About the service: Haddon House provides accommodation, personal and nursing care for up to 40 people. Some people using the service were living with dementia. The home is divided in to four units. The service is located in the Clowne area of Chesterfield. At the time of our inspection there were 34 people using the service.

People’s experience of using this service:

People were supported by enough staff to ensure their needs were met. Staff had time to interact with people in a positive way. People’s medicines were managed safely. Risks associated with people’s care had been identified and were managed in a way that did not restrict their freedom.

We carried out a tour of the home and found it was generally clean and well maintained. However, we identified some areas which required attention. The registered manager told us these areas were being addressed in their development plan.

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 access to healthcare professionals when required. People received a nutritious diet which met their needs and preferences. However, the mealtime experience could be improved on. Staff received training and told us they were supported by the management team.

We spent time observing staff interacting with people who used the service and found they were kind and caring. People’s relatives we spoke with commented highly of the care and support their family member received.

We looked at people’s care records and found they reflected their current needs and preferences. A range of activities were provided which gave people opportunity to access social stimulation. The service had a complaints procedure and complaints were acted on.

The home had a registered manager who conducted a range of audits in areas such as infection control, medicine management, health and safety and documentation. Actions raised as part of the audits were addressed.

More information is in the full report.

Rating at last inspection: Good (report published 12 August 2016)

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection.

Haddon House provides accommodation for up to 40 older people who are living with dementia, who require personal and nursing care. There were 33 people using the service at the time of our inspection.

This inspection took place on 19 May and 24 May 2016. The first day of the inspection was unannounced.

There was no registered manager at the service. 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 following the guidance in people’s risk assessments and care plans and the risk of unsafe care was reduced. People’s records were up to date and indicated that care was being provided as detailed in people’s assessments. The records had been updated to reflect changes in people’s care needs. Medicines were managed safely.

People were safeguarded from abuse because the provider had relevant guidance in place and staff were knowledgeable about the reporting procedure.

Consent to care and support had been sought and staff acted in accordance with people’s wishes. Legal requirements had been followed consistently where people were potentially being restricted.

People told us they enjoyed their food and we saw meals were nutritious. People’s health needs were met. Referrals to external health professionals were made in a timely manner.

People and their relatives told us the care staff were caring and kind and that their privacy and dignity was maintained when personal care was provided. Relatives were involved in the planning of their care and support. There was a wide range of activities and events available to enable people to take part in hobbies and interests of their choice.

Complaints were well managed. The leadership of the service was praised by external professionals and relatives and communication systems were effective. Systems to monitor the quality of the service Identified issues for improvement. These were resolved in a timely manner and the provider had obtained feedback about the quality of the service from people, their relatives and staff.

There were thirty people living in the home at the time of this inspection. The home specialises in providing care for people with dementia. Therefore many people could not tell us what it was like to live at the home so we spoke with three relatives to gain their views.

One relative told us they were “More than happy with the care provided”. The care plans in place described people’s care needs and how staff were to deliver care. There were systems in place to ensure these were updated regularly.

People were routinely offered a choice of food and drinks. The people we spoke with told us they enjoyed the meals offered. Relatives we spoke with told us that the food was of a good quality.

There were systems in place to safeguard peoples and appropriately handle any allegations of abuse. All the relatives spoken with told us they were happy with the care provided and have never felt the need to raise any concerns.

Staff received regular training in order that there were suitably skilled to meet people’s needs. Training was mostly up to date with just a few gaps evident. Staff told us that where there were gaps training was being arranged. Systems were in place to provide suitable induction and on-going supervision to staff.

There were systems in place to handle complaints appropriately. The manager held relatives meetings and had an open door policy to encourage people and relatives to discuss concerns. Where complaints had been received these were thoroughly investigated.

The purpose of this visit was to check if the provider had taken actions to address the findings of our visit on 27 September 2012.

Medications management systems were in place. There were audits and checks to monitor how staff handled and administered medicines. The records indicated people were receiving their medicines on a regular basis.

Since our last visit a significant amount of training has been delivered to the group of 56 staff. Some of this has been mandatory training such as moving and handling and infection control. Other training provided has been specific to ensuring staff were trained to meet people's needs such as dementia care and challenging behaviours.

Staff told us that there had been an increase in the level of training being delivered. They confirmed that they knew what training was planned for them.

We found that people's confidentiality was protected through suitable storage of records.

We found that people were offered choices, and where possible consulted about their care. Where people did not have full capacity to make decisions, their right to be as involved as much as possible was respected.

Regular activities were offered to people. One person told us how they liked the PAT (Pets as Therapy) dog that visited the home.

Two relatives told us how they were, “Looked after and supported” as well as the person living in the home. One relative told us the home was, “Marvellous” and they, “Could not speak too highly” about the home. They regarded the staff as being, “Wonderful” and said they always carried out any requests they made.

One person said that staff were kind and always popped in their room to check they were alright. Whilst we observed positive staff interactions with people, we found that there were not robust systems in place to ensure all staff received appropriate training that enabled them to competently care for people.

We found that there had been occasions where people had not received their medication as it was prescribed and also gaps in recording when medicines were given. This meant that there was no clear record of what medicines had been given to people.

If any complaints had been received they had been handled openly and responses given to complainants that demonstrated the concerns had been fully looked into. Regular meetings were held for relatives to keep them informed and included in the running of the home.

We asked people what they thought about the home about the home: One person told us “It’s alright here”. Another person said “my bedroom is nice; I have my own things in it”.

One relative told us the staff were “marvellous” and they “couldn’t thank them enough”. The relative told us they were kept well informed and “could ring at any time day or night” to find out how the person in the home was.

One person told us “I have no complaints at all”, another person said “There is nothing that I am not happy with I would go to the person in charge if I was worried about anything“.

People told us the “food is very good”, “meals are alright you get a choice”

One person told us they “trusted the staff and they were nice”.