The inspection was unannounced and took place on 10 October 2018. At the last inspection on 28 June 2017 we rated the service as 'requires improvement'.

Following the last inspection we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions asking if the service was safe, effective, responsive and well led to at least good. The registered provider sent us an action plan, detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of the Regulations.

Hazelroyd Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Accommodation is provided for up to 30 people, across three floors. At the time of the inspection, there were 27 people living in the home.

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.

People said they felt safe living at Hazelroyd Nursing Home and we found there were systems and processes in place for people's needs to be safely met. Staffing levels were supportive of people's individual care needs. People received their medicines on time and staff understood each person's abilities and health needs.

People were supported to have maximum control and choice over their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice and staff understood legislation around people's mental capacity.

Staff had a kind and caring approach and showed respect when interacting with people and good regard for people's privacy and dignity.

People enjoyed meaningful activities and there were appropriate opportunities to engage with the activities coordinator in groups or on a one to one basis. There were many resources to support people's activities and we made a recommendation the provider extends these to include resources such as audio books, for people with impaired vision.

Systems and processes for assessing and monitoring the quality of the provision, including identifying risk, were robustly implemented. Audits were thorough and there was clear evidence of management oversight of the service. People, relatives and staff spoke highly of the registered manager and the way the service was run.

This inspection was unannounced and took place on 28 July 2017. There were 30 people living in the home when we visited.

Hazelroyd Nursing Home provides residential and nursing care for up to 30 older people some of who may be living with dementia.

The last inspection was in August 2015. At that time we gave the service a rating of ‘Good’ but found breaches relating to consent and management of Deprivation of Liberty Safeguards (DoLS). We found improvements had been made in this area but recommend care files are updated to make sure people’s consent to sharing information with family is sought and clearly recorded.

Since the last inspection the registered manager retired and a new manager was appointed. The new manager was currently going through application to CQC to become the 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.

People who used the service told us they felt safe and staff knew how to recognise and report abuse.

Systems were in place to promote safety within the home. This included checks on the environment and review of accidents and incidents. However more work was needed on plans for supporting people in the event of an emergency.

Improvements were needed to make sure the home was clean and the risk of cross infection was minimised.

We recommended the provider addressed specific areas we had identified, and ensured their refurbishment programme was put into immediate action so that good infection control measures were in place.

People’s medicines were for the most part managed safely. However, procedures for use and storage of prescribed thickening agents needed to be improved. We made a recommendation in relation to this.

Risks to people’s personal safety were assessed and plans put in place to mitigate the risk.

People spoke very highly of the staff but we found there were not always enough staff available to meet people’s needs safely.

We found staff were being recruited safely. Staff received appropriate training and they told us the training was good. Staff told us they enjoyed working at the home, felt supported by the manager and received supervision and appraisals.

We heard staff asking people for consent and giving explanations before supporting them. We found the service had made improvements to make sure they were working in line with the requirements of the Mental Capacity Act 2005 and the requirements relating to Deprivation of Liberty Safeguards (DoLS). However staff needed to be sure about people’s consent to share information with families.

People told us they enjoyed the food and we saw people were offered a choice of food and drinks which took account of their likes, dislikes and nutritional needs. However, clearer actions needed to be recorded when people’s dietary intake was not sufficient to maintain their health.

We saw people were supported to maintain their health and had access to the full range of NHS services.

People told us staff treated them with dignity and respect and whilst we observed some good practice, we also observed some examples of where improvements were needed.

People told us their family and friends were made welcome in the home and were offered refreshments during their visits. We saw staff encouraged the involvement of people’s families and friends in the home.

Staff knew people well and we saw some good examples of care and consideration of people’s privacy and dignity. However we also noted some examples of where better practice was needed to make sure people were cared for in a way that met their privacy and dignity needs.

People were supported to take part in a variety of in house activities but there was little interaction for those who

We visited Hazelroyd on 27th August 2015.The inspection was unannounced.

Hazelroyd is a two storey building with provision to accommodate up to thirty older people. It is a care home without nursing which provides care for people living with dementia and physical disabilities over 65 years. On the day of inspection there were 28 people living there ‘including one person attending for respite.’

There was 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.

Safeguarding information and contact details were easy to access. Posters encouraged reporting of potential abuse and the details of who could be contacted were present on notice boards. The service had a safeguarding policy in place. Staff told us they had reported any concerns. Staff felt their concerns would be listened to and actioned. Staff received training on safeguarding and were able to tell us different types of abuse and the warning signs they looked for.

People’s care records and risk assessments were kept up to date and reflected people’s current needs. Identified risks were supported by measures to reduce or remove the risks. Staff told us about people’s care records and associated risks.

Rotas showed us a sufficient number of suitably trained staff were deployed to meet people’s needs and safeguard them from risks. People told us staff supported them and met their needs.

People’s medicines were administered in a safe way. People received their medicines in line with their prescription. People had their medicines administered by a member of staff. We found medication administration records were signed correctly. Medicines were stored appropriately in a cupboard. People had ‘as and when required’ (PRN) medicine. These medicines had a protocol sheet advising staff when these could be administered.

Some care plans contained detailed information which showed people’s needs had been thoroughly assessed to allow staff to deliver appropriate care. However this was not consistently applied and we found other care plans were missing key assessments and had not been updated following people’s changing needs.

We saw people were supported to maintain good health and had access to healthcare professionals. People had regular contact with doctors, opticians, dentists and district nurses. Another person received advice from a dietician.

We spent time observing care and support being given. Staff were seen to treat people with respect and dignity. Staff had developed relationships with people so they appeared comfortable, at ease and shared discussion and laughter with staff. We saw staff asked people what they wanted to do before they did it. If people refused their decision was respected.

We looked at the complaints procedure for the service. Complaints were recorded, analysed, responded to and learnt from. We saw one complaint had been followed through in line with the policy. Complaints, accident and incidents were monitored to look for trends. The service sent out an annual questionnaire to people and their relatives. Responses were looked at to improve the service and quality care.

We spoke with a staff member who told us they had confidence in the registered manager and believed any concerns would be listened to, recorded and actioned. People that used the service told us they liked the registered manager and felt issues would be looked into. The registered manager ensured a robust programme of quality assurance was in place. We saw quality audits were completed regularly. These audits fed information into a biweekly report sent to the provider’s office. This report identified trends and areas of improvement for the service.

The Care Quality Commission (CQC) monitors the operation of the DoLS (Deprivation of Liberty Safeguards) which applies to care homes.

Care records showed people’s capacity was not assessed under the Mental Capacity Act 2005 (MCA) which meant there was a risk their rights were not protected.

The service was not meeting the requirements of the Deprivation of Liberty Safeguards. (DoLS). We saw that no referrals had been made for people that had been deprived of their liberty.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of this report.

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.

We spoke with six people living in the home and five staff. These were some of the things they told us:

“The staff are very nice.”

“I get all of the help I need.”

“I think the food is very good.”

“I enjoy working here; we have a good staff team.”

We found that people’s care was being planned and delivered in the way they preferred. The medication system was being managed safely and people received their medication at the correct times.

There were enough staff on duty to meet people’s needs and all of the staff had a qualification in care.

There was a complaints procedure in place and people told us that they would feel able to raise any concerns.

During our visit we spoke with four people who use the service although, due to their complex care needs, some people were unable to comment directly on the care they recieved.

Two of the people we spoke with said that the care they received was good and that they liked the staff. One person said that they "couldn't wish for any better" and that staff help them "just as I need".

One person said that some staff are better than others but that they get the support they need.