About the service:

Hazelmere House 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 the inspection. Hazelmere House has the capacity to support up to 60 people; at the time of the inspection 36 people were living at the care home.

People’s experience of using this service:

The quality of safe care and treatment people received had improved since the last inspection. We saw that people’s level of risk was determined from the outset and measures were in place to keep people safe.

Effective quality assurance measures were in place. Processes and systems to assess and monitor the provision of care had improved since the last inspection. Audits and checks were routinely completed; these helped to maintain a good level of high-quality, person-centred care.

People told us they felt safe. The registered provider had measures in place to ensure people were protected from harm and abuse. Safeguarding procedures were clearly in place and staff were familiar with the processes that needed to be followed.

Staffing levels were analysed and reviewed in relation to the dependency needs of people who were living at Hazelmere House. Staffing levels were appropriately managed and staff were effectively deployed across the home.

People received care and support from staff who had been appropriately vetted and had undergone the necessary pre-employment recruitment checks.

Medicine management procedures were safely in place. Staff were appropriately trained, had their competency levels checked and were familiar with best practice guidance and the up to date medication administration policy.

Robust health and safety checks were in place and regulatory compliance was maintained. Up to date certificates were in place for gas, electricity, legionella and fire safety.

The registered provider was complying with the principles of the Mental Capacity Act 2005. People were appropriately assessed from the outset and measures were in place to ensure people were not unlawfully restricted.

Staff were supported with training, learning and development opportunities. Training was up to date, staff were regularly supervised and told us they felt supported on a day to day basis.

People’s nutrition and hydration support needs were assessed from the outset. People had access to external healthcare professionals and guidance was incorporated within people’s care records.

We observed kind, compassionate and caring interactions between staff and people receiving support. We received positive feedback about the dignified and respectful approach of staff and it was clear that staff were familiar with people’s preferences and wishes.

People were encouraged and supported to participate in a range of different activities. There was a dedicated activities co-ordinator in post; they arranged a variety of activities based around people’s enjoyments and interests.

The registered provider had formal complaints process in place. Complaints were regularly reviewed, discussed and responded to in line with company policy.

Rating at last inspection: At the last inspection the service was rated ‘Requires Improvement’ (Report published May 2018). Following the last inspection, the registered provider submitted an improvement plan which we checked during the inspection. We found that improvements had been made.

Why we inspected: This was a scheduled inspection based on previous ratings.

Follow up: We will continue to monitor the quality and safety of care being provided and return to inspect the service as per inspection schedule.

Hazelmere House Care Home Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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.

Hazelmere House Care Home Nursing Home provides accommodation for up to 56 people who have nursing needs. At the time of our inspection there were 38 people living at the home, two of whom were in hospital. The home provides a wide range of long and short term nursing and residential care for older people. All bedrooms in the home are en-suite and communal facilities include a large conservatory and bar area. There is wheelchair access and a secure keypad entrance. Car parking is available to the front and side of the building.

This service was last inspected in June 2016 where we rated the service as requiring improvement. We identified breaches of regulations 11 (Need for consent), and 17 (good governance). After our inspection June 2016, the provider submitted an action plan to the Commission outlining the action they would take to improve the service.

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

There had been a change in registered manager since our last inspection in 2016. The new manager successfully registered with the Care Quality Commission in September 2017.

At this inspection we found that the new registered manager was working diligently and was making significant improvements in the management of the home and staff. On taking up their new position they had carried out their own assessment of the home’s compliance with the requirements of the Health and Social Care Act 2008 and associated Regulations and had identified that significant improvement was required to ensure the safety and wellbeing of the people who lived at the home.

On this inspection we identified further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 on safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of this report.

The atmosphere in the home was welcoming and sociable. People told us that they were well cared for and spoke highly on the manager and staff.

People told us that they felt safe living in the home and staff were committed to providing good standards of care.

Measures designed to reduce risk were not always put into practice so some people remained at risk of harm or their needs not being met.

Safeguarding systems, processes and practices protected people form abuse, neglect, harassment and breaches of their dignity and respect.

There was an adequate number of suitably trained and experienced staff on duty to meet the needs of the people who lived at the home.

Staff recruitment procedures and process were thorough, with all appropriate checks being made to make sure new employees were suitable to work with vulnerable people.

Staff were well trained and well supported. They told us that they appreciated the support, direction and leadership provided by the management team and their morale was good.

