We carried out this unannounced inspection on 9 January 2018.

The last inspection took place on 3 and 4 of July 2017 where the service was rated as requires improvement. Due to discrepancies in the report we agreed to re-inspect this service.

Hazelbrook Christian Nursing Home 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.

Hazelbrook Christian Nursing Home is registered care for 38 people with either nursing or social care needs. The home is situated in Horwich town centre close to shops and other local amenities. It is readily accessible by car, public transport and motorway networks.

The home had a registered manager who had worked at the service for over 20 years. 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 who used the service, relatives and staff told us they found the registered manager helpful and supportive.

Staffing levels on the day of the inspection were sufficient to meet the needs of people who used the service.

Systems were in place to ensure staff were safely recruited. Staff demonstrated a commitment to providing high quality personalised care for the individuals who accessed the service.

Staff told us they received the training and supervision they needed to be able to carry out their roles effectively.

Robust systems were in place to ensure the safe handling of medicines and people received their medicines as prescribed.

Regular checks took place to ensure the safety and cleanliness of the environment. Systems were also in place to reduce the risk of cross infection in the service.

Care records contained detailed information about people’s health and well-being.

People received a well-balanced and nutritious diet. Choices and alternatives were available and special diets were catered for.

People we spoke with told us the staff were kind and caring. We observed good interactions between staff and people who used the service.

There were a range of activities available for people to join in with if they wish. People’s spiritual needs were met as required.

People were encouraged to provide feedback on the service they received. Any complaints or suggestions were acted upon to help improve people’s experience of the service.

The home was not purpose built but had been adapted to ensure that people could move freely around the home and suitable aids and equipment were available. There was a passenger lift to the first floor.

This inspection took place on 3 and 4 July 2017. The first day was unannounced. The second day was pre-arranged.

Hazelbrook Christian Nursing Home is registered to accommodate up to 38 older people who need nursing or personal care. On the day of our inspection 25 people were living at the home.

The home has a registered manager in post who was present for our inspection. 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.

At the last inspection in October 2014, the service was rated Good. At this inspection we found areas where the service provided had deteriorated. The service now requires improvement in two of the key questions we ask, making this requires improvement overall.

The quality monitoring processes used in the home had not identified areas where people's individuality was not respected. The registered manager was aware of areas for improvement with regard to care planning and social interaction, but had not acted on them at the time of our visit. People were not supported to have opportunities to enjoy meaningful social interaction. Activity provision was limited and not tailored to people's individual interests.

People could not always be assured that they would receive support that was based upon their individual needs and preferences. This was because care plans were generic and not person-centred. Information about people’s individual needs was sparse and difficult to follow.

People were not always treated with kindness and compassion by staff. This was because staff did not always take care to protect people’s privacy, confidentiality and dignity. Staff supported people to keep their independence.

People were safe because they were supported by staff who understood how to identify and report potential harm and abuse. Staff were aware of any risks to people and what they needed to do to help reduce those risks, such as helping people to move safely around the home.

People were supported by staff who had the skills to meet their needs. Staff had received training relevant to their roles and were supported in their roles by the manager and their colleagues. Checks had been completed on new staff to make sure they were suitable to work at the home.

People were supported to make choices in their daily lives. People were enabled to make decisions. Where a person lacked capacity to make a certain decision they were protected as staff followed the principles of the Mental Capacity Act 2005.

People received food they enjoyed and were supported to eat and drink enough to keep them healthy. When needed, people were supported to access other healthcare professionals to make sure their health needs were met. People's medicines were managed and stored in a safe way, and they had their medicines when they needed them.

Staff were supported by the registered manager. Staff felt involved in the running of the home and were able to have one to one time with the registered manager.

The inspection was carried out on 21 October 2014 and was unannounced. The last inspection of Hazelbrook Christian Nursing Home took place of 14 November 2013 and was found to be meeting all the regulatory requirements.

Hazelbrook Christian Nursing Home is registered to provide accommodation for 38 people who required nursing or personal care. On the day of our inspection there were 32 people living at the home. The home is located in the Horwich area of Bolton.

The home had a registered manager in post. 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 and associated Regulations about how the service is run.

The registered manager was available to assist us with the inspection. The manager had worked at the home for a several years and was a registered nurse.

