About the service: Hesslewood house is a care home providing care and support to people living in three separate areas; 'Oak' provides nursing care, 'Beech' provides personal care for adults and older people, some of whom may have a physical disability, learning disability or dementia related condition and 'Cherry' provides support to people living with dementia. At the time of inspection there were 53 people using the service.

People’s experience of using this service: People and their relatives told us the service was safe. Care plans contained appropriate assessments of risk to people and provided instructions to staff to reduce the likelihood of harm. Appropriate recruitment checks were conducted and there were enough staff on duty to support the needs of people and keep them safe.

People, relatives and staff all had concerns with the food provided at the service. An external catering company prepared and provided the food. The management team were aware of the issues relating to the food within the service and were working with the external company to improve this.

On the first day of inspection we identified areas of the environment that required refurbishment. On the second day of our visit, some of these areas had been re-decorated and the manager had implemented an action plan for the remainder of the work needed.

People and relatives were positive and spoke highly of staff. We observed staff were kind and caring and people were observed to be content and happy in staff presence. People told us they were encouraged to be as independent as possible and staff respected their privacy and dignity.

Care plans were developed with people and their relatives. Staff were encouraged to complete activities in communal areas of the service. A complaints procedure was in place in an accessible format.

People and their relatives spoke positively about the registered manager. Staff told us the registered manager was supportive and approachable. Systems were in place to monitor the service to ensure the service was consistently monitored and quality assurance was in place but not effective.

Rating at last inspection: Requires Improvement (Report published 22 February 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection. We brought the inspection forward due to information we received of risk.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Hesslewood House 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 service is registered to provide accommodation and care for up to 66 people.

The service is divided into three areas; ‘Oak’ provides nursing care, ‘Beech’ provides personal care for adults and older people, some of whom may have a physical disability, learning disability or dementia related condition and ‘Cherry’ provides support to people living with dementia.

The inspection was unannounced and took place over two days on 28 November and 7 December 2017. At the previous inspection in September 2015 the service was rated Good. On the first day of this inspection there were 61 people using the service.

The provider is required to have a registered manager as a condition of their registration and there was a registered manager in post. They had been registered since June 2017. 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.

Most people and relatives we spoke with told us they felt safe living at the service. Care workers received training on safeguarding vulnerable adults and knew how to raise any concerns. Risk assessments were in place and regularly reviewed. Accidents and incidents were recorded and analysed by the registered manager. Systems were in place for the ordering, storage and administration of medicines.

Care workers were recruited following robust recruitment procedures. There were mixed views about staffing levels at the service. We found there were sufficient care workers to meet people’s needs safely but have made a recommendation in our report that the provider reviews how staff are deployed in order to maximise people’s opportunities for social engagement and emotional well-being.

People were supported to make their own decisions and when they were not able to do so, decisions were made in their best interests. The provider had submitted appropriate Deprivation of Liberty Safeguards (DoLS) authorisation applications, however some improvement was required to the provider’s systems to ensure that staff were knowledgeable about any conditions of people’s DoLS authorisations.

Care workers received induction, training and supervision. The registered manager took action after our inspection to organise additional training in relation to epilepsy and diabetes.

People’s needs were assessed and there were care plans in place to guide care workers on how to support people. Some care files contained personalised information about people’s wishes and preferences. However, there was some inconsistency with this, and some care files lacked clarity about people’s healthcare needs. People had access to visiting healthcare professionals where required.

People had a choice of meals and received appropriate support with their nutrition and hydration needs. However, we received mixed feedback about the food available and some improvements were required to the consistency of people’s dining experience.

People told us that care workers were kind and caring and we observed positive, friendly interactions between people who used the service and care workers. Care workers ensured people’s privacy and dignity were upheld, and supported people to maintain their independence and skills where they were able to.

There were some activities available at the service but the social and leisure opportunities were limited, especially in the nursing area of the home.

There was a quality assurance system in place and the registered manager completed regular audits of practice at the ho

We visited Hesslewood House on 5 September 2013 as part of a scheduled annual inspection. The visit team included two experts by experience, a specialist professional advisor and a pharmacist. The two experts by experience joined the team to consider the needs of the different people who used the service. One expert by experience considered the needs of people residing on the ‘Young disabled unit’ whilst the second expert by experience spent time on the residential and nursing units.