We could see that people were involved in decisions about their care. They told us that staff listened to them and acted on what they said. However, staff needed further training on gaining consent to care and did not always complete assessment in accordance with the Mental Capacity Act 2005 (MCA), Code of practice to ensure people receive the right support to assist them with their decision making.

People enjoyed a varied and nutritious diet, which catered for

The inspection was unannounced and took place on 29 June 2016.

Hazelmere House Nursing Home is owned and operated by Bupa Care homes (GL) Limited. It is a purpose built 56 bedded home set in a residential area of Wilmslow. The home provides a wide range of long and short term nursing and residential care for older people including 8 bedrooms set aside for intermediate care. Intermediate care is supported by a team of health care professionals employed by the local authority. They work closely with other health and social care providers offering assessment, treatment, rehabilitation and support for older people and adults with long term conditions at times of transition in their health and support needs.

All bedrooms in the home are en-suite and communal facilities include a large conservatory and bar area. There is wheelchair access and a secure keypad entrance. Car parking is available to the front and side of the building.

This service was last inspected in August 2015 where we rated the service as requiring improvement. We found that the provider was not meeting all the regulations in relation to safe care and treatment, safeguarding people, staffing, consent, person centred care, handling of complaints and assessing and monitoring the quality of care.

We judged that most areas had a minor impact on people, but some had a more significant impact. We served two warning notices and six requirement notices and we asked the provider to take action. Following our inspection in August 2015, the provider sent us an improvement plan and told us that all the necessary improvements would be made by 31 December 2015. During this inspection we saw that improvements had been made within the service in relation to people’s safety, staffing, staff support, person centred care, dealing with complaints and reporting safeguarding concerns. However there remained concerns in relation to following the principles of the Mental Capacity Act, keeping accurate, complete records and quality assurance. You can see what action we told the provider to take at the back of the full version of the report.

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. At the time of our inspection there were 49 people living in the home.

We found that the manager and clinical services manager had started to implement many changes and staff and people living in the home and their relatives felt that there had been a significant improvement in the standards in the home since they had been in post; however there remained some areas for improvement.

We saw that the service was now following safeguarding procedures and accurately recording and reporting where issues had arisen. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns.

We found that there were sufficient staff deployed to meet the needs of the people living in the home. The home was using a high level of agency staff to maintain staffing levels and there were occasional times when the identified number of staff were not on duty. The manager was proactively managing this on a daily basis to improve the situation.

We looked at staff recruitment files to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

The provider had their own induction training programme which was designed to ensure that any new staff members had the skills they needed to do their jobs effectively and competently. This resulted in staff having the skills and knowledge to carry out their jobs well and provide safe and effective care.

During the inspection we met the Clinical Services Manager, two nurses and three carers. We met and spoke with eight people who lived at the home and four relatives/ family groups.

One person who used the service said the staff: "Are gentle and kind and make sure that I’m safe." Another person said:"Staff sometimes ask me if I’m alright and do I need anything, asking if the care that I have is what I want, which it is." Another person said: "It's not home, but it is the next best thing and I feel safe here, the staff are very gentle and kind." However another person said they felt like: "A product, rather than a person," and their view was: "The place stinks," when reflecting on their opinion of the service.

We found through our observations and the comments received that people's views were not always gained prior to staff providing support and that their dignity was not always maintained. We observed that people's privacy was maintained.

We reviewed three care plans and found that two of the three care plans were incomplete. We saw that the planned communal activities for the week were available for people to read on the notice boards and that a new activities co-ordinator had been recruited.

We reviewed five staff records and the information in these files confirmed that appropriate recruitment checks had been carried out.

We found that when staff were in receipt of training and not available to provide care appropriate staffing levels were not in place.

We spoke with six people who lived at the home who said they were happy with the care and support provided. They told us that staff respected their rights, their privacy and their dignity. Comments included: "they look after me well” and “it’s very good here.” People told us that staff attended to them if they used their call bell, but there were times when they had to wait for support. They said they had choice and were involved in the daily activities if they wished to be.

We spoke with three family members who regularly visit the service. Both family members said that they considered the care to be good. Comments included:”Its very good care” and “staff are very helpful.”

We also looked at a sample of care records. These contained information regarding the needs and wishes of individuals and the care that they had agreed with the service. We noted that some records required updating and discussed this with the manager at the time of the visit.

We looked at the homes complaints procedures and saw that there was a policy in place to capture concerns and documented timescales for complaints to be investigated and responses given.

We looked at the infection control measures within the home and found that the home was clean with systems in place to ensure this was maintained.

