We carried out a review of the data available to us about Blackthorns on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Blackthorns, you can give feedback on this service.
Blackthorns is a residential care home providing personal care to up to 62 people. The service provides support to people with physical disabilities, sensory impairments and to people living with dementia. At the time of our inspection there were 44 people using the service.
The care home accommodates people across 6 different wings, with a range of different shared spaces and facilities. At the time of inspection, one wing was not in use, which was on a lower level. This meant everyone was living on the same floor.
People’s experience of using this service and what we found
Whilst agency staff were employed at the service, action had been taken to reduce the impact on continuity of care. Staffing levels and deployment were observed to be safe. Recruitment checks were carried out on staff to ensure they were appropriate for the role. Medicines were managed safely, and potential risks were assessed and mitigated. We were assured in most areas of infection prevention and control. Safeguarding measures were effective.
Staff received training, supervisions and appraisals. The service worked well with other agencies to ensure people had timely access to healthcare as required. Some improvements were in progress towards ensuring care planning was consistently detailed and person-centred, including for people new to the service. Meals were appetising and well presented.
Staff were caring, respectful and kind, and the management team lead by example to instil a positive and open culture. People were supported to maintain their independence and treated with dignity.
Referrals were promptly made to services such as the dietician, district nurses and the speech and language team [SALT]. People were supported to engage in leisure activities and positive 1 to 1 interaction, including those people cared for in bed. A complaints log was in place but could benefit from further development to show analysis of themes and trends to drive improvement. Support was provided to people at the end of their life.
There was a new registered manager in post since the last inspection, who was committed to continuous improvement of the service to make a difference in people’s lives. We have made a recommendation about developing a service improvement plan which sets out these aims and ambitions. Some oversight systems and processes needed refining and embedding to show longer term oversight. The service worked in partnership with other stakeholders.
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 (published 12 June 2019).
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.
People’s experience of using this service:
People were supported by a consistent team of staff who were kind and caring. Staff had good relationships with the people they supported, and people told us that they felt safe.
Risks to people’s wellbeing were assessed but were not always consistently managed. Lessons were not always learnt when things when wrong.
Accidents were logged and analysed to identify any emerging trends. However, the system for the oversight of incidents needed to improve to ensure that people were kept safe.
The service was not fully occupied and the staffing levels we observed on the day we visited were not an accurate reflection of people’s day to day experience as there were a number of additional management staff present on the days of the inspection. We found that staffing levels were satisfactory but we identified some issues with the deployment of staff and the impact of simultaneously having a number of newly appointed staff.
A number of new staff had been appointed and the service was no longer reliant on agency staff. People were positive about the responsiveness of staff.
Staff induction was not personalised and did not take in account new staff’s previous experience and competency. The provider’s representative agreed to ensure that this was reviewed. Staff received ongoing training to develop their knowledge.
Medicines were safely managed. There were clear systems in place for the ordering, administration and monitoring of people’s medicines.
People told us that they enjoyed the meals but the delivery was not well organised and did not ensure that people always had choice. Peoples weights were monitored but the management plan was not always consistently followed.
People had good access to healthcare where appropriate.
Care plans were not always up to date and did not provide staff with the information they needed to provide personalised care. End of life care was not well developed.
Complaints were investigated and responded to in a timely manner.
The provider had systems in place to audit the care provided but these checks had not prevented some of the shortfalls in the quality of service provision.
The registered manager told us that they were leaving the service and the provider had interim arrangements in place to provide management oversight.
Rating at last inspection: Good. We published our report in September 2017.
Why we inspected: This was a planned inspection based on the rating at the last inspection. Following our last inspection, the provider sent out an action plan setting out the actions that they intended to take to address the shortfalls that we found.
Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Blackthorns is a residential service providing accommodation and personal care for up to 62 older people. On the night of our visit there were 52 people living at the service.
A registered manager was in post and attended the service on the night of the 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.
