This inspection took place on the 16 and 18 July 2018 and was unannounced.

This was the first inspection of Hazelmere Nursing Home following the change of provider to Inspiricare Ltd on 22 May 2017.

Hazelmere Nursing 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 home is registered to provide nursing and personal care and accommodation for up to 23 older. At the time of the inspection there were 19 people living there. People had different health care needs. Some people required support and guidance with personal care, while others needed continual nursing care due to frailty and medical conditions, including living with dementia.

The registered manager was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff had attended safeguarding training. However, staff failed to demonstrate a clear understanding of protecting people from harm and, the provider had not ensured that referrals were made to the local authority in line current guidelines. In addition, the provider had not informed CQC of incidents that had occurred within the home, which may have affected the support provided.

An effective quality and monitoring system was not in place, which meant the issues identified during the inspection had not been identified; or if they had been identified they had not been addressed. This included care plans, risk assessments, daily records and the management of medicines.

The provider had introduced an e-learning training programme that was accessible to staff and systems were in place to support staff to complete this, to ensure they were up to date with their practice. However, staff had not all completed the required training for their role. For example, not all nurses had completed the e-learning medication training even though there were concerns with their practice.

There were sufficient staff working in the home. Robust recruitment procedures ensured the staff were safe to work in care and, Supervision supported staff to be aware of their roles and responsibilities and people told us staff provided the care and support they needed.

Emergency procedures had been developed to support people if they had to leave the building and staff followed the provider’s infection control policies to protect people from infection. There was ongoing maintenance of the home and continued improvements to the environment, with regular checks to ensure the health and safety of people, visitors and staff.

Staff had an understanding of the Mental Capacity Act 2005 (MCA) and the need to support people who did not have capacity to make decisions. The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the MCA and DoLS and were aware of current guidance to ensure people were protected. DoLS applications had been requested when needed to ensure people were safe.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. Staff were aware that people had different communication needs, such as sensory loss, and were able to explain how they supported people to communicate. However, staff had not all completed