Hazelwell Lodge is a residential care home for up to 35 people. The home specialises in the care of people living with dementia. At the time of the inspection there were 32 people at the home.

At the last inspection in October 2015, the service was rated Good.

At this inspection we found the service remained Good.

This inspection was bought forward due to a high number of safeguarding notifications received from the provider. We therefore wanted to check people were safe and comfortable at the home.

People at the home were living with dementia and some were unable to fully express their views or wishes verbally. During the inspection people looked relaxed and comfortable in their environment. There was good engagement between staff and people and all incidences of people becoming upset or unsettled were responded to promptly.

Staff were able to recognise the signs of abuse and knew how to report concerns. The registered manager and provider worked in partnership with other agencies to make sure all concerns were fully investigated and action was taken to keep people safe.

People had care plans which outlined their abilities and the things they required support with. Care plans relating to people’s behaviour which may impact on other people were clear and staff were following the guidelines in these. We found that some improvements could be made to make sure care plans supported staff to be pro- active in monitoring and recording people’s physical healthcare needs.

Staff were well trained in meeting people’s specialist dementia care needs. The registered manager was experienced and knowledgeable about current practice for people living with dementia. They provided on-going formal and informal training for staff to make sure people benefitted from their knowledge.

People were cared for by staff who were kind and patient. Staff knew people well and used different approaches with different people according to their personalities and likes. There was a warm and happy atmosphere with lots of laughter and good humoured banter. One person told us, “Staff are very patient, they help you and never find fault.” A visiting relative said they found all the staff to be “Helpful and kind.”

People received care that was responsive to their changing needs and took account of their individuality. People were encouraged to maintain their independence where possible and make choices about their day to day lives. One person said “They don’t do everything for you. I can still do lots of things even if I am nearly 100.” The staff sought advice from healthcare professionals if they had concerns about a person’s well-being.

The registered manager and provider continually monitored the quality of care, the building and equipment to make sure the service remained safe and comfortable for people, staff and visitors. Where shortfalls in the service were identified, action was taken to make sure improvements were made.

This inspection was unannounced and took place on 13 October 2015.

Hazelwell Lodge is registered to provide care and support to up to 35 people. The home specialises in the care of people living with dementia. It is divided into two areas. One area is called The Bay and the other is named The Lillies. The Lillies is part of the Somerset County Council Specialist Residential Care (SRC) provision which means it is supported by a mental health link nurse from the local community health trust.

The last inspection of the home was carried out in August 2014. No concerns were identified with the care being provided to people at that inspection.

There is 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 were supported by a registered manager and staff team who were passionate about their work and committed to providing a high standard of care. The registered manager and provider had a clear philosophy for the home and aimed to constantly up date and improve the service.

Staff were well trained and supported to meet people’s specialist needs. Practice was continually monitored by the registered manager and senior staff. This led to a well-motivated staff team, who had the skills and knowledge to provide effective care and support to people. This resulted in a very happy and relaxed atmosphere for people.

Staff worked with other local organisations to make sure people had access to community facilities. There was a good programme of activities within the home to ensure people were socially stimulated and occupied. Staff encouraged people to take risks in line with ordinary life. This was to ensure they continued to be able to take part in activities and maintain their independence as far as possible.

People were able to make choices about their day to lives. Staff had a good knowledge of people and used this knowledge to assist people to make decisions if they lacked the mental capacity to make specific decisions for themselves.

People felt safe at the home and with the staff who supported them. People were very relaxed with staff. Staff were kind and caring and people felt comfortable and at home. One person told us “Mostly I don’t know what I’m doing but they don’t mind. I’m at home it doesn’t matter.” People who were unable to fully express their views verbally were very relaxed. They interacted with each other and staff happily. They chatted, smiled and laughed.

People had their needs assessed and care was planned in accordance with people’s needs and wishes. People, or their representatives, were involved in decisions about how their care was provided. Staff monitored people’s mental and physical health and ensured they received treatment from healthcare professionals according to their individual needs.

People’s nutritional needs were assessed and meals were provided in line with people’s needs and preferences. Snacks were available in communal areas to enable people to help themselves if they wished. One person said “I eat when I’m hungry of course. There’s always food.” Another person said “All the food is good.”

The staff responded to changes in people’s needs and adjusted care accordingly. Care plans were up dated to make sure they reflected people’s up to date needs. Staff also adjusted the support they provided on a daily basis to account for people’s fluctuating abilities and moods.

The registered manager was very visible in the home and available to listen to people’s concerns or suggestions. People, who were able to, said they would be comfortable to make a complaint. One person said “They make you feel comfortable. There’s always someone to talk to.” A visitor said “I would certainly complain if I needed to. I have every confidence anything would be sorted out.”

Our inspection set out to answer five questions: is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. It is based on our observations during the inspection, discussions with people living at the home, and with the staff supporting them, and on looking at records.

Is the service safe?

People told us they felt safe. We saw that staff treated people with respect. Safeguarding procedures were in place, and staff knew how to recognise abuse. Arrangements were in place to make sure that the registered manager and staff learnt from incidents and investigations. Safeguarding incidents were reported to the appropriate authorities.

