Our most recent inspection took place on 13 November 2018 and was unannounced. We last inspected this service on 10 and 11 May 2017. At our last inspection we rated the service requires improvement overall and requires improvement in four out of the five questions we inspect against. We identified three breaches of regulation of The Health and Social Care Act 2008. We found that there were not always enough staff to support people with their assessed needs. We also had concerns about the support and training offered to staff to help them be more effective. We found the overarching quality assurance systems were poorly developed and did not identify areas for improvement. We also found the service had not notified us of a recent event in which a person using the service was at risk.

Following the inspection, the provider sent us their action plan telling us how they were going to address our concerns and comply with regulation. At our inspection on 13 November 2018 we found vast improvements in the way the service was managed with regular input and support from the registered provider. We found one repeated breach of regulation.

Hazeldown is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The care home can accommodate up to 18 people in one adapted building. There were 12 people at the time of our inspection. The service is situated in the high street in a small village with some amenities. People have their own room and shared amenities including two lounge areas a main kitchen and a separate resident’s kitchen and dining area.

There is 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 previous breach in relation to staffing had been addressed. There were now enough staff to meet the assessed needs of people using the service. Staff recruitment processes were sufficiently robust and staff once employed were well supported. They received the training necessary for their job role.

The service had improved with strong leadership and provider oversight which helped ensure good outcomes of care for people. However, there were still a number of issues regarding the safety and upkeep of the service. These had not been identified by the registered provider and could result in avoidable harm for people using the service.

The registered manager had since the last inspection familiarised themselves with what needed to be notified to the CQC. The service had very few incidents and people all reported feeling safe and well supported by staff. Staff spoken with were aware of their responsibilities to support people and had undertaken training to help them recognise abuse and knew what actions to take.

Staff supported people to take their medicines safety and as intended. They supported people to maintain good health and see health care professionals when appropriate to do so. People were offered a balanced diet and encouraged to think about their food choices in line with their assessed needs and food preferences. There was guidance for staff about people’s health needs and staff undertook specific training when appropriate. Most people had been supported to see the dentist and there were oral hygiene assessments in place.

We have made a recommendation about implementing The National institute of Clinical Excellence, (NICE) guidance in relation to oral hygiene.

Everyone apart from one person was deemed to have capacity and there were no unnecessary restrictions for people. Staff asked people for their co

The inspection took place on 10 and 11 May 2017 and was unannounced on the first day but the manager knew we were coming back on the second day. The last inspection to this service was on the 1 October 2014 and the service was rated as good with no breaches. The registered manager at the time has since left and now provides some administrative support to the current manager.

The service is registered to provide residential accommodation for up to eighteen people with a recognised mental health need. The service is not fully occupied and had ten people using the service when we visited with one person in hospital.

There is 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 2008 and associated Regulations about how the service is run.

The service was fully staffed and had the number of staff it said it needed. The staff employed were observed to be extremely caring and compassionate and worked hard to enhance the lives of people they were supporting. They gave up their free time to support people socially. We found there were insufficient staff to meet people’s needs. Staffing levels had remained static for years despite an increase in people’s needs. Staffing levels did not enable people to go out when they wanted when they needed support to do so. Most people did require support to go out because of the remote location of the service. The manager was on shift supporting staff and trying to oversee the overall management of the service and associated upkeep of records and auditing. They did not have a deputy to delegate things to. Care staff were providing care and support as well as doing domestic duties and cooking. This impacted on their ability to take people out according to their expressed needs and wishes.

People received their medicines as intended by staff who were suitably trained to administer medicines but staff would benefit from more specific guidance about the use and when to administer medicines as required. Medication profiles would also help to ensure staff received their medicines according to their preferences.

Risks to people’s safety were mitigated as far as possible because staff were knowledgeable about people’s needs and sought advice when needed. There were individual and generic risk assessments in place. Equipment was regularly checked to ensure it was safe to use. The environment was restrictive for people with physical disabilities due to steep stairs and internal steps.

Staff recruitment was adequate but there were no audits on staff files and there was no evidence of how the interview process was used to determine that staff had the right skills and attributes for the job. Staff felt well supported by the manager who was very knowledgeable and understanding. However formal mechanisms of support were limited. Staff had supervision but they were not regular and staff did not have annual appraisals. Staff training and induction was good when first employed but there was limited evidence of opportunities for continued training and sharing positive practice. Most staff had higher qualifications and, or a care certificate.

People were encouraged to be involved in decision about their care. Everyone was deemed to have capacity. Staff were aware of the requirements of The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. When implemented correctly it ensures that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process.

Staff understood what constituted abuse and how they should respond to any allegations of abuse. However there had been a failure to notify CQC of different events affecting the well-being of people using the service and there

This unannounced inspection took place on 1 October 2014. The last inspection was on 6 June 2013 where no breaches to regulations were found.

This home provides residential care and support to people with mental health conditions. It can support up to 18 people and there is 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.

People told us they felt safe living at Hazeldown Care Home. They said the staff treated them well and that they did not feel discriminated against. They said that the staff knew them really well and were aware of their likes and dislikes.

Staff understood what abuse was and knew how to report a safeguarding concern to the local authority if they had concerns. No safeguarding issues had been raised with us or the local authority.

Poor performance by staff was acted upon by the manager to ensure the staff were the correct personnel to be working in the home. The staff were inducted, trained and supported to ensure they were supporting people safely.

People’s medication was stored safely and administered correctly. The pharmacist had recently completed an audit of the medication system used in the home to ensure the medication was being managed safely.

Staff received appropriate induction and training to enable them to carry out their roles effectively. They received good support from the management team.

Staff had attended training on the Mental Capacity Act 2005 (MCA) and had a clear understanding of the implications and actions required to support people appropriately.

Arrangements were in place to ensure that people’s physical and mental health needs were met..

People said they were happy and supported well. Each person knew their key worker and was complimentary about the role of the key worker and how they had been helped.

Respect and caring attitudes were used when staff spoke with people in the home. People living in this home were offered care and support in a kind, caring and compassionate way that met their individual needs.

People had the opportunity to complain and action was taken to address any concerns or complaints raised. People were asked their views on the quality of the service and involved in any future developments for the home.

During our inspection we observed staff interacting positively with the people using this service and giving them time to agree to specific tasks and providing choices where this was appropriate.

We spoke with four people living at Hazeldown and they all expressed satisfaction with the service. One person told us “I don’t see myself being anywhere else other than here; I think I will live out the rest of my days here.” They further commented that they liked their room and when asked told us that they had no suggestions for improvement to the service. We asked another person if they were happy living at the home and they responded “Yes.” A third person commented “I get looked after very well.”

We found that the home had appropriate arrangements in place to manage people's medicines safely.

The home was generally well maintained and safety checks were undertaken on a regular basis. We saw that recent checks had been undertaken from external agencies such as the fire service and an electrical testing company.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People who used the service told us that they were happy with the care they received at Hazeldown. One person we spoke with commented that the home was “much better than the last place I was at”. Another person we spoke with told us they were ”very happy” living at the home.