Blossoms Care Home Limited

Blossoms Care Home Limited is registered to provide accommodation and personal care for up to 22 people. At the time of the inspection, the service was occupied by 20 people who were living with a range of health and support needs. These included diabetes, epilepsy and dementia.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

People’s experience of using this service and what we found

Right Support:

Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

People were positive in their feedback. Comments included, “They are very knowledgeable and very kind to me” and “We are happy here and safe.”

The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their needs.

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

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care:

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. A relative said, “They are always very caring and go above and beyond to make resident's families feel welcome. They make the residents feel very special and do lots of activities with them.”

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

People’s care, treatment and support plans reflected their range of needs, and this promoted their wellbeing and enjoyment of life. A relative said, “The staff are extremely caring and friendly and I cannot thank them enough for all that they do.”

Right Culture:

People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes.

Staff turnover was very low, which supported people to receive consistent care from staff who knew them well.

The service enabled people and those important to them to worked with staff to develop the service. Staff valued and acted upon people’s views.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published on 13 May 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Blossoms Care Home Limited is registered to provide accommodation and personal care for up to 22 people. At the time of the inspection, the service was occupied by 20 people who were living with a range of health and support needs. These included; diabetes, epilepsy and dementia.

People’s experience of using this service and what we found

People and relative’s views about the service were positive. One person said, “Oh yes, they look after us so well. They are good.” And A relative said, “Staff are very caring, very loving and they really do care for people. The manager is brilliant. She is wonderful. It is a wonderful home, that is all really.”

People were safe at Blossoms Care Home Limited. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. The registered manager followed safe recruitment practices.

People were involved in the running of the service and were consulted on key issues that may affect them

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

There was positive leadership in the service. The service was well led by the registered manager who led by example and had embedded an open and honest culture. Effective governance systems to monitor performance continued to be operation in the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 22 July 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Visitors were asked about their Lateral Flow Test (LFT) result to ensure they were negative before staff facilitated the visit and temperatures were taken. Visitors were also advised to sanitise their hands-on arrival and wear face masks. Appropriate updated visiting policy and procedure was in place.

Arrangements were in place for visitors to meet in a safe area within and outside the service which minimised the risk of infection spread. The registered manager had opened up the home for visiting based on latest government guidance.

Plans were in place to isolate people with COVID-19 to minimise transmission if required. The service had good supplies of personal protective equipment (PPE) such as masks and hand sanitisers that were readily available at stations throughout the service.

Staff had received training on how to keep people safe during the COVID-19 pandemic and staff and were regularly tested for COVID-19 through both the LFT and polymerase chain reaction (PCR) tests. The building was clean and free from clutter and there were enhanced cleaning practices.

People’s experience of using this service and what we found

People were positive in their feedback. One person said, “Staff are wonderful and caring.” Relatives also said, “From the first phone call to Blossoms prior to mum moving in, I have had 100% confidence that it was the right choice for mum. The staff are all amazing and within days of mum arriving many of them knew her likes and dislikes.” A healthcare professional also said, “I can confirm in my experience that the residents receive safe care from Blossoms residential home”.

Our observation showed people were safe at Blossoms Care Home. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. The new registered manager followed safe recruitment practices.

People received the support they needed to stay healthy and to access healthcare services. Each person had an up to date care plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

Medicines were stored and managed safely by staff. There were policies and procedures in place for the safe administration of medicines, which staff followed. Staff training records confirmed staff had been trained in medicine administration.

People had received care from staff who were well supported with induction and training. Staff received one to one supervision and annual appraisals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We saw that people participated in activities, pursued their interests and maintained relationships with people that mattered to them.

The service was well-led. Effective quality audits were in place and continuous improvement and learning had been embedded in the service. We observed that the new registered manager was proactive in ensuring people received good care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 February 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We carried out an unannounced focused inspection of this service on 14 January 2020, 16 January 2020 and 22 January 2020. Breaches of legal requirements were found. After the last inspection, the provider completed an action plan as required to show what they would do and by when to improve safe care and treatment, staffing, premises and equipment, receiving and acting on complaints, person centred care, duty of candour and good governance.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Blossoms Care Home Limited on our website at www.cqc.org.uk.

Follow up

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

Blossoms Care Home Limited is registered to provide accommodation and personal care for up to 22 people. At the time of the inspection, the service was full. People had a range of health and support needs. These included; diabetes, epilepsy and dementia.

People’s experience of using this service and what we found

Our observation showed people were not always safe at Blossoms Care Home. People were not always protected from risks from the environment. Carpets downstairs and upstairs in the communal areas remained tired in décor and grubby with some areas worn, torn and in need of repair.

Staff had not received regular supervision meetings and their annual appraisal of their work performance with the registered manager. Staff had not completed specialised training in diabetes. Staff had not received training in dementia and Mental Capacity Act 2005 (MCA).

Relatives and staff told us that people were not stimulated enough. Our observation showed there was limited activities for people in the service. People had not always participated in activities and pursued their interests.