Medicines administration needed to be improved, but the registered manager was clear about what needed to be done, and had communicated that to staff.

People who lived in the home were only deprived of their liberty when this had been authorised by a Supervisory Body under the Deprivation of Liberty Safeguards. This meant that the provider only restricted people’s liberty if they needed to be kept safe and did not have capacity to make decisions.

There were enough staff on duty to keep people safe.

Food was prepared and served following recognised safety procedures.

Is the service effective?

The service provided care in line with people’s individual needs. This was recorded in care plans. The service specialised in caring for people with dementia, and all staff were trained in this aspect of care.

The philosophy of the home was one that encouraged a relaxed atmosphere for people with dementia. It took account of recent developments and guidance in dementia and end of life care.

The quality of care was monitored to make sure that it was effective. Where shortcomings were identified, measures were put in place so that improvements could be made.

Is the service caring?

People were supported by caring staff. A relative told us, ““I can’t sing their praises enough.” We saw staff speaking to people in a kind and considerate way. One person told us, “I consider I’m very lucky to be here.”

Staff were trained to understand people’s needs. One staff member told us, “I really enjoy working here. The atmosphere is different; there is team cohesion. Everyone works well together”.

People’s wishes were recorded in care plans, and support was provided in accordance with them.

Is the service responsive?

We saw that staff listened to what people wanted, and gave them time to make their wishes known. Several staff told us about the importance of giving people choice, one saying, “You never make assumptions (about what people want).”

The service responded to people’s changing needs. When people were unwell or they needed specialist assessment, the provider asked community professionals to undertake assessments.

Nutritious food was always available, and the service responded as people’s dietary needs changed. For example, high quality fruit smoothies were available to supplement regular meals.

There were relatives’ meetings that were introduced after people asked for them, showing that the service listened and made changes.

Is the service well-led?

The service had a system of regular quality assurance that monitored care and showed where it could be improved.

The registered manager was experienced in dementia care and had introduced a number of initiatives to improve people’s experience of care.

Staff understood their roles and responsibilities. There were clear lines of accountability and staff knew what to do if they had concerns.

The home provided specialist care for people who had a dementia. Staff received excellent on-going training to make sure they had the skills to effectively support the people who lived at the home. The building had been decorated to provide a dementia friendly environment.

People who lived at the home said that they were never made to do anything they did not wish to do. One person said “The girls do their best to please you. They help you with the things you ask them to but they don’t make you do anything.”

Everyone who lived at the home appeared comfortable and relaxed with the staff who supported them. People told us they felt well cared for and received the help that they needed. One person said “They care about me and help me with everything.”

People we spoke with said the home supported them if they were unwell and ensured they were seen by appropriate professionals. One person said “If you aren’t well they take you to the doctor or get them to come here. They stay with you and so it’s never frightening and you don’t have to remember what they say. The girls have become my memory and that really helps.”

There was a robust recruitment process which ensured that new staff had the relevant skills and were of good character.

There were systems in place to effectively monitor the quality of care and to identify and minimise risks to people.

Some of the people who lived at the home were unable to fully express their views because of their dementia. We therefore spent time talking with staff and observing care practices as well as talking to people who used the service.

People told us that they were able to make choices about their day to day lives. One person said “You can do what you like really; the staff aren’t strict about anything.” Another person told us “I have a routine that suits me fine and keeps me independent.”

People were happy with the care and support they received at Hazelwell Lodge. Comments included; “Staff are good and I am well cared for” and “Everything is brilliant.”

We saw people who were unable to express their views appeared relaxed and content. People appeared very comfortable and all were well dressed and clean which demonstrated that staff took time to assist people with their personal care needs.

People we spoke with were complimentary about the staff who supported them. Comments included; “The staff are lovely,” “Most staff go out of their way to please you and make sure you are happy” and “Staff are always helpful.”

No one we spoke with had any complaints about their care. People who were able to express an opinion said that they would be comfortable to speak with a member of staff if they were unhappy about the service they received. A visitor told us that in the past they had raised a minor issue and were happy with the action that was taken.

Many of the people living at Hazelwell Lodge are unable to fully express their views verbally. On the day of the visit people appeared relaxed and comfortable with the staff who supported them.

People are able to make choices about their day to day lives and have unrestricted access to their personal rooms and the communal areas in their part of the home. Everyone has access to a large garden. One person said “You can do what you like, just please yourself really.” Another person said “No one forces you to do anything.”

Everyone asked said that they were happy with the care and support which they received. Comments included “They are always ready to help you,” “I’m well looked after,” and “I think it’s as good as anywhere could be.”

People said that the food in the home was good and they were always offered choices. One person said “The food is very good, they always ask what you like,” another person said “Food is good and there’s always a choice.” Everyone agreed that they always had plenty to eat and drink.

People living at the home said that there was always enough staff to support them. One person said “There’s always someone around, always ready to help you.”

People gave positive feedback about the staff who supported them. Comments included; “Can’t fault the staff,” “Staff are very helpful,” “Staff are very obliging” and “Staff are very kind.”

People asked said that they would tell a member of staff if they were not happy with any part of their care. One person said “Staff would help if I wasn’t happy.” A relative said if they had any complaints they would speak to the manager and “She would put it right.”