Risks to individuals were identified and there were plans in place which set out how the risks should be managed. We looked specifically at the risks associated with falls and found that where necessary, equipment was put in place to reduce the likelihood of injury.
The manager had oversight of accidents and we saw that these were analysed to identify any contributing factors.
Staff were clear about the steps that they needed to take in the event of an emergency but it was agreed that the documentation would be strengthened to further safeguard people.
Staffing levels were adequate and there were sufficient staff available to meet people’s needs at night. The service was however dependent on agency staff and continues to recruit a permanent staff team. We saw that there were plans to reduce staffing in the early morning and it was agreed that this would be reviewed.
Blackthorns is a residential service providing accommodation and personal care for up to 62 older people. On the day of our visit there were 56 people living at the service.
A registered manager was in post and present on the day of the 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.
Staffing levels had improved since the last inspection and there were sufficient staff available to meet people’s needs. The service was however dependent on agency staff and continues to recruit a permanent staff team. There were systems in place to ensure that the newly recruited staff were vetted to ensure their suitability.
Medicines were well organised, appropriately stored and administered as prescribed.
Risks were identified and where necessary equipment was put in place to reduce the likelihood of injury. Health and safety audits were undertaken and checks made on equipment to check that they were working effectively.
Staff were trained and inducted into their role but did not always put their training into practice. People had good access to health care professionals when they needed support or treatment.
The registered manager and staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. People's best interests had been considered when decisions that affected them were made. Applications for DoLS authorisations had been submitted where restrictions were in place.
People enjoyed the meals and they looked nutritious and nicely presented. Greater oversight of people eating in their rooms would ensure that those at risk were identified promptly.
Relationships between people living in the service and staff were positive. Staff were caring and kind. There were activities in place which people enjoyed. Regular meetings were held with people who lived in the service and their relatives to ascertain their views and identify areas where the service could develop.
People were positive about the management of the service. The manager was assessable and encouraged a culture of openness. Audits were undertaken to identify shortfalls and action plans developed setting out how they intended to improve.
This inspection took place on the 14 December 2015 and was unannounced. Blackthorns is a residential service providing accommodation and personal care for up to 62 older people. On the day of our visit there were 57 people living at the service.
A new manager had recently been appointed and was present during the inspection but was not registered. 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.
There were not always sufficient numbers of staff available to meet people’s needs which meant that people did not always receive good care. Further work was needed to ensure people needs and preferences were met. Care plans were not always up to date and did not provide staff with sufficient guidance. This combined with a new staff team meant that individuals whose needs were more complex were at increased risk of poor care. Staff were generally caring but care delivery focused on the completion of tasks.
The new manager was working to raise morale and develop staff skills but this was at an early stage of development.
Staff received training, but there was a new staff team and the training did not always provide them with the knowledge and skills they needed to meet the needs of people living at the service. Medication administration practice did not always follow the recommended professional guidance.
There were effective procedures in place to ensure that references and other checks were undertaken and to reduce the risk of employing unsuitable staff.
The provider had systems in place to reduce the risk of people experiencing abuse and staff had been provided with guidance in reporting issues of concern.
Audits were undertaken by the manager and area manager but these were not always effective as they did not identify some of the key issues which we found at the inspection.
During this inspection we identified a number of 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.
We spoke with the registered manager and three staff. We spoke with nine people who used the service. We looked at records at the home. Below is a summary of what we found.
During our inspection we looked to see whether we could answer five key questions: is the service safe, effective, caring, responsive and well led?
Is the service safe?
The staff we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe how they effectively protected people from the risks of cross infection and maintained good clinical hygiene in the service.
Recruitment procedures were rigorous and thorough. Staff received the training they needed to ensure that people were cared for safely for example, moving and handling and safeguarding of vulnerable adults from abuse. Staff also received training on the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant that staff had been provided with the information they needed to recognise signs of abuse, risks to people's safety and how to report these concerns so that actions were taken to safeguard people.
Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to improve.
The service was clean and safe throughout.
Is the service effective?