Staff treated people who used the service with respect and only provided care and support to people with their consent. One person who used the service told us “Staff are very respectful and very kind. Everybody shows respect and they always knock on doors”.

People told us they were satisfied with their care. One person told us “The care is wonderful, couldn’t wish for better, day or night”. Care plans were detailed and person centred. All care plans were reviewed on a monthly basis as part of a ‘Resident of the day’ initiative.

Care workers and registered nurses supported people to take their medicines in a variety of different ways and at times that met the individual needs and preferences of people living in the home. One person told us “They’re very good here, they’ve always given me my medicines properly” whilst another said “I get my painkillers when I need them, and they always make sure I have my cream on”.

Staff were employed in sufficient numbers to ensure the needs of people who used the service were met. Additional staff had been employed to ensure consistency of staffing levels.

Quality assurance was undertaken in line with the provider’s quality assurance policies and procedures. Any learning identified following complaints or safeguarding incidents was recorded and shared appropriately to inform practice.

Records were accurate, fit for purpose and were stored securely.

We visited Hesslewood House to assess compliance with a warning notice we had issued at the last inspection on 18 December 2012. The warning notice was issued because the service had not complied with a compliance action in relation to outcome 9 Management of Medicines (regulation 13). The compliance action had been made at an inspection on 4 October 2012.

People that used the service were not consulted on this visit. We discussed with the manager and area manager action that had been taken to achieve compliance with the regulation. They told us new auditing and monitoring systems had been put into place and new documentation had been introduced to record these audits. They told us staff had received up-dated medication administration training and their practices had improved.

We looked at the systems that had been implemented, saw evidence the staff had been re-trained and completed a check on medication storage, administration, recording and disposal. We found that the management of medicines had improved and the regulation had been met.

This visit was undertaken as a responsive follow up to an earlier visit where it had been identified that improvements were needed in the areas of staffing, quality assurance and the management of medicines. The purpose of this inspection was to ensure that these improvements had been made.

People who used the service who we spoke with told us that they were happy with the support they received. We observed staff interaction with people who used the service on the residential unit and saw that staff had a good knowledge of people who used the service and treated people with respect. One person we spoke with who resided at the service told us "I love it here" and "If I get a bit upset about something there is always somebody to talk to and staff are understanding"

We saw records that showed that more staff have been employed at the service. We also saw minutes from relatives meetings and saw that actions had been taken following quality assurance audits.

The relatives of people who used the service who we spoke with told us that they were satisfied with the care and support their relatives received. One person told us "Staff have not taken away reality" and "Staff are keeping my mum's dignity". One visitor told us that the door entry system sometimes caused visitors to have to wait to access and exit the building and that staff had to leave what they were doing in order to answer the door.

People and relatives who spoke with us knew who the staff were and had a good relationship with them. People told us that the staff encouraged them to be independent but were available for support when needed. One person told us “Staff always explain when they are going to carry out personal care, and what they are going to do.”

We found that staff levels were not always sufficient to meet the care needs of people who used the service. We have raised concerns in this report about poor staff practices with regard to medication. We have commented on how staff were not learning from events/investigations in that proactive measures to ensure people got their medication safely and on time were not in place.

Hesslewood House is registered to provide accommodation and nursing or personal care for up to 86 people. The service has three units for young adults and older people, some of whom may have a physical disability, learning disability or dementia related condition. The three units are Oak tree, Cherry tree and Beech tree. On the first day of this inspection there was 65 people using the service.

The inspection was unannounced and took place over two days on 9 and 16 September 2015. At the previous inspection on 5 September 2013 the regulations we assessed were all being complied with.

The registered provider is required to have a registered manager in post and on the day of the inspection 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 told us that they felt safe living at the service. We found that staff had a good knowledge of how to keep people safe from harm and that there were enough staff to meet people’s needs. Staff had been employed following robust recruitment and selection processes. Medication was suitably managed.

People were supported to make their own decisions and when they were not able to do so, decisions were made in their best interests. If it was considered that people were being deprived of their liberty, the correct documentation was in place to confirm this had been authorised.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health professionals based in the community.

People’s nutritional needs had been assessed and they were happy with the meals provided at the service. We saw there was a choice available at each mealtime, and that people had been consulted about the choices available on the service’s menu.

People told us that staff were caring and this was supported by the visitors who we spoke with.

The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns.