Blossom Fields

Blossom Fields is a care home with nursing for up to 43 predominately older people. People have either general nursing care needs or are living with dementia. The service has three units over three floors with a 16-bedded dementia care unit being on the middle floor. At the time of this inspection there were 40 people in residence.

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

At the last inspection we found the service provided an outstanding model of care and support. Since the last inspection there had been a change of management with a new provider taking over the legal entity of Grove Care. The new provider was embedding their systems in respect of quality monitoring and staff training. We did not find the service was outstanding at this inspection. However, there was a commitment to provide care that was person centred where people were at the forefront.

Most people and their relatives spoke positively about the service they were receiving. They told us there was enough staff and staff were kind, caring and responsive to their needs. Two people raised concerns about the care they had recently received. The management team were proactive in addressing the concerns during the inspection with an apology given. In response staffing at night was increased to ensure there was two staff on each floor of the home.

People were kept safe because risks were assessed and mitigated. Medicines were managed safely. Safe recruitment was undertaken to ensure people were protected. Staff knew what to do if they were concerned about a person’s welfare including any allegations of abuse.

People were supported with meaningful activities based on their interests. There was a programme of activities that included people being supported in the local community, group and one to one activity along with external entertainers. The local church supported the home with monthly services. Relatives and visitors were welcomed to the home.

People received enough to eat and drink. People at risk of malnutrition were given the support to ensure they had a good level of nutritional intake. People had access to other health professionals and referrals to other agencies were made when needed. Feedback from professionals was positive about how the management and staff engaged with them and the people they supported.

Staff had received training suitable to their roles. This was being updated with staff completing the new provider’s online training. Effective infection control measures were in place.

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.

Blossom Fields provided a comfortable and a homely atmosphere for people. The home was clean and free from odour. Plans were in place to refurbish some areas of the home such as furniture in bedrooms.

People and relatives were involved with regular meetings being held with them. This was an opportunity to seek their views about the service along with their individual care reviews. The new provider had yet to send people, relatives, and staff a survey that they could use to make any necessary improvements.

There were systems in place to monitor the quality of the service and drive improvements. Staff described a team, that worked together to deliver care that was person centred. There was an open, transparent, and positive culture and people, their relatives, staff, and professionals told us the management team were approachable.

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 outstanding (published 3 January 2019). The rating at this inspection had changed to good.

Why we inspected

We undertook this comprehensive inspection due to the length of time since the last inspection.

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.

The overall rating for the service has changed from outstanding to good based on the findings of this inspection.

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

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.

The registered manager was shielding when we conducted the inspection and based as a homeworker. They constantly supported the home remotely and assisted with the inspection by sending relevant records we required. A newly appointed deputy was in post and the provider had acted promptly to ensure an increased, safe management team and oversight. One deputy manager (a nurse) and a clinical lead nurse were redeployed to Blossom Fields from one of the providers sister homes. Both nurses had previous experience in managing a Covid outbreak and their contribution was greatly appreciated and welcomed by the deputy and permanent staff.

People’s wellbeing both emotionally and physically was paramount during the Covid outbreak. Staff understood the anxieties the outbreak would cause to both the people they cared for and their loved ones. The atmosphere was respectful, peaceful and compassionate tinged with great sadness. Since the outbreak the deputy contacted relatives whose loved ones had tested positive to Covid 19 every day. This updated them on the health and wellbeing of their loved one, which had been greatly received. Additionally, weekly updates were provided to all families to offer reassurance and share any news.

We spoke with three members of staff to see how they were feeling and if they felt supported by the provider and managers. Comments included, “They have been great since I returned to work, my shifts have been devised so I don’t work long hours as the virus has left me quite tired and weak”, “I feel very safe and protected here. We are very sad and surprised by the outbreak, when we have worked so hard to keep everyone safe” and “The care remains person centred, I feel supported, the deputy and clinical lead are very hands on”.

People continued to receive prompt medical attention when they became unwell and relationships with health professionals remained very effective during these difficult, sensitive times. GP’s and out of hours support they gave when planning palliative support for those people who were receiving end of life care was ‘effective and caring’.

There were some good examples where the home had sought advice and support by outside health professionals. One NHS nurse had facilitated a questions and answers support session. Blossom Fields staff had the opportunity to ask about any concerns they had and if there was anything, they could do to improve their practice. The NHS nurse provided information to further enhance best practice, recognised and commended the home on their care and how they were handling the outbreak and details of experts the home could contact for further help and support.