During our visit we also looked at the numbers and skills of staff employed. We found that there were times when the staff were very busy but people's needs were met.

When we visited Hazelmere House Nursing Home we spoke with ten of the people who lived there and three of their visiting relatives and friends. All without exception made positive comments about the standards of care and accommodation. Several people described the home and the standard of care provided as excellent.

Some of the people we spoke with were able to discuss the way their care was provided. We asked them about their experiences of how the service involved them and kept them informed. They told us that they were treated with respect and were involved in making decisions about their care and support. They told us that they knew about their care plans and were happy with arrangements made for their care and support.

One person who spoke with us at some length told us that they believed that they “could not be in a better place” to live. When asked to sum up their comments overall they said “excellent accommodation, excellent staff, excellent standards of care, very clean and the manager always listens, her door is always open”.

Another person who told us that the home and standard of care as “excellent” said they had decided to move in permanently after giving it a try for one month. They told us that they had been very impressed with the way staff had responded to their needs and treated them with respect.

Comments about the adequacy of staff numbers varied but most people told us that there was always enough staff on duty to meet their needs. One person said “I have been very happy here, the staff are great, very skilled and overall the place is excellent”.

During our visit to the home we spoke with people to gain their perceptions of the home and services provided. They told us they are looked after well, are treated properly and with respect and are able to do the things they want to do. For example, one person told us they could get up and go to bed whenever they wished. All gave examples of the things they did during the day including reading, watching television, socialising with other people living in the home, having visitors and taking part in activities organised by the activity coordinator such as dominoes, board games, baking, playing cards and going out in the local community. People said they had been provided with details about the home, staffing levels and the services provided before admission.

People told us staff were very nice, kind and helpful.

The people we spoke to about living at the home said they were happy living there. They all said staff looked after them well and wherever possible allowed them to live a life of their choice. People said the daily life and activity was good and staff assisted them to maximise their independence.

All the people we spoke to who live at the home said they feel safe living there and nothing worried them.

We asked a relative of a person who lives in the home whether they thought they were safe and they replied “oh yes”. They further said that care workers were “respectful” and they had never heard anyone raise their voice to a resident.

This inspection took place on the 17 and 23 July and 10 August 2015. The inspection was unannounced.

Hazelmere House Nursing Home House is owned and operated by Bupa Care Homes (GL) Limited. It is a purpose built 56 bedded home set in a residential area of Wilmslow. The home provides a wide range of long and short term nursing and residential care for older people including 8 bedrooms set aside for intermediate care. Intermediate care is supported by a team of health care professionals employed by the local health authority. They work closely with other health and social care providers offering assessment, treatment, rehabilitation and support for older people and adults with long term conditions at times of transition in their health and support needs.

All bedrooms in the home are en-suite and communal facilities include a large conservatory, bar area, wheelchair and full lift access and a secure keypad entrance. Car parking is available to the front and side of the building.

Our last inspection of Hazelmere House Nursing Home House took place in May 2014 when we found that the registered provider was not meeting all the standards of a service of this type. Nurse call bells were not always responded to promptly and care and treatment was not always planned, recorded and delivered in a way that would ensure each person's health and welfare. We judged that these failings had minor impact on people who used the service, and we told the provider to take action. Following our inspection in May 2014 the provider sent us an improvement plan and told us that all necessary improvements would be made by 15 August 2014. On this inspection we found that improvements made subsequent to our last inspection had not been sustained.

At the time of the inspection the home did not have 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 registered manager left the home in April 2014.

Whilst we found that people were provided with care that was kind and compassionate, the home was not being managed effectively. A new manager had been appointed and was in the process of applying to the commission to become registered but withdrew their application and stepped down shortly after the second day of our inspection.

We found that concerns and complaints raised by the people who lived at the home had not been responded to effectively and managers were not learning from past events, or taking effective corrective action to improve the service.

Although some people told us they felt safe, we found that managers and staff had not always taken effective action to protect vulnerable people from abuse and neglect.

Absenteeism amongst staff was not being managed effectively. There were times when there were not sufficient staff to provide a safe service to the people who lived in the home.

We identified breaches of the relevant regulations in respect of person-centred care, need for consent, safe care and treatment, safeguarding service users, good governance, and staffing. You can see what action we told the provider to take at the back of the full version of the report.

Senior managers took action during the course of the inspection to address the shortfalls which we identified. The peripatetic manager who had been supporting the previous manager was appointed as acting manager of the home and initiatives were put in place to address long standing staff management issues. The provider must ensure that these improvements are sustained.