Blakesley House Nursing Home

Blakesley House Nursing Home is a care home providing personal and nursing care to up to 22 older people, including those who are living with the experience of dementia. At the time of our inspection, 14 people were using the service.

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

People were not always protected from the risk of avoidable harm. Although risks to people's safety and wellbeing were identified, and measures were in place to minimise these, incidents such as falls and aggression had continued to happen.

Records were not always completed appropriately and in a timely manner. People did not always receive their medicines safely and as prescribed. Safety checks were undertaken regularly including fire safety and environment checks. However, we found some safety issues during our visit, such as unsecured cupboards and windows.

Although there seemed to be enough staff on duty to meet people’s needs, during mealtime, people being cared for in their rooms were not always supported promptly.

People’s health and nutritional needs were met.

The provider’s monitoring systems had not always been effective as the systems had not identified the shortfalls we found at this inspection.

The provision of activities had improved and we saw people were consulted and supported to undertake activities of their choice.

Feedback indicated people using the service were happy with the care they received. Relatives’ opinion of the service varied, with one being happy with the care and the other expressing negative feedback.

There were robust procedures for preventing and controlling infection, and the staff followed these.

There were procedures to help make sure staff employed were suitable and had the skills and knowledge they needed. These included recruitment checks, regular training and supervision. The staff told us they were happy working at the service.

The provider was suitably qualified and experienced. They worked with staff who had been at the service for a long time and who knew people well. There were appropriate systems for reviewing people's health and working with relevant health and social care professionals.

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 August 2021) and there was a breach of regulation 9 (Person-centred care). At this inspection we found improvements had been made in this area but the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 7 July 2021. One breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care and good governance.

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, 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 not changed. 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 Blakesley House Nursing Home on our website at www.cqc.org.uk.

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 have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

The provider had taken steps to prevent and control the spread of infection. They had reviewed and improved their procedures and practices to help protect people during the COVID-19 pandemic. There were suitable cleaning schedules and systems in place and we saw the home was clean and hygienic. The provider and senior staff carried out regular audits to make sure the environment was clean and safe.

The provider worked closely with healthcare professionals and the local authority to learn and develop best practice. Staff were well trained and understood their roles and responsibilities in keeping people safe from infection. Staff wore personal protective equipment (PPE) such as masks, gloves and aprons. However, we saw one staff member with their masks under their chin whilst they were supporting a person. We raised this with the provider who told us the care worker was employed to work on a one-to-one basis with the person. They explained that the nature of the activity being provided was verbal communication. English was not the first language of the person or the care worker, therefore the movement of the mask facilitated better verbal communication.

Following our feedback, the provider told us the person was no longer requiring one to one support, but in the future, they would explore the use of visors to help communication whilst keeping people safe.

The provider supported people to stay in touch with family and friends in a safe way. Visitors were required to take COVID-19 tests and wear PPE.

Blakesley House Nursing Home is a care home providing personal and nursing care to up to 22 older people, including those who are living with the experience of dementia. At the time of our inspection, 13 people were using the service.

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

People were not always supported to undertake activities of their choice and told us there was little to do. There was an activity plan displayed although this did not reflect the activities undertaken. The staff did not always engage with people to find out what they wanted to do.

The provider’s monitoring systems had improved since our last inspection although further improvements were required, as the systems had not identified the shortfalls we found in relation to the provision of activities for people who used the service. Stakeholders told us communication had improved and they were happy with the service overall.

People were protected from the risk of avoidable harm. The risks to people's safety and wellbeing had been identified, assessed or managed. Records were completed appropriately and the local authority was informed of accidents and incidents.

Feedback indicated people using the service were happy with the care they received. However, people who were being cared for in their rooms told us staff did not always have enough time to spend time with them. Relatives we spoke with told us people were well cared for and thought the staff were good but had mixed feelings about the provider.

People who used the service received their medicines safely and as prescribed. Safety checks were undertaken regularly including fire safety and environment checks.

There were robust procedures for preventing and controlling infection, and the staff followed these.

There were procedures to help make sure staff employed were suitable and had the skills and knowledge they needed. These included recruitment checks, regular training and supervision. The staff told us they were happy working at the service.

The provider was suitably qualified and experienced. They worked with staff who had been at the service for a long time and who knew people well. There were appropriate systems for reviewing people's health and working with relevant health and social care professionals.

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 December 2020) and there were multiple breaches of regulation. At this inspection we found improvements had been made in some areas but the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 3 December 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person-centred care and good governance.

