This inspection took place on 20 June 2018 and was unannounced.

Hazelgrove Court Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides personal care to a maximum of 48 people, some of whom are living with a dementia and/or a physical disability. At the time of the inspection there were 46 people who used the service.

At the last comprehensive inspection in May 2016 we found the service was meeting requirements and was awarded a rating of Good. At this inspection we found the safe domain needed some improvement and rated this as Requires Improvement. However, we found the evidence continued to support the rating of good overall. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Systems were in place to ensure people received their prescribed medicines safely, however some improvement was needed with record keeping to ensure staff had up to date guidance to keep people safe.

During the inspection we looked at some bedrooms, bathrooms, and communal areas and found that generally the environment was clean and staff followed safe infection control practices. However, there were some areas in need of improvement. There was a malodour on the first floor that was coming from a carpet. This carpet had been cleaned and the malodour had improved but not fully eliminated. We were informed new flooring was to be purchased.

On our arrival we noted boxes and equipment stored under the stairwell next to the fire escape and near to the registered managers office. We informed the registered manager that this posed a tripping hazard, in addition to obstructing the route in and out of the service and needed to be moved to a more permanent place. The registered manager took action to address this during our visit.

Staff had received safeguarding training and were confident they knew how to recognise and report potential abuse. Staff were recruited carefully and appropriate checks had been completed to ensure they were safe to work with people.

Risks to people's safety and health were assessed, managed and reviewed. People and relatives told us there were sufficient numbers of staff on duty to ensure people’s needs were met.

The registered manager had systems in place for reporting, recording, and monitoring significant events, incidents and accidents. The registered manager told us that lessons were learnt when they reviewed all accidents and incidents to determine any themes or trends.

People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences. A training plan was in place and staff were suitably trained and received all the support they needed to perform their roles.

People were supported to have a good diet which met their needs and preferences. People told us they liked the food that was provided. People were supported to access health professionals to maintain their health and wellbeing.

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.

Staff understood people's different ways of communicating and how to make people feel valued. The home had a strong person-centred culture. People told us the staff were kind and caring and treated them

We inspected Hazelgrove Court Care Home on 5, 10 and 13 May 2016. The first day of the inspection was unannounced which meant that the staff and registered provider did not know that we would be visiting. We informed the registered provider of the date of our second and third visit.

Hazelgrove Court Care Home is purpose built and can accommodate up to 48 people. The service provides care and support to people requiring personal and nursing care and people living with dementia. There are two separate units. The ground floor of the service accommodates people who require personal and nursing care. The first floor of the service provides accommodation for people living with dementia. At the time of the inspection the home was providing care to 47 people.

The home has a registered manager in place. 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.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about the different types of abuse and what action they would take if they suspected abuse was taking place. Safeguarding alerts had been made when needed.

Risk assessments were in place for people who needed them and were specific to people’s individual needs.

Emergency procedures were in place for staff to follow and personal emergency evacuation plans were in place for everyone.

Robust recruitment processes were in place and appropriate checks had been made.

There was sufficient staff on duty. People and relatives told us there was enough staff day and night to meet the needs of people who used the service. A dependency tool was used to determine safe staffing levels.

Medicines were managed appropriately. The service had policies and procedures in place to ensure that medicines were handled safely. Accurate medicine administration records were kept to show when medicine had been administered and disposed of.

Required certificates in areas such as gas safety, electrical testing and hoist maintenance were in place.

Staff had received up to date training to support them to carry out their roles safely. Their performance was monitored and recorded through a regular system of supervisions and appraisals.

People were supported to maintain their health through access to food and drinks. Appropriate tools were used to monitor people’s weight and nutritional health. People spoke positively about the food on offer.

Staff demonstrated good knowledge and understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberties Safeguards. The registered manager had a good system for recognising when DoLS applications needed to be made or reviewed. However best interest decisions were not always recorded in care records.

