We inspected Hazel Bank Care Home on 7 November 2017 and our visit was unannounced. At the last inspection in March 2015 we rated the home as good overall.

Hazel Bank provides accommodation, personal and/or nursing care to up to 39 people who may be living with dementia or other mental health issues. At the time of our inspection there were 33 people living at the service.

A registered manager was in post who was planning to step down and deregister with the Care Quality Commission (CQC). An acting manager had recently been employed who was planning to register with the Care Quality Commission. 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 processes were in place. Staff had been trained in recognising and reporting signs of abuse. Accidents and incidents were appropriately reported and investigated with actions taken to protect people. Assessments were in place to mitigate risk to people and these were updated to reflect changing need.

Medicines were managed safely. People received medicines appropriately from staff trained in the safe administration of medicines.

The service was clean and mostly well maintained. Staff had access to equipment designed to prevent the spread of infection such as gloves, aprons, hand sanitising gels and wipes. The provider took immediate actions to address concerns we raised with heating and hot water on the top floor.

Staff were recruited safely and had received appropriate training to offer safe and effective care and support. Safe numbers of staff were deployed at the service and staff were able to spend quality time with people. Staff received regular supervision and appraisal and felt supported by the management team.

The service was compliant with the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Best interest decisions were evident in people's care records. People were consulted about their choices/preferences and their consent sought prior to care and support tasks. People and/or their relatives were involved in the planning of their care. Care records were individualised, up to date and relevant to people's needs. People's end of life wishes were documented and advanced care planning in place where appropriate.

People received a varied and nutritious diet. People at nutritional risk had their weight and food/fluid intake monitored. However, better documentation was required to reflect people were receiving sufficient fluid intake.

We saw good evidence of staff providing compassionate and caring care. People's privacy and dignity was respected. People with specific needs such as sensory loss or cultural requirements were supported to ensure they were involved with the day to day life of the service. Information about people was displayed in their bedrooms as a quick guide for staff. This helped staff understand people's likes, dislikes and care needs.

An activities programme was on offer, according to people's wishes which included regular activities within the home and trips out.

People's health care needs were met through good communication with the multi-disciplinary team such as GPs, district nurses, opticians, community matron and dentists. The service used video links to aid further access to a telemedicine service which meant some people required less visits to hospitals.

A robust complaints procedure was in place. Minor concerns were also documented and investigated with actions taken as a result. people told us they were happy with the service and were able to approach the management team if they had any concerns.

A range of quality assurance tools were in place to monitor and drive improvements to the service. People'

This inspection took place on 4 March 2015 and was unannounced. At the last inspection on 18 June 2014 we found three breaches in regulations which related to the safety and suitability of the premises, staff training and complaints. The provider sent us an action plan which told us improvements would be made by 30 September 2014. At this inspection we found improvements had been made to meet the relevant requirements.

Hazel Bank Care Home provides nursing care for up to 39 people, who may be living with dementia or have mental health needs. There were 34 people living in the home when we visited. Accommodation is provided over two floors with lift access between the floors. There are two communal lounges and a separate dining room as well as toilets and bathroom facilities. A central kitchen, laundry and hairdressing salon are located on the ground floor.

The home has 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 they felt safe and staff knew how to identify and report any safeguarding concerns, and also knew of other agencies they could contact if they felt concerns were not being addressed.

Systems were in place to make sure the premises and equipment were safe and a refurbishment plan was underway to improve the environment.

Safe systems were in place to manage medicines and ensured people received their medicines when they needed them. People had access to health care services and staff ensured specialist advice was followed.

Staff training had improved since the last inspection although refresher training in safeguarding was required. Systems were in place to ensure all staff received regular supervision and appraisal.

Staff understood and had implemented the legal requirements relating to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

People praised the staff for their kindness and were satisfied with the care they received. We saw staff engaged with people at every opportunity. Staff had a good knowledge and understanding of people’s needs and worked together as a team. There were sufficient staff to deliver the care people required and care plans provided information about people’s individual needs and preferences.

A varied programme of activities were available and we saw people enjoyed taking part in making Easter bonnets, a quiz and dancing. People told us the meals were good and we saw a choice of food and drink was offered throughout the day.

The way in which complaints were managed had improved and we saw complaints had been investigated and responded to appropriately.

The registered manager led by example and used the quality assurance systems to make improvements to the service. We saw the registered manager was visible in the home monitoring, supporting and encouraging the staff team to ensure people received the care and support they needed.

The inspection visit was carried out by one inspector and a specialist advisor in mental health. During the inspection, they spoke with the home manager, operational manager, quality assurance manager, one of the company directors, three care staff (two care workers and one registered nurse), ten people who lived at the home (four of whom were being nursed in bed and one who chose to remain in their room), six relatives who were regular visitors and the community matron.

Before the inspection we reviewed all the information we held about the home and contacted the local authority Adult Protection Unit and Contracts and Commissioning Team. On the day of the inspection we looked around the premises, observed staff interactions with people who lived at the home and looked at records. There were 33 people living at the home on the day of the visit; 14 of whom required nursing care and 19 required residential care. Five people living at the home were living there on a temporary basis following a fire at their sheltered housing accommodation.

At the last inspection in September 2013 the service was found to be meeting the regulations we looked at.