During our previous inspection on 3 January 2014 we noted some shortfalls in the way people were supported with their mobility needs. We looked to see if improvements had been made. The service had updated all moving and handling plans in people's records to reflect their mobility needs including details of the aids they required and how many staff needed to support them to be safe.
People's health and care needs were assessed before they came to the home to determine their needs and make sure the service could meet them effectively. People's needs relating to their skin care, continence, daily living choices, mobility and risk of falls had been identified in care plans where required. We did discuss with the manager that the care plans were repetitive and inconsistent in some areas. They assured us that they would address this with staff immediately.
People's health and care needs had been assessed and care plans were in place. People were involved in their care plan reviews and signed their care plans where they were able to. Where people needed to make bigger decisions and they lacked the capacity to do so, mental capacity assessments and best interest decision meetings had taken place to. This meant that people's capacity to consent to their care had been assessed before people made decisions on their behalf and they were involved in the decisions about their care.
We saw arrangements were in place for care plans to be reviewed regularly to make sure information about people's care and support needs remained appropriate and accurate. We discussed with the manager that, because of the repetition of some records and updates in different areas of others, we were concerned that staff did not have the most up to date information they required to care for people safely. We followed our concerns up by speaking to staff, they were all aware of people's changing needs. The manager assured us that the inconsistency in the records would be addressed.
People had access to a range of health care professionals some of which visited the home.
Is the service caring?
We saw staff were attentive to people's needs throughout our inspection, they interacted positively with people and gave people time to respond. We found staff showed patience when communicating with people who lived in the home.
People we spoke with were positive about the care provided by staff. We asked one person if the staff were caring and they told us, "Very much." Another person told us about the staff, "They're fine." Someone else said staff were, "Very good."
Is the service responsive?
We saw people were able to access help and support from other health and social care professionals when necessary.
People were able to participate in a range of activities. During our inspection people were taking part in bingo in one of the dining rooms. People were engaged and interacted well with staff. We sat with people while they played bingo, they enjoyed the activity. There were colourful notices of upcoming activities and photos of activities people had participated in. People accessed a reminiscence area of the service and enjoyed this.
The service responded to people's needs. Throughout our inspection call bells were answered promptly and people walking around the service were often joined by a staff member to ensure they were happy and walked with them if they needed some guidance. One person who preferred to stay in their bedroom told us, "They check on me regularly."
Is the service well-led?
The service had a quality assurance system in place to identify areas of improvement. There were regular audits on medication, health and safety and infection control.
Records seen by us identified that the service was well maintained and all required servicing of equipment and other supplies was done regularly. As a result the quality of the service was continuously improving.
We found staff employed to work at the service had all the necessary skills to support the people who lived in the home. Staff told us that they felt well supported and received regular training.
One person told us that the manager was, "One of the best.' Another person told us about the manager, "She is a nice manager." The service held team meetings and residents meetings to include people in the running of the service. The manager told us that a satisfaction survey was planned for later this year to gain people's views in more detail.
We found a manager that was responsive to our questions and matters raised with them. The service needed to develop further their safe systems relating to moving and handling to ensure the safety of everyone. We examined the complaints systems in place and found that the manager responded in a timely way and learnt from matters brought to their attention.
A relative told us, 'I looked at many homes before choosing this one and I cannot find fault with it. The cleanliness is amazing.' They also told us, 'If I had any complaints I would be happy to speak with the manager. I think the manager would try to solve any problems I raised.'
We observed that staff were genuinely caring and respectful towards the people they were supporting. It was clear from our discussions with staff that they enjoyed their work and wanted to do their best for people.
People with whom we spoke were complimentary about the food served at the home. They added that the food was nice and they enjoyed their meals. The portions seen during a lunchtime meal were plentiful and seconds were offered. Tea, coffee and juice was offered to people throughout the day.
People were happy with the cleanliness of the home and decoration and it showed that some thought had been put into the surroundings. They provided a homely environment with furniture and fittings that many of the people living at Blackthorns may have had in their own homes. This was a talking point for many of the people living there.