Hazell Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Hazell Court accommodates up to 55 people, some living with dementia. In the main building of Hazell Court people did not require nursing care. In the rehabilitation unit people received nursing care. The rehabilitation unit was commissioned from the NHS, the service worked with West Suffolk Hospital, people used the rehabilitation unit after a stay in hospital and were supported to move home.

During our comprehensive inspection on 16 and 17 October 2018, there were 41 people living in the main service and 12 people in the rehabilitation unit, 53 overall.

At our previous inspection of 20 October 2016, this service was rated Good overall. However, safe was rated requires improvement, this was because there were some improvements being made relating to how the service recorded when people received their medicines, which had not yet been fully implemented. At this inspection of 16 and 17 October 2018 we found improvements had been made in safe. We found the evidence continued to support the rating of Good overall. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. We found that people were provided with a very caring service and caring is now rated as outstanding.

Improvements had been made in safe and people received a safe service. There were systems in place designed to reduce the risks of abuse and avoidable harm. Where incidents had happened, the service learned from these and used the learning to drive improvement. Risks to people continued to be managed well. People were supported with their medicines in a safe way. Staff were available to support people and the systems to recruit staff safely were robust. There were infection control procedures in place which reduced the risks of cross contamination.

People continued to receive an effective service. People were supported by staff who were trained and supported to meet their needs. People had access to health professionals when needed. Staff worked with other professionals involved in people’s care. People’s nutritional needs were assessed and met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The environment was well maintained and suitable for the people using the service.

Without exception, people were provided with an exceptionally caring service. People's diversity was respected and all people were treated equally regardless of their specific needs. People shared very positive relationships with staff. Staff interacted with people in an extremely compassionate and caring way which had a positive impact on people’s wellbeing. People’s privacy, independence and dignity was respected. People were listened to in relation to their choices, and they and their relatives, where appropriate, were involved in their care planning. Staff knew people well and their care was tailor made to meet their preferences. People were valued and the service provided showed people that they mattered.

People continued to receive a responsive service. There were systems in place to assess, plan and meet people’s individual needs and preferences. People had access to social activities to reduce the risks of isolation and boredom. There was a complaints procedure in place and people’s complaints were addressed. People’s end of life decisions were documented to reduce the risks of people’s preferences about how they wanted to be cared for at the end of their lives not being met.

People continued to receive a service which was well-led. The registered manager had a programme of audits which demonstrated that they assessed and monitored the

Hazell Court provides accommodation and care for up to 55 people, with 12 beds available for people who require rehabilitation and nursing care. The service was split with 43 people based in the residential unit and 12 people based in the rehabilitation unit.

There were 55 people living in the service when we inspected on 20 October 2016. This was an unannounced inspection.

There was 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.

Improvements were required to evidence that people had received their prescribed medicines. The registered manager was fully aware of the improvements required and was taking action to reduce the risks to people. These improvements were ongoing and not fully implemented and embedded in practice.

People received care that was personalised to them and met their individual needs and wishes. People were encouraged to be as independent as possible by a staff team who knew them well and where additional support was needed this was provided in a kind, caring, respectful manner.

There were sufficient numbers of staff who had been recruited safely and who had the skills and knowledge to provide care and support to people in the way they preferred, ensuring that they obtained consent before providing care.

Systems were in place which safeguarded the people who used the service from the potential risk of abuse and staff understood the various types of abuse and knew who to report any concerns to.

Staff knew how to minimise risks and provide people with safe care and there were procedures and processes which guided staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised.

People were encouraged to attend appointments with other health care professionals to maintain their health and well-being and people’s nutritional needs were assessed and people had a balanced diet.

There was an open and transparent culture in the service and staff were very motivated. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. Processes were in place that encouraged feedback from people who used the service and their relatives. An effective quality assurance system was in place and as a result the service continued to develop and improve.

As part of our inspection, we spoke with seven people who used the service and four relatives. We also spoke with the registered manager and four staff members. We looked at five people's care records. We looked at medication practices and procedures, staff training, supervision and appraisal records and the provider's arrangements to monitor the quality of the service provided. Records relating to complaints management were also viewed. Observation of staff practices throughout the day of our inspection was undertaken to ensure that people who used the service were treated with respect and dignity.

We considered our inspection findings to answer 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;

Is the service safe?

When we arrived at the service the administrator checked our identification and asked us to sign in the visitors book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service. One person said, “I never thought I would need a home such as this but they do look after me well.”

