessed. Medicines were managed and administered in a safe manner. There were sufficient staff available to ensure people received person centred care. Staff were safely recruited. Systems and processes were in place to ensure people were protected from abuse.

Staff had received regular training, supervision and an annual appraisal to support them to provide effective care. 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 had choice around what they ate and were supported to maintain good health.

We observed kind and caring interaction between people and staff. People living in the home and their relatives praised the caring nature of the care staff and registered manager. People were involved in planning their care.

Care plans were person centred, detailed and updated as and when people's care needs changed. People were supported to lead active and fulfilling lives and went on regular daytrips. Systems were in place to manage complaints.

People and relatives told us they were happy with the overall service at Hazel House. Quality assurance processes were in place to monitor the quality of care delivered. The registered manager worked in partnership with external health and social care professionals to ensure people's health and social care needs were met.

Further information is in the detailed findings below.

Inspection carried out on 21 December 2015

During a routine inspection

This inspection took place on 18 December 2015 and was unannounced. When we last visited the home on 12 May 2014 we found the service met all the regulations we looked at.

Hazel House is a care home which has been registered to accommodate a maximum of eight people who have learning disabilities.

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.

Safeguarding adults from abuse procedures were available and staff understood how to safeguard the people they supported. Staff understood what to do if people could not make decisions about their care needs as assessments of people’s capacity had been carried out. Staff had received training on the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005. These safeguards are there to make sure that people receiving support are looked after in a way that does not inappropriately restrict their freedom. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way.

People received individualised support that met their needs. The provider had systems in place to ensure that people were protected from risks associated with their support and care was planned and delivered in ways that enhanced people’s safety and welfare according to their needs and preferences.

People were involved in decisions about their care and how their needs would be met. They were supported to eat and drink according to their individual preferences. Staff treated people with kindness, compassion, dignity and respect.

Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. Medicines were managed safely.

People told us they were happy with the care provided. Staff were appropriately trained and skilled to care for people. They understood their roles and responsibilities as well as the values of the home. Staff received supervision and an annual performance review. They confirmed they were supported by the registered manager and received advice where required.

The registered manager was accessible and approachable. People who used the service and staff felt able to speak with the registered manager and provided feedback on the service. Complaints had been responded to and action taken to resolve them.

Monthly audits were carried out across various aspects of the service, these included the administration of medicines, care planning and training and development. Where these audits identified that improvements were needed action had been taken to improve the service for people.

Inspection carried out on 12 May 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. We used a number of different methods to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences. We observed how staff were interacting with people who used the service, looked at care records that showed how people's needs were being met and a recent survey that the service had completed which reflected the views of people's relatives about the service.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were risk assessments in place to ensure that people’s safety and well-being were maintained when receiving care and support. This meant that people’s needs were identified and met in a manner that promoted their independence and safety. Guidance was available in people’s care plans regarding their need for one-to-one support and where they had particular behavioural needs we saw that these were monitored regularly. We observed that people’s changing behaviour was responded to sensitively in a manner that enhanced the individual's well-being. Sufficient staff were available to meet people’s needs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People's needs were assessed and support was delivered to meet their individual needs. We looked at three care plans. These provided information about people’s needs and gave guidance for staff about how they should be met. We saw that care plans and risk assessments were complete and up to date. If someone had to move to another service, there would be no interruptions to their care and treatment. Health plans clearly identified people's health care needs and ongoing treatment. People had been involved in the preparation of their health plans. Staff spoken with understood the health care needs of the three people whose records we looked at. Care records showed the service had completed an assessment of people’s needs prior to them being discharged to another service. This meant that the service worked with other providers to make sure that people's health and social care needs were addressed.

Is the service caring?

We observed that people were treated well by staff. We saw that staff understood their needs. People were spoken to in an appropriate manner. People's needs were assessed and support was delivered to meet their individual needs. We looked at three care plans. These provided information about people’s needs and gave guidance for staff about how they should be met. Care records showed that people had been involved and consulted about their care. Care plans were person centred, written in an easy read and available in pictorial formats that reflected the needs, wishes and the likes and dislikes of people who used the service.

Is the service responsive?

Care plans identified the person's needs resulting from their cultural background. Daily notes showed that people who used the service had taken part in activities and were supported to access their local community. For example, people were supported to go to the attend day centres and clubs.

