This unannounced inspection took place on 24 April 2018. At the last inspection we rated the Well-led section of the report as ‘Inadequate’. There were also regulatory breaches in safe care and treatment, staffing and good governance. At this inspection we found some improvements had been made, however some areas required further improvements. Following the last inspection in July 2017, the provider was asked to complete an action plan in September 2017, to show what they would do and by when to improve the key questions of safe, effective and well led to at least good. The home had been rated as requires improvement at the last two inspections. At this inspection we found the rating continues to be requires improvement; however there had been progress to some areas.

Hazelwood 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. The home is situated on an estate outside the town of Ilkeston. The accommodation is on one level and divided into three separate ‘wings’ which were colour coded for reference. Each ‘wing’ had a small kitchen area, lounge or dining area. There was also an open plan lounge off the main reception area which had access to the garden. The service was registered to provide accommodation for up to 30 people. At the time of our inspection 23 people were using the service.

Hazelwood has a registered manager; however they were currently off long term from the home. The provider had made acting arrangements with an acting manager to support the home.

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 did not always receive their medicines as prescribed. Some areas of the home were not managed to protect people from the risk of cross infection. There was not always sufficient staff to support people’s needs at different times of the day. Some risk assessments had not been completed to consider how to reduce the risks. However other risks had been completed and guidance provided and this was followed.

People felt able to have a choice of meal. However the meal experience could have been improved to encourage independence. . When care plans were completed they were not always consistent and included the person’s access details. Communication did not always ensure information was shared between staff to support people’s needs. Audits had not always been completed to highlight when changes were required to reflect improvements.

Staff knew how to protect people from abuse. Lessons had been learnt from events and measures taken to make improvements. When people required support with their wellbeing referrals had been made to a range of health care professionals. The home was friendly and welcoming and people could personalise their space.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People felt the staff were kind and caring and provided support when they needed it to maintain their independence. Their dignity was respected and staff considered people’s needs. There was a range of activities on offer to provide interest and stimulation to people. When complaints had been made they were addressed in line with the provider’s policy.

People’s views were considered and partnerships had been develop with arrange of partners to support wellbeing and ongoing health. The acting manager had completed notifications to reflect events or incidents. We saw the rating was displayed at the ho

This inspection visit was unannounced and took place on 2 May 2017. At our last inspection visit on 8 August 2016 we asked the provider to make improvements to the staffing numbers, medicines managements and the auditing and management of the home. The provider did not initially send us an action plan; however we did receive the plan ahead of the inspection which explained the actions they would take to make improvements. At this inspection, we found improvements had not been made. The service was registered to provide accommodation for up to 30 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 24 people were using the service.

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.

We saw that the previous rating was not displayed in line with our guidance. . The manager had not always sent us notifications relating to important events that occurred at the service. This meant we could not be sure appropriate action had been taken, in respect of these events to reduce future risks to people.

The service had not always completed assessments to reflect people’s capacity relating to specific decisions. We could not be assured that when people lacked capacity their needs had been considered in line with the guidance available. . People’s care plans did not always contain up to date information, so we could not be sure the care provided would be in line with the persons needs. .

Staff had not all received updated training and competency checks had not been completed to ensure training had been understood.

The provider had not completed audits to support the development of improvements or to consider peoples safety in relation to falls and management of medicines.

Risk assessments for individuals had not always been reviewed and assessments to ensure peoples ongoing safety. Staffing arrangements did not ensure people’s needs were met in a timely manner. Systems to reflect the levels of staffing had not been used to consider when additional staff maybe required.

People enjoyed the food and felt they had choices of the meals they received, however we could not be sure peoples specific dietary needs had been met. People told us they felt safe and that staff knew how to recognise signs of abuse and what they needed do to protect people from abuse. Health care professionals were involved in people’s on-going health needs and the staff knew how to make referrals to access additional support then required. People were able to engage in social activities.

Views from people and relatives had been sought and improvements which had been made were communicated through a notice board system. . People told us they were treated with kindness and compassion and their privacy was respected. The recruitment systems ensured that staff had the right skills, knowledge and experience and were suitable to work with people using the service. People knew how to raise any complaints or concerns and felt confident these would be dealt with in accordance with the provider’s complaints procedure.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection was unannounced and took place on 8 August 2016. The service was registered to provide accommodation for up to 30 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 26 people were using the service.

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.

The provider had determined the staffing levels, however these were not at a level to support people’s needs. Medicines were not managed safely and in accordance with good practice. Risk assessments had not always been completed or updated to consider the risks and provide appropriate guidance.

The home had not always completed regular audits to identify where improvements could be made and had not recognised if accidents or incidents reflected any trends or patterns. The manager had not always notified us of events as part of their regulation requirements. Staff told us they felt supported, however they had not received any supervision, which would enable them to identify areas for their development or support.