We saw that all staff had received training in safeguarding of vulnerable adults from abuse. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

We found that people who used the service were protected against the risks associated with the unsafe use and management of medicines.

We reviewed staffing records regarding The Mental Capacity Act (MCA) 2005 in relation to Deprivation of Liberty Safeguards (DoLS) and saw this training was up to date. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The service had submitted DoLS applications properly using the correct policies and procedures.

Is the service effective?

There were systems in place to audit medication and care plans which ensured there were effective systems in place for monitoring the safe delivery of care.

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that staff had signed records to show they had been reviewed monthly and updated appropriately. The registered manager had arranged for recording times at the end of each shift for staff to update people’s records. This meant that staff were provided with up to date information about how people's needs were to be met.

One person felt that the service did not provide sufficient drinks through the day particularly during hot weather. We saw in people’s notes that their weight and fluid balance charts were recorded appropriately.

Is the service caring?

People told us that they received the care they needed. People living in the service told us that they were happy living there. Our observations showed that care and support was provided in a timely manner.

People who used the service had a care plan in place detailing their specific care needs and the support to be provided by staff.

Two people who used the service said they enjoyed the meals. One person said that they found the menu was not that well varied, but the food was well cooked.

Is the service responsive?

People's preferences and diverse needs had been recorded in accordance with people's wishes.

One person felt that they had to remind the staff to assist them to move from a wheelchair to a lounge chair. When they did the staff did move them using a hoist and they thought this was done correctly, respecting their dignity.

We saw people’s care plans contained their chosen activities. During our inspection we saw the activities co-ordinator engaged in activities with people who used the service.

We found that there were appropriate arrangements in place pertaining to complaints management.

It was reported to us that the service used urine bottles to empty catheter bags which were old and discoloured. The service had replaced these with disposable bottles.

Is the service well-led?

The provider was able to demonstrate that there were systems in place to assess and monitor the quality of the service provided. The views of the people who used the service and staff had been sought. People's views about the service were noted to be positive.

As part of this inspection process we spoke with the manager, three members of staff, five people who used the service and two visitors.

Our observations suggested that people living at the service were happy, that they felt safe and were well cared for. It was evident that people who used the service had a good relationship and rapport with the staff who supported them.

People's health and personal care needs were assessed and there were detailed care plans in place for care staff to follow so as to ensure that people were supported safely and in accordance with people's individual preferences and wishes. Staff spoken with demonstrated a good understanding of people's health and personal care needs and how each person wished to be supported.

The provider was able to demonstrate that a robust staff recruitment policy and procedure was in place and followed to ensure that people living at the service were kept safe. Staff received appropriate professional development. We found that medication practices and procedures required improvement.

This was a follow up inspection to check compliance on maintaining a safe environment. Our previous inspection on 18 November 2012 found that two showers recorded very high temperature that posed a risk of scalding. At this inspection we found matters much improved. This meant people were cared for in a safe environment that supported their health and welfare.

During our inspection to this service we visited both the main care home and the new rehabilitation unit. We spoke with five people who lived here, four visiting relatives and three staff members. Everyone we spoke with were positive about their experiences and had praise for the service on offer.

We looked at the personalised care and support people received and found this met essential standards. One person told that the staff were "Wonderful, caring and do what you ask of them".

We examined the environment and looked at procedures in place for cleanliness and infection control. Systems in place for infection control did protect people who used the service. In the process of looking at all bathrooms we took the temperature of two showers and recorded very high temperature that posed a risk of scalding. We have made a compliance action to protect people from this risk.

We examined a number of records and found that these were well kept.

We spoke with six people who use this service and they confirmed that their dignity and privacy is respected. One person told us that staff enabled them to be independent. “I like a hand to get myself dressed, but I like to get undressed when I want on my own”. Another person told us “all the staff are very nice dear. They help me with whatever I need”.

One person we spoke with told us “The food here is very good. They come round and ask you what you would like. Today I chose the Cornish pasty. They give you a list of activities on offer, but I have never read it. But I regularly play a game of dominos and I like that”.

Another person told us “The food is good. I like to have small portions of tasty food and that is what I get”.

Another person told us “There is one carer I particularly like. They wash me and keep me clean. They are very good to me. I had a bath this morning”.

A relative who visited most days told us they were very pleased with the care and support given to their relative. “I come every day so I should know”.

One person told us when asked that they felt safe at the home. Another person said that they were very close to one member of staff so would speak to them if they had any problems.

The feedback from all residents and visitors spoken with was positive about the staff at Hazel Court.