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, 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 not changed. 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 Blakesley House Nursing Home on our website at www.cqc.org.uk.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified one breach in relation to person-centred care. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The provider did not always follow good infection prevention and control guidelines to protect people from the risk of harm. We issued urgent conditions telling the provider to make immediate improvements to keep people safe.

Further information is in the detailed findings below.

Blakesley House Nursing Home is a care home providing personal and nursing care to 22 older people, most of whom living with the experience of dementia. At the time of our inspection, 10 people were using the service.

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

The risks to people's safety and wellbeing had not always been identified, assessed or managed. Records were not always completed appropriately and the local authority was not always informed of accidents and incidents. This put people at risk of avoidable harm.

Quality surveys indicated people using the service were happy with the care they received. However, relatives we spoke with told us people did not always receive personalised care which reflected their preferences and met their needs.

People were being supported in their rooms and we saw no activities or stimulation were provided. Activity records were disorganised and out of date. The records of deceased people were mixed with current ones which showed a lack of respect.

Overall, medicines were managed well, and people received these safely and as prescribed. However we found one discrepancy during our visit, which the provider could not explain.

The provider had systems in place to monitor the quality of the service. However, these had not always been effective and had failed to identify the shortfalls we found during our inspection. Stakeholders told us communication was not always effective and could be improved.

We discussed these areas of concern with the provider. They agreed to look at how they could make improvements in these areas and sent us reviewed documents.

There were suitable procedures to help make sure staff were suitable and had the skills and knowledge they needed. These included recruitment checks, regular training and supervision. The staff told us they were happy working at the service although did not always feel valued and appreciated by the provider.

The provider had responded promptly where shortfalls in relation to infection prevention and control. We found during this inspection that there were suitable systems in place. The staff were aware of these and the systems had been reviewed and updated appropriately.

The provider was suitably qualified and experienced. They worked with staff who had been at the service for a long time and who knew people well. There were appropriate systems for reviewing people's health and working with relevant health and social care professionals.

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 7 August 2018). However, on 11 November, we carried out a targeted inspection of the service to look specifically at infection prevention and control (IPC). This was because we had been alerted to concerns. During the inspection, we found significant shortfalls and issued the provider with urgent conditions telling them to make immediate improvements.

Why we inspected

The inspection was prompted in part due to concerns we found during the IPC inspection. A decision was made for us to inspect and examine those risks, as we wanted to check if the provider had made the necessary improvements.

We inspected and found there was a concern with risk management, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, responsive and well-led.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, person-centred care and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Blakesley House 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.

Blakesley House Nursing Home provides accommodation and nursing care for up to 22. At the time of our inspection there were 11 people living at the home.

The provider is registered as an Individual and as such is not required to have 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. The provider runs and manages the service.

Not all the environment was suitable for people living at the service, particularly those living with dementia. The garden was bare and uninviting, not easily accessible and people were unable to use it appropriately.

The service was clean and had systems to protect people by the prevention and control of infection, however, liquid soap and hand gel were not topped up in the staff toilet and entrance hall so these would be readily available when needed.

There were systems and processes in place to protect people from the risk of harm. There were enough staff on duty to meet people’s needs.

Checks were carried out during the recruitment process to ensure only suitable staff were employed.

There were arrangements in place for the safe management of people’s medicines and regular checks were undertaken.

The provider was aware of their responsibilities and had acted in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People’s nutritional and healthcare needs had been assessed and were met.

People were supported by staff who were suitably trained, supervised and appraised.

Staff were caring and treated people with dignity and respect. Care plans addressed each person’s individual needs, including what was important to them, and how they wanted to be supported.

People were able to take part in a range of activities. They were cared for in a way that took account of their diversity, values and human rights.

People’s end of life wishes were discussed and recorded.

People living at the home, their relatives and stakeholders told us that the manager and senior team were approachable and supportive. People and their relatives were supported to raise concerns and make suggestions about where improvements could be made.

The provider had effective systems in place to monitor the quality of the service and ensure that areas for improvement were identified and addressed.

The manager kept themselves informed of developments within the social care sector and cascaded important information to the rest of the staff team.

Blakesley House Nursing Home is registered to provide accommodation for up to 22 people. At the time of our inspection, 12 people were living at the service. The provider is registered as an Individual and as such is not required to have a registered manager in place. The provider runs and manages the service.

A range of activities were organised and external entertainers visited twice a week to provide an activity program to people who used the service, however there was a lack of person centred activities for people who were living with the experience of dementia. We have made a recommendation around this person-centred activity provision.

The provider was aware of their responsibilities and had acted in accordance with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s capacity was assessed and they consented to their care and support.

Improvements had been made to the training of staff, and we saw that all staff had received training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

Improvements had been made in relation to the management of risk. The risks to people’s safety were identified and managed appropriately. The provider had processes in place for the recording and investigation of incidents and accidents.

