We inspected Hartfield House on 7 and 9 August 2018. The first day of the inspection was unannounced. We previously inspected the home in May 2017 where we found improvements were needed to ensure risks associated with peoples’ complex health needs were well managed. We also found improvements were needed to ensure daily notes and other documentation was consistently completed. At this inspection we found improvements had been made.

Hartfield House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hartfield House provides accommodation and personal care for up to 20 people in one adapted building. At the time of the inspection 19 people were living at the home. People living at the home were older people who had a range of needs associated with old age and their health. Some people were living with the early stages of dementia.

People were supported by staff who were kind and caring. They knew people well and had a good understanding of their health and care needs, choices and interests. Staff worked hard to ensure people received good quality care that was person-centred. There were a range of activities taking place and people were supported to keep busy and engaged throughout the day. They were able to continue their own interests and hobbies. People were relaxed and comfortable in the company of staff. People’s dignity and privacy was respected. The company statement, “Care like family” was evident throughout the inspection.

Before people moved into the home assessments were completed. This helped ensure their needs and choices could be met. Information from these assessments were then used to develop care plans and risk assessments. These were regularly reviewed. Staff had a good understanding of people’s needs and the risks associated with supporting people and these were well managed.

There were enough staff working each day to meet people's needs. Safe recruitment practices were followed to ensure staff were appropriate to work at the home. Staff had received training they needed and there were opportunities for additional training specific to the needs of the service. This included the care of people with specific health problems such as diabetes. Training was regularly updated.

People were supported to eat and drink a variety of freshly cooked meals and drinks each day. Their health was monitored and staff responded when health needs changed by contacting appropriate healthcare professionals.

Systems were in place to ensure accidents and incidents were well managed and actions taken to prevent reoccurrence. Staff understood how to safeguard people from the risk of abuse and discrimination. Systems were in place to ensure medicines were ordered, stored, given and disposed of safely.

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. Staff had received training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and demonstrated an understanding of the legal requirements.

People and staff were asked for their opinions on the service and whether they were happy at the home. Staff felt supported within their roles and told us the registered manager had an ‘open door’ policy and they could discuss any concerns or problems with them.

There were a range of audits and checks in place. These were used to identify where improvements were needed across the service. There was a complaints policy in place and people and visitors told us they would raise any concerns with staff.

Hartfield House Rest Home provides accommodation for up to 20 older people. There were 16 people living at the home at the time of the inspection. People required a range of care and support. There were some people who lived independent lives but required support for example with personal care and moving and walking safely. People were able to stay at the home for short periods of time on respite care or can choose to live at the home permanently. Staff provided end of life care with support from the community health care professionals but usually cared for people who needed prompting and minimal personal care support.

There was no registered manager at the home. They had left just prior to the inspection. A new manager was in post and had commenced the registration process with 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.

This was an unannounced inspection and took place on 9 and 11 May 2017. This was the first inspection at Hartfield House since the new provider had taken over.

People were supported by staff who were caring and compassionate. They knew people really well and understood their individual needs and choices. They knew people as individuals and were committed to ensuring people received good quality care and support.

There were a range of risk assessments in place to help people stay safe and to retain their independence. Although, not all risks for people with complex health needs had been identified these were managed safely because staff understood people’s needs..

The provider had identified areas that needed to be developed however time was needed to allow these to be fully developed and embedded into practice. People’s records did not always reflect what they had done each day.

People’s medicines were stored, administered and disposed of safely by staff who had received appropriate training. Some people had been prescribed ‘as required’ medicines. Information about why and when these should be given were not always in place. However, staff had a good understanding of people and their medicines.

Staff had a clear understanding of the procedures in place to safeguard people from abuse. They knew what actions to take if they believed people were at risk of harm or abuse.

There were enough staff to meet the needs of people who lived at the home. There was a safe recruitment system to ensure staff employed were suitable to work at the home.

There was a training and supervision programme in place. This ensured staff had the knowledge and skills to meet people’s needs. Staff told us they were well supported.

Mealtimes were a sociable occasion. People were given choice about what they wanted to eat and drink and received food that they enjoyed. Nutritional assessments were in place to ensure people’s needs were met.

The manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff sought people’s consent before offering any support.

People were supported to maintain good health and had access to external healthcare professionals such as their GP when they needed it.

People’s care was personalised and reflected their needs and wishes. Care records showed assessments had taken place and people were involved in the drawing up of their care plan. They were able to make individual and everyday choices and staff supported them to do this. The opportunity for social activity was available should people wish to participate.

People had access to the complaints procedure and complaints were handled appropriately.

There was an open and positive culture at the home. People were happy living there and all staff were committed to improving t