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Inspection carried out on 10 December 2018

During a routine inspection

This inspection took place on 10 December 2018 and was announced. At our last inspection on 4 February 2016 the service was found to be good.

Hazelwood House provides supported living to five adults with complex mental health needs so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living. People have assured short-hold tenancy agreements and their own en-suite rooms within the house.

The supported living service 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.

The service was outstanding in the way it was run.

There was a clear vision about the direction and culture of the service, which promoted an ethos of involvement and creative ideas to ensure people had a full and satisfying life. The provider and local management team demonstrated these values in their actions through their work with people who lived at the service and staff. Innovative solutions to support people included employing them as peer support workers and working with other organisations and stakeholders to enable people to move on from high support accommodation. In this way the service was exceptional, distinctive and people were at the heart of the service.

People felt safe at the service and told us they enjoyed living there. They told us staff provided them with good support, in a way and at a time that they wanted and that they were treated with dignity and respect.

People were supported to be as independent as possible and this included taking their medicines themselves. For those who required support, medicines were administered safely and on time.

Risk assessments were in place and people had developed their own relapse prevention plans which outlined what their symptoms of ill health looked like and how they wanted to be supported in times of a mental or physical health crisis. Care plans were up to date, comprehensive, holistic and person centred.

People were supported to pursue activities of their choice and attend college courses. The provider also facilitated people going on holiday abroad by assisting them to get the relevant documentation to travel and by arranging staff to accompany them.

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. There was a strong focus of person centred care within the service, which staff followed in practice to ensure people led a full and varied life. This meant people experienced an improved quality of life because they were supported to explore new opportunities and were proud of their achievements.

Staff recruitment was safe. Staff understood how to safeguard people and knew what to do if they had any concerns. Staff had completed training in key areas and annual refresher training took place. Regular supervision and appraisal helped them identify areas for learning and development and team meetings were used to share best practice as well as a source of learning across the staff team.

Staff told us they enjoyed working for the provider and health professionals told us there was continuity of trained, skilled staff who were able to form therapeutic relationships with people. Health professionals told us the management team and provider worked in collaboration with them to maximise and improve people’s health and well-being.

There were quality systems in place to ensure service provision was of good quality. People living at the service and other stakeholders praised the local management team and the provider f

Inspection carried out on 4 February 2016

During a routine inspection

This inspection took place over one day on 4 February 2016 and was unannounced. At our last inspection on 17 December 2013 we found that the provider met all standards that we inspected.

Hazelwood House provides supported living to four adults with mental health and complex needs. People have assured shorthold tenancy agreements and their own flats within the service.

The service 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.

People told us that they felt safe within the service and well supported by staff. We saw positive and friendly interactions between staff and people. People were treated with dignity and respect.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm. Staff had an understanding of the systems in place to protect people who could not make decisions and were aware of the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

Medicines were administered safely and on time. Staff had completed training in medicines and administration. People were supported to become independent with their medicines in a structured and safe way. People understood what their medicines were and why they had been prescribed.

Risk assessments were written in collaboration with people. People were able to tell us why they had risk assessments and how risk assessments helped them identify triggers in them becoming unwell. The provider showed excellent inter-agency working and regularly shared risk assessments with mental health care professionals.

Staff received regular supervision and appraisal that helped them identify areas for learning and development. Supervisions and appraisals were used as an opportunity for staff to improve care practices.

The service focused on the recovery model of care which puts people’s individual recovery at the heart of care provided. People were positive that the home was a stepping stone to enable them to have a full and active life.

The service ensured that people had individual tailored activities that reflected their interests and goals. People attended college or had part time employment. People told us that the provider created a ‘family atmosphere’ within the home. Trips abroad and within the UK were organised by the provider and people using the service. People were encouraged to have a normal, fulfilling life and look towards the future.

Staff understood the principles of the Mental capacity Act (MCA) 2005 and were aware of how this impacted on the people they worked with both in theory and in practice.

There was excellent communication and joined up working between the home and mental health services. Health care professionals spoke highly of the management of the service and the care the service provided.

There were regular reviews of people’s mental health. Staff knew how to refer people for both physical and mental health issues. People were involved in planning their own healthcare needs.

People were supported to have enough to eat and drink. Staff encouraged healthy eating and helped people plan meals and recipes.

People were encouraged to have as much control and input into their care as possible. The service focused on people’s individual recovery. People told us that they wrote their own care plans and were supported by staff. Care plans were personalised to the individual and monitored through regular key working. People were positive about the care that they received from staff and felt that they were treated as individuals.

We saw that the provider encouraged innovation. A new on-line computer syste

Inspection carried out on 17 December 2013

During a routine inspection

Three people receiving care were happy with the care they were receiving. Their comments included, �Staff help as much as you want them to�; �I am more independent here. I do my shopping, cook, go to cinema and have a part-time job as a volunteer� and �Staff help me with my appointments�.

We asked questions to examine if people were protected from abuse, or the risk of abuse. Overall, we were satisfied that staff were aware of different forms of abuse and how to recognise signs of them, including who they needed to contact to report if they suspected abuse.

Appropriate arrangements were in place in relation to the recording of medicines. We saw that medicines were given at the right time, which staff indicated by signing on the individual MAR chart.

Three people who used the service were sure that their comments and complaints were listened to and acted on effectively. They told us that they could talk to the manager or staff, knowing that their concerns would be listened to. Some of their comments included, �My keyworker is someone I am comfortable with and if l had a complaint l will raise it with him� and �Staff listen to our views�.

We reviewed the records of some people who used the service. These contained detailed information relating to people�s care and treatment. Evidence from people�s plans of care showed that they were regularly reviewed and were up to date.

Inspection carried out on 18 March 2013

During a routine inspection

During our visit, we reviewed three care files; spoke with one of three people in residence, and two staff. This allowed us to observe the interaction between staff and people who use the service; specifically to arrive to a view regarding how the provider involved people in their care and whether people experienced safe care from competent staff, including protection from abuse. In all these areas we noted there was good practice.

We saw that people�s privacy and dignity was respected and there was evidence they were involved in their care and received safe and appropriate care from competent staff. This was affirmed in the feedback we got from people during the course of our inspection. We asked a number of questions; including �What do you like most about the way staff support you?�, prompting a number of responses; �Staff are very good�; �If you have an appointment to go to hospital staff are always there to support you� and �they respect my privacy. They knock on my door before they enter�. We found this positive feedback was consistent in all the other standards we inspected.