Staff knew how the people communicated and responded to their requests. People’s views were recorded in one-to-one meetings, and when their care plan was reviewed. Staff explained that regular key worker discussions were used to help the person to be involved in decisions about their care. Staff listened to people and acted on their views. Care records showed that where professional guidance had been obtained this was recorded in people's care plans and was being followed by staff. People's care records that they had access to a range of health services and social care support.

Is the service well-led?

People who used the service, their representatives and staff were asked for their views about their care and treatment and these were acted on. An annual quality survey had been carried out. The manager explained that a report had been produced, and any suggestions to improve the service were addressed. Peoples' suggestions were used as the basis to improve the care provided by the home.

Six monthly audits had been carried out covering a range of areas such as medications management and care planning. These showed that the quality of service provision was assessed and monitored. We looked at the accident and incident records. This clearly showed that appropriate action had been taken to prevent accidents or incidents from happening. The manager showed us how they monitored accidents and incidents to look for any patterns and to record any preventative actions. Care was managed to make sure that people had their needs met safely. Where issues were identified improvements were made.

Inspection carried out on 7 October 2013

During a routine inspection

People who used the service had learning difficulties. Two people who used the service did not make comments regarding the care provided. Five people informed us that they were well cared for and staff had treated them with respect. They said they were able to engage in activities they liked.

We observed that people who used the service appeared well cared for and were dressed appropriately. Staff were noted to be constantly supervising people to ensure that they were safe.

People who used the service stated that they had access to healthcare professionals and they had been given their medication. Assessments, including risk assessments had been carried out. The care provided had been reviewed regularly to ensure that the current needs of people were met. Staff were aware of the choices and preferences of people.

There were arrangements for staff support and supervision. Staff stated that they worked as a team. Essential training had been provided. This ensured that staff were able to meet the needs of people.

There were arrangements for quality assurance and audits. A recent satisfaction survey indicated that people who used the service and their representatives were satisfied with the services provided.

Inspection carried out on 6 February 2013

During a routine inspection

We observed that people were involved and consulted about decisions affecting their care. Staff understood how to support people to make choices about their care and treatment. We saw that staff understood their needs. People received the care and support they needed. We observed that staff spoke to people in a manner that showed respect. People were calm and relaxed in their interactions with staff. Staff knew how to respond to safeguarding concerns to keep people safe and promote their rights. Staff were able to explain how they would recognise the signs of abuse, and how to report their concerns.

Appropriate checks were undertaken before staff began work. Staff told us that they had been through a thorough recruitment process. We observed that staff kept records relating to people who use the service securely. We saw that all records were up to date.

During an inspection to make sure that the improvements required had been made

We haven't been able to speak to people using the service because this was a desktop review and did not involve a visit to the service. Our inspection of the 22 June 2011 found that there was a lack of a choice of meals and a sufficient quantity of food items to meet people's needs. The provider wrote to us and told us they had consulted with people who use the service about the choices of meals they would prefer. The provider sent us examples of the new menu, and feedback they had received from people who use the service about the meals that they preferred.

Our inspection of the 22 June 2011 found that there was a lack of appropriate cleaning as one of the toilets had an unpleasant odour. The provider wrote to us to inform us that they had replaced the flooring in this area. They also provided us with copies of the revised cleaning schedule.

The provider wrote to us and told us that training would be provided to senior staff on how to deliver supervision to staff. The provider had sent us certificates for those senior staff that had completed the training. This meant that effective supervision and support was being provided to staff.

Inspection carried out on 8 June 2011

During an inspection in response to concerns

We observed that people were involved and consulted about decisions affecting their care. Staff knew how to communicate with them. People were treated well by staff. We saw that staff understood their needs. They were treated respectfully and spoken to in an appropriate manner.

We saw that people appeared to be relaxed when eating their meals.

There were only a limited range of food items available in the temporary kitchen area. Takeaways were being provided as the main meal of the day. There was no fresh fruit or vegetables available for people to eat. People might not therefore always receive meals that meet their nutritional needs.

People spoken to confirmed that they trusted staff and felt safe. They could discuss their concerns with the staff. People said to us that staff were available to help them. Staff spent time talking with people and engaging in one to one activities with them.