The provider had put systems in place to ensure people lived in a safe environment. We saw a variety of health and safety checks were conducted on a regular basis by staff and external agencies.

Improvements had been made to fire safety, and we saw that the provider carried out regular fire checks and fire drills. All people using the service had personal emergency evacuation plans (PEEPs) in place.

Improvements had been made to the recruitment procedures and systems were in place to ensure that only suitable staff were appointed to work with people who used the service.

There were enough staff on duty to keep people safe and meet their needs, and there were contingency plans in place in the event of staff absence.

There were appropriate procedures in place for the safeguarding of vulnerable people and these were being followed.

There was a procedure for the recording, storing and administering people’s medicines and the staff were aware of this. Staff received regular training in the administration of medicines.

Staff treated people with kindness and dignity and took into account their human rights and diverse needs.

People’s nutritional and healthcare needs had been assessed and were being met.

Assessments were carried out before people were admitted to the service to ensure the service could provide appropriate care. Care plans were developed from the assessments and reviewed regularly.

There was a complaints procedure in place and people and their relatives knew how to make a complaint. They felt confident that their concerns would be addressed. People and their relatives were sent questionnaires to gain their feedback on the quality of the care provided.

There were regular staff meetings, and these were recorded. Staff told us that communication was good and they had regular handover meetings.

People, relatives and professionals we spoke with thought the home was well-led and the staff and senior team were approachable and worked well as a team. The staff told us they felt supported by the provider and there was a culture of openness and transparency within the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Systems were in place to make sure that staff reported events such as accidents and incidents, complaints and other concerns although there was little evidence to demonstrate these systems were always used effectively as there were no records of complaints or of action following accidents or other incidents.

There were procedures for managing emergencies. Staff had received appropriate training to their roles and were aware of relevant procedures and contacts to access help and support.

The home had proper policies and procedures to protect people who used the service from abuse and staff had suitable training. Staff were aware of the procedure to follow in the event of a safeguarding concern.

Recruitment practice was safe and thorough and ensured that suitable checks were in place with regard to qualifications, employment history, identity, health declarations and criminal records. There was suitable induction training for new staff.to ensure that staff carried out their duties safely.

Is the service effective?

People using the service experienced care that was planned and scheduled to meet their needs and reduce any risks. People using the service and their relatives were involved in the development of their care plans. A statement of agreement was signed by people using the service or their representatives to indicate agreement to the care they received.

Daily records were maintained to ensure the care delivered reflected the care plan and allowed the provider to identify concerns or changes to people's needs enabling them to respond promptly.

Is the service caring?

People were supported by kind and attentive staff. We observed staff providing kind and empathetic support to people living in the home. Staff offered people choices and respected their rights to dignity and privacy. The provider took account of people's equality and diversity and this was reflected in people's care plans.

People using the service and their relatives completed an annual satisfaction survey. The latest report showed a good level of satisfaction with the care provided. People we spoke to were happy with the care and support they experienced. A family member of one resident told us, 'They're very good. I have no complaints.' Another person commented, 'I'm happy here, the staff are kind and I have information on how to make a complaint.'

Is the service responsive?

Care plans were reviewed on a monthly basis to ensure that the care provided reflected current needs. Observation of the care provided on the day of our visit showed that staff were aware of people's preferences and routines and could therefore support people effectively.

There was a program of activities and to help to keep people involved in the daily life of the home and interact with others. People were supported to attend outside visits and appointments although there were no organised outings for people living at the home.

People knew how to make a complaint if they were unhappy although there was no evidence of recorded complaints.

Is the service well-led?

The provider had a variety of systems to monitor the quality of service provided and audit their performance. People using the service and their relatives had regular opportunities to provide feedback on their care and express their views. There were appropriate procedures for dealing with complaints and reporting accidents and incidents.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. Where people were not able to make decisions about their care the provider carried out assessments and involved people's relatives and other professionals.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Care plans and risk assessments were completed but people did tell us that they sometimes had to wait for support. One person said 'the staff do their best but they are very busy.'

People were supported to be able to eat and drink sufficient amounts to meet their needs but the food was not always enjoyed by some people. One person said 'the food is a bit boring but it's alright.' Another person said 'I enjoy the food, it's the highlight of the day.'

Appropriate arrangements were in place to make sure people received the medicines they needed.

There were enough qualified, skilled and experienced staff to meet people's needs.

Most people's personal records, including medical records, were accurate and fit for purpose. Health care records for one person were not adequately maintained and this was discussed with the deputy manager and staff during the inspection.