The service continued not to be well led. Record keeping had not improved. Records had not been adequately maintained. Improvements had been made to systems in place to monitor the quality of the service. However, the audit was not robust enough and they had not always identified the concerns we found during this inspection.

The registered manager did not understand and acts on the duty of candour, which is their legal responsibility to be open and honest with people when something goes wrong.

Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. The provider followed safe recruitment practices.

People received the support they needed to stay healthy and to access healthcare services. Each person had an up to date care plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

Medicines were stored and managed safely by staff. There were policies and procedures in place for the safe administration of medicines, which staff followed. Staff training records confirmed staff had been trained in medicine administration and annual competency checks completed.

Staff understood the importance of promoting people’s choices and provided the support people required while promoting and maintaining independence. This enabled people to achieve positive outcomes and promoted a good quality of life.

People appeared well care for by staff. The staff were caring and knew people, their preferences, likes and dislikes well. We received good feedback from people, relatives and healthcare professionals about the care provided by staff.

We observed people’s rights, their dignity and privacy were respected. Staff supported people with their lunch at a gentle pace whilst engaging with them. People continued to be supported to maintain a balanced diet and staff monitored their nutritional health.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (Report published on 14 March 2019) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found some improvements had been made in some areas. However, we found continued breaches of Regulation 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. New breaches of Regulations 9, 16 and 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Blossoms Care Home Limited 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. Blossoms Care Home is a service that provides accommodation and personal care for up to 22 older people with dementia. At the time of the inspection, the service was fully occupied with 22 people who were living with a range of health and support needs. These included; diabetes, epilepsy and dementia. The service had a large communal lounge, dining room available on the ground floor; with armchairs and TVs for people.

At the last Care Quality Commission (CQC) inspection on 08 August 2016, the service was rated as Good. At this inspection, we found the service Requires Improvement.

The service has a registered manager. 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.

Risks to people’s care needs had not been appropriately managed. We identified issues with a lack of risk assessments for people living with diabetes and epilepsy. We will check this when we return.

People were not always supported to eat and drink enough to meet their needs. Choices were not always provided regarding food. People told us they were not always given a choice of food.

People told us they were not always involved in their care. There were limited activities located around the service for people to be engaged with. Not everyone was engaged in activities during our inspection. We made a recommendation about this.

Staff did not receive regular training and supervision to help them meet people's needs effectively.

The registered manager ensured the complaints procedure was made available if people wished to make a complaint. One person told us that they complained to the registered manager but nothing was done about it. This is an area for improvement.

Although systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service, these had not been rigorously followed. Records were not always accurate, complete and consistent.

People were not given the opportunity to provide feedback about how the service could be improved. Feedback provided by professionals were not acted upon.

Staff treated people with dignity and ensured people's privacy was maintained particularly when being supported with their personal care needs.

People received the support they needed to stay healthy and to access healthcare services.

The provider followed safe recruitment practice. There were appropriate numbers of trained staff to meet people’s needs and keep people safe.

Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for. There were systems in place to support staff and people to stay safe.

Medicines were managed safely and people received them as prescribed.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

We found three 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 this report.

There was a registered manager in post at the time of this inspection. 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.

This is the first comprehensive inspection of the service by the Care Quality Commission (CQC) since registration in February 2014.

People were happy with the care they received at the service. People were treated with respect and their dignity upheld. Staff asked people for their consent before providing them with care and support. People received the support they required in line with their preferences and wishes.

People received safe care and support. Staff understood the types of abuse and neglect which could happen to people and their responsibility to report any concerns to keep them safe. People had received their medicines safely as prescribed and staff supported them to keep their money safe. Staff assessed risks to people and had support plans in place to manage the risks to keep them as safe as possible. There were sufficient staff on duty to meet people’s needs.

Staff assessed people’s needs and their support plans showed the care and support they required. Staff met with people and their relatives regularly to discuss their support plan and identify any changes in people’s needs. The service also received input from healthcare professionals involved in people’s care. People received support in line with principles of the Mental Capacity Act 2005 (MCA) and the requirements of the Deprivation of Liberty Safeguards (DoLS).

People accessed the health and care services they needed. People received the support they required in the final years of life and told us staff kept them as comfortable as possible. People had a choice of fresh and nutritious food which they liked.

Staff felt comfortable speaking with the registered manager and felt able to suggest ways for improving the service. People, their relatives and staff found the registered manager approachable and open to ideas and feedback. The registered manager held meetings with people to get their views about the service and their feedback was used to develop the service. People understood the complaints procedure. The registered manager responded appropriately to complaints, in line with the service’s procedures.

The registered manager made regular checks on the quality of the service and made improvements when necessary. Staff felt supported in their role to provide care to people and received regular supervision. Staff attended regular training courses, and had the knowledge and skills to support people with their health needs. Health professionals told us the service communicated well with them to ensure people received the support that reflected their needs.