During our inspection we spent time in all areas of the home including the lounges, the dining room and with people’s permission chatted with some people who preferred to stay in their bedrooms. This enabled us to observe how people’s care, support and interaction between staff was provided. We observed and heard staff speaking to people in a kind and respectful manner. There was a friendly and relaxed atmosphere within the home. People living at the home told us that staff were kind and caring. One person said, “I have everything I need here. The staff are lovely.” One relative spoken told us, “The staff are marvellous; nothing is too much trouble for them. They are very kind and caring.”

On the day of our inspection we saw that people were supported by sufficient numbers of staff. The staff we spoke with confirmed they attended regular training which was relevant to their roles. We also looked at some staff files and saw that robust recruitment procedures were in place and all the relevant checks had been completed prior to new staff commencing their employment at the home.

We saw that the home had suitable arrangements in place to help protect people living at the home from the risk of abuse. People we spoke with told us they felt safe living at Hazelbrook.

The Care Quality Commission has a duty to monitor activity under the Deprivation of Liberty Safeguards (DoLS). Staff on duty confirmed that they had undertaken training in the Mental Capacity Act 2005 and in Deprivation of Liberty Safeguards.

We looked at five care records and found that these contained clear and concise information to guide care staff about how people’s care needs were to be met, their preferred wishes and likes and dislikes. We saw the care records contained risk assessments, which identified risks and described the measures in place to ensure people were protected from the risk of harm. We saw that the care plans were regularly reviewed and reflected any changes to people’s care needs. We saw that when the care records were not in use they were securely stored to ensure confidentiality was being maintained.

During the inspection we saw that people were encouraged and supported to eat and drink sufficient amount to meet their needs. We observed some people required assistance when eating their meals and this was done in a sensitive and dignified manner.

We spoke with the manager, nurses, care staff and the ancillary team. Staff spoken with said they felt supported by the manager and felt comfortable in approaching the manager at any time. We observed good working relationships between the staff team and senior staff. Staff comments included, “We all work well together” and “The home is well run”.

Prior to inspection we spoke with other healthcare professionals who told us they had no concerns about the home and the care provided. They said that the home was well run and all the staff were very good.

We visited Hazelbrook Christian Nursing Home on 14 November 2013 and found the home to be warm, clean and tidy. We were told most people were up and had been served breakfast. We saw that people who used the service were well presented and we heard staff interacting with them in a friendly, polite manner respecting their dignity and privacy.

We looked at three records and saw they contained relevant medical and health information, personal preferences and social history. There was evidence of working with other health professionals, risk assessment and monitoring charts seen.

We saw relevant policies and procedures were in place to place to quality assure the services. There was evidence of staff and residents meetings, activities and staff supervisions.

We saw relevant policies around safeguarding and we spoke with three members of staff who demonstrated an understanding of the issues. The staff with whom we spoke were confident to report any issues they may encounter.

Staff we spoke with told us, “I enjoy my job; it’s a good place to work”. Another said, “The staff all support one another we work well as a team”.

We spoke with two visitors, one told us, “This place is brilliant and the staff are so caring and dedicated, they keep us informed all the time about X’s progress”. Another said, “My X has settled in well, they are well cared for”.

We visited Hazelbrook Christian Nursing Home on 1 February 2013 and found the home to be warm and clean. Most of the people who used the service were up and sat in the lounges. We saw that people were nicely groomed and smartly dressed. We observed that staff interacted with people in a polite and friendly manner.

We looked a four care records and saw that they contained detailed information about the care and support each person required. This included personal preferences, medical and social background, wound care, nutrition and hydration, monitoring charts and input from other professionals such as the GP and dietician. We saw that the care records were regularly reviewed and update.

We spoke with four people who used the service, one told us, “I’m fine, I have no complaints”. Another person said, “They (the staff) look us after us really well”.

We spoke with three relatives, one told us they were very happy with the care provided. Another person told us that their relative had been in another home prior to moving into Hazelbrook Christian Nursing Home and they felt happier with the care and support provided at this home.

We saw that relevant polices and procedures were in place. We asked two members of staff about their understanding of safeguarding and whistle blowing. Staff spoken with demonstrated they had a good understanding in this area and had received training in the protection of vulnerable adults.

We spoke with a several people who use the service. Comments included:

“The food is good”. “There is always a choice at meal times”.

“We could do with more going on during the day”.

“The staff are very kind and they look after us really well”.

One relative told us, “The home is well run, the staff are very good. I come at different times of the day and I have never seen anything that would give me any cause to worry about the care my mother receives”.