Before this visit we had received information of concern about how the home dealt with complaints. We found evidence which supported this information.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

There were some systems in place to protect people who lived at the home from abuse and avoidable harm. For example people’s medicines were stored safely and administered as prescribed and care was planned and delivered in a way that ensured people's safety and welfare. There were sufficient numbers of suitably qualified staff to meet the needs of the people who lived at the home.

However we found care staff had not had appraisals or first aid training. The lack of qualified first aiders at the home meant people who lived at the home may be at risk in the event of an emergency. We have asked the provider to make improvements.

We also found the premises and grounds at the home were not adequately maintained. This meant people who lived there were not living in safe surroundings that promoted their wellbeing. We were particularly concerned that the temperature of the hot water at the home was not adequately controlled; this meant vulnerable people were at risk of scalding. We have asked the provider to make improvements.

Is the service effective?

Peoples’ care, treatment and support at the home achieved good outcomes and promoted a good quality of life for the people that lived there. People told us they were happy with the care provided at the home and their care and support needs were being met. One person said, “I’ve been here for about 12 months, I was in another home before but I like it much better here. I’m happy here.”

From our observations and from speaking with staff, people who lived at the home and relatives we found staff knew people well and were aware of peoples care and support needs. We also found staff had received appropriate training to meet peoples’ needs.

We saw there was equipment such as adapted baths and grab rails in place. These enabled people to maintain their independence.

The care plan for one person (who was cared for in bed) identified they were at risk of developing pressure sores. We saw this person was regularly turned from side to side and these actions were consistently recorded. After a prolonged period of bed rest the person had not developed tissue damage; this demonstrated the effectiveness of care given.

Other people’s care plans where the potential for tissue damage had been identified showed effective care delivery. No pressures sores had developed and one person admitted with a pressure sore had seen their pressure areas restored to full health.

Is the service caring?

We saw staff treated people with dignity and respect and maintained their privacy and dignity. We heard care staff speaking courteously and kindly with people, asking permission before helping to support them and explaining what was happening.

We observed people who lived at the home were supported by caring and attentive staff who were patient and encouraging when they were supporting them. We observed how staff interacted with people whilst medicines were administered. Staff were respectful when they spoke with people and enabled people to take their medicines in an unhurried manner. We also observed lunchtime in the dining room and saw it was a sociable experience for people.

During our visit we saw the atmosphere was calm and relaxed. Some people were relaxing in their own rooms. Others were chatting in the lounges or watching television. People appeared comfortable and were well dressed and clean, which demonstrated staff took time to assist people with their personal care needs. One person told us, "They help me with washing and dressing and are very kind."

This showed us staff treated people who lived at the home with compassion and respect and encouraged them to retain their independence here where possible.

Is the service responsive?

Care and support was provided in accordance with peoples’ preferences, interests and diverse needs. Records we looked at, discussion with staff and observations showed that people's wishes were respected and acted upon.

People had access to activities and were supported to maintain relationships with their friends and relatives. We also saw care staff regularly visited people cared for within their own rooms. Published research evidence suggests that keeping people regularly occupied and stimulated can improve the quality of life for people with dementia.

There was a full activities programme in the home which included organised games, quizzes and musical entertainment. The home employed activity coordinators to organise the programme. One person, who was sat in the lounge, told us, “I’m not bothered about joining in with the quiz; they are always doing things here though.”

This meant the home was organised so that it met peoples’ social and emotional care needs, in addition to their physical care needs.

Is the service well-led?

We found people were not protected against the risks of inappropriate or unsafe care because the provider did not have effective systems to assess and monitor the quality of service people received. We have asked the provider to make improvements.

We also found the complaints system at the home was not effective. Comments and complaints people made were not responded to appropriately. We have asked the provider to make improvements.

In this report the name of registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still registered managers on our register at the time.

The home manager told us they had been in post since March 2014. They told us they had applied to the Care Quality Commission to become the registered manager at the home. People and their relatives we spoke with gave positive feedback about the new manager.

A relative said, “We have had issues in the past but things appear to be improving.”

We found people who used the service were involved in developing their care and were asked to consent to the implementation of their care plans. We also found staff treated people respectfully and asked for consent with certain activities, for example, when supporting people with meals.

We found people's risk assessments and care plans were person-centred and the care plans we reviewed clearly set out what the needs of people were including their specific likes and dislikes. We found staff were polite and attentive to people's needs.

We found the environment of the home, in most areas, to be visually clean but some areas required extra attention to detail, for example, underneath lounge tables and the environment in the laundry room. People's rooms were clean and appeared comfortable.

We found staff were effectively trained and supported in order to carry out their duties affectively and received regular one-to-one sessions with the registered manager and annual appraisal. We also found the provider had an effective complaints process and the registered manager was able to manage complaints and follow them through to a satisfactory conclusion.

During the inspection we spoke with four people who used the service and the two visiting relatives. We also spent time observing how staff interacted with people and how care and support was provided. One person who used the service said they liked it at the home and they "got along with all of the staff". Another person said staff were polite and they enjoyed the food. One relative we spoke with said they were happy with the care being provided and their relative "loved the food".

People using the service had complex needs which meant that most were unable to tell us their experiences therefore we spent three hours observing the care delivered and interactions between staff and the people using the service. We talked with two people who use the service who were able to communicate with us.

Those two people told us they were comfortable in the home and the staff were very friendly and that the food was very good.

People told us that they like the staff and that the food is usually good. People also told us that activities are arranged on both an individual and group basis.

Staff and a visitor told us that they didn’t think there were enough staff on duty to fully meet peoples' needs.