Staff understood what constituted abuse or poor practice. There were systems and processes in place to protect people from the risk of harm. Staff received training to meet the needs of people living in the home and this was regularly updated. Staff received training and support from experienced staff as part of their induction to working in the home.

People received food and drink that met their nutritional needs and when required they had been referred to healthcare professionals to maintain their health and wellbeing.

Staff were caring in their approach, and offered support with aspects of people’s needs. Staff we spoke with had a good understanding of people’s support needs, and understood the importance of maintaining people’s dignity and their privacy was respected.

People felt confident they could raise any concerns with the registered manager and that they would be addressed. There were processes in place for people to express their views and opinions about the home and we saw that their views and had been listen to and acted upon.

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

As part of our inspection we spoke with three people receiving care and four relatives, the manager and four care staff working at the service. We also examined care plans and other records. There were 26 people living at the home at the time of our visit.

A summary of what we found is set out below.

Is the service safe?

The care staff we spoke with were knowledgeable about the systems in place to protect people who received care from abuse or neglect.

The home had policies for the management of medicines and care staff were following these. We saw audits of medicines records and administration practices were carried out every two months. The service had arrangements in place to protect people against the unsafe management of medicines.

Care plans were in place which assessed people’s needs and identified how to protect people against the risk of care which was unsafe. Care staff were experienced and received training and supervision which ensured they were supported to carry out their role.

Is the service effective?

Peoples’ needs had been assessed. Care plans we reviewed contained an accurate assessment of peoples’ needs and included important information to ensure people were protected from the risk of receiving inappropriate care. People received sufficient food and drinks to protect them against the risk of malnutrition and dehydration.

Care staff told us the provider encouraged them to study for qualifications in health and social care to ensure they fully understood how to provide people with good quality care.

Is the service caring?

We spoke with someone who was visiting a friend. They said, “The carers really care about the people here.”

We observed care staff providing care and saw they were considerate, patient and encouraging. People had brought furniture and other personal belongings from their homes to personalise their rooms. Rooms were decorated according to people's personal taste.

Is the service responsive?

One person we spoke with told us they had been on a trip to the seaside earlier in the week. They said they had really enjoyed it despite it raining. They told us they had fish and chips.

A relative told us they had wanted to organise a birthday party. They said shortly after making the request care staff had made the necessary arrangements.

Another person using the service told us their relative had previously used the service for respite care. The person now required long term care and they had approached the home which did not have any places at the time. They said the manager had re-arranged things to accommodate them. They said their relative had been able to settle down quickly because they were familiar with the service and they were less anxious as a result. The also said their relative experienced pain and that the service had organised patches which had helped reduce the pain they experienced.

Is the service well-led?

Care staff we spoke with told us the manager’s priority was always the safety of people who used the service. They told us the manager dealt effectively with any issues which occurred.

A relative told us they had a concern which they raised with the manager. They told us the manager had taken their concern seriously and had done something about it.

The manager carried out regular audits of medicines. They also reviewed the quality of the premises involving people who lived in the home in suggestions for improvement. The manager reviewed incidents identifying the key learning points. These were discussed with staff at meetings to reduce the risk of a similar incident happening again.

Several people told us they were not sure if they had ever been asked for their consent to their care. On the two care records we looked at we saw there were no signatures to denote agreement to the care or any other form of verification of consent to their care. This meant there was the potential for a person using the service to have important decisions made about them without being fully informed.

People we spoke with told us they were satisfied with the care and support they received. One person told us “It’s lovely here” and another said “They look after me”. One person told us “The night staff are brilliant”. A relative described the care as fabulous. We saw that staff had warm relationships with people and one person told us “It’s comfortable here”. Most people using the service also told us they enjoyed their food and described the meals as good.

When people’s needs changed relevant specialists were called in and re-assessments of need were undertaken.

People we spoke with told us they were satisfied with the cleanliness of their rooms and thought the home was always hygienic. One person told us “It’s spotless”. Staff we spoke with were able to describe infection control procedures and said they used personal protective equipment such as gloves and aprons. They were clear about what to do to prevent infections spreading.

We saw there were sufficient staff on duty to meet people’s needs and there was a clear process for the management of complaints.

People told us they were satisfied with the service and relatives also confirmed that they had no worries about the care provided. They were very positive about the care that they received and highly praised the staff. One person using the service told us that the service was “very nice” and another said they “like living here” and that “staff are very good”. Another person said there was “nothing to grumble about” and a relative described the service as “fantastic”. One relative told us that the service was “like home” and another told us that they thought staff did “their best”.

People we spoke with stated the food was good and told us they enjoyed their meals. One person told us that the food was “excellent”.