People were supported to maintain good health and had access to healthcare professionals and services when needed. Staff accompanied people to hospital appointments and we could see people had regular visits from their own G.P.

From our observations, staff demonstrated that they knew the people’s needs very well and could provide the support needed.

People were actively involved in care planning and decision making and this was evident in signed care plans. Information on advocacy was available and had been used in the past.

People and their relatives spoke highly of the service. People said they were treated with dignity and respect.

Personalised care plans were in place which provided staff with the information needed to meet people’s individual needs, wishes and preferences. Care plans had been reviewed regularly.

The service employed an activities coordinator to plan activities and outings for the people who use the service. People told us the

In our previous inspection, carried out 21 May 2013, we had set a compliance action in relation to ensuring records were accurate. The records that we found needed to be improved were those that detailed when topical medicines and creams had been applied. We also noted that staff needed to make sure the fluid balance charts for one person were accurately maintained. We carried out this follow up inspection to determine what improvements had been made.

During the visit, we did not speak with people who used the service about the issues raised at the previous inspection. From a review of the records and systems in place for checking that records were accurately maintained, we found that the staff had taken action to improve their record-keeping.

We found that the manager had taken proactive steps to ensure the home was compliant in all areas. We found that care people were now receiving was meeting their needs.

At the time of the inspection there was no registered manager in post. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

During the inspection we spoke with four people who used the service and two relatives. We also spoke with staff in the home. People told us that they were happy with the care and service received. One person said, "The staff are very good and there are enough to help me when I need it." Another person commented, "The meals are very nice, I join in some of the activities, bingo is my favourite." A relative told us, "The staff are lovely and caring, my family member is always clean and smartly dressed." We saw that staff treated people with dignity and respect. Staff were attentive and interacted well with people. We saw that people had their needs assessed and that care plans were in place.

We saw that people were encouraged and supported to receive adequate nutrition and hydration.

The home employed staff with the correct skills experience and qualifications and pre employment checks were carried .

The home had a clear complaints procedure in place.

Some records were not accurately completed therefore people were not protected from the risks of unsafe or inappropriate care and treatment.

We used the Short Observational Framework during this visit (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who may be unable to communicate verbally due to their cognitive ability. We carried out these observations in the first floor lounge of the home during the afternoon on of the first day of the visit as some people who used the service were less able to express their views due to complex needs.

We saw that people were provided with care in a supportive and caring manner. This

included support given with drinks and snacks. We found that almost all of the interactions between staff and people living at the home were positive. However, some people experienced more interactions than others.

During the visit we spoke with three people who used the service and three relatives.

People who used the service expressed satisfaction with the care and service that they received. The people we spoke with told us, “They look after me, I don’t like to be shut in but I can go out in the garden when the weather is nice.” They also told us they were, “Not keen on the meals, it is the same thing every day.” Another person we spoke with told us they liked living in the home but said the food was not good.

We spoke with the relatives of three people during the visit one relative told us, “It is wonderful and the girls are lovely.” They also told us you just have to ask and they put things right, the TV reception was poor so the manager asked the handyman to look at it and they are getting a new socket put in near the window. Another relative told us, “He/She are well looked after.”

We observed staff interacting well with people who used the service, staff were attentive and spoke to people courteously and respectfully.

We spoke to people using the service and their relatives and they told us that they “had no complaints, I can’t fault it”, “It’s always clean.”, “You’re allowed to personalise the room, you can bring your own curtains if you want, if you have a picture the handyman will put it up for you.” and “I like to go to bed about 6pm and I get up at about 8am.”

Relatives told us “It’s like going to visit her/him at home.”, “The manager is approachable, you can say anything to him and if you have a problem they’ll get it sorted out.”, “The staff are good, they’ll sit and explain things to you about the care.”, “There’s not always enough staff.” and “When he/she became picky about food they got in what he/she wanted.”

Some people at the home were unable to communicate with us, but looked happy and well cared for.