Prior to our visit we were informed of the procedures we should expect when visiting, this was the policy for all professionals arriving at the service. Professionals were asked not to visit the service if they displayed any symptoms related to Covid 19. On our arrival we were greeted by a clinical lead nurse and had our temperature taken, we were asked to sanitise our hands and to wear the PPE given to us. Everyone visiting provided contact details to support the track and trace system. Visitors were shown to the area of the home they were visiting, by the shortest and most direct route.

There were policies, procedures and contingency plans in place. Clear recording and management for monitoring those staff who had tested positive were robust. The live system used, informed the registered manager when an individual’s isolation was completed. It was clear from the evidence provided that many staff had not returned after the isolation period, because they still felt unwell and the provider fully supported extended sick leave. Audits were undertaken, and actions were taken to ensure improvements were made. Staff had received training in IPC and regular updates were provided. Spot checks took place to check staff understanding and compliance with the use of PPE and infection prevention and control practices.

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. Blossom Fields is a care home with nursing for up to 43 predominately older people. People have either general nursing care needs or are living with dementia. The service has three units over three floors with a 16-bedded dementia care unit being on the middle floor. The building is a purpose-built care home designed around the needs of the older person and those people with dementia or cognitive impairment. There was one passenger lift and three secured staircases which meant all parts of the service were accessible for people with impaired mobility. At the time of this inspection there were 43 people in residence.

Level access into the service was from the car parking area. The front of the property looked out on to the main Winterbourne road. To the rear of the property there was a secure courtyard area, where people could sit out in the warmer weather. To the side of the property the provider had developed a Memory Lane. This was a mock 1950’s street created within the grounds of the service, providing a unique place where people who lived in the service could spend time with the aim of sparking memories of their younger days. The lane included a greengrocer, a Post Office, a pub, a telephone box and a bus stop with a seat where people could relax. The provider had made some changes to Memory Lane to update the features and introduce additional memorabilia (for example a record shop).

Why the service is rated Outstanding:

At the last inspection we found the service provided an outstanding model of care and support to people with nursing care needs, but in particular, to people living with dementia. The provider has continued to build on this, has made further improvements and sustained the ability to provide an outstanding service.

The provider was forward thinking and innovative in their approach to providing the best possible care. The dignity pledge and the dementia pledge were both at the heart of everything they did. The service and staff have continued to demonstrate their commitment to care for people with dignity and to enhance the lives of people living with dementia. The provider and staff team kept up to date with current practice and linked with care provider forums and support groups. They ensured people had access to the local community and their facilities and the community was invited to enter the home and participate in social activities. The service continued to have a good reputation within the local community and also with health and social care professionals.

There has been a change in the registered manager since the last 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.

People were kept safe. Staff received safeguarding adults training and ensured people were protected from harm and abuse. They knew what to do if concerns were raised and who to report any concerns to. Any risks to people’s health and welfare were well managed. Staff were trained in how to move people one place to another safely, using the appropriate equipment. The premises were well maintained. The management of medicines was in line with good and safe practice.

Pre-employment checks were robust and ensured that only suitable workers were employed to work in the service. Staffing levels for each shift were calculated to ensure each person’s care and support needs could be met. The numbers were adjusted as and when people’s needs changed.

People were provided with an outstandingly effective service. The training programme ensured each staff member had the necessary skills and knowledge to carry out their roles and responsibilities effectively. The provider had identified key staff and given them extra responsibilities in specific areas. Dementia care training was interactive and a ‘dementia suit was used’. This enabled to staff to experience what it was like to live with dementia. New staff were well supported and had a robust induction training programme to complete. They were supported by a buddy and a mentor until they had settled in to their role. All other staff had a programme of refresher training to complete. Care staff were encouraged to complete nationally recognised qualifications in health and social care.

People were supported to make their own choices and decisions where possible. Staff understood the need for consent and what to do where people lacked the capacity to make decisions. We found the service to be meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were provided with the food and drink they liked to eat. Feedback we received was wholly positive about the meals provided. The catering staff and the care team ensured people enjoyed their food and received a balanced diet. Where there were risks of malnutrition or dehydration there were plans in place to reduce that risk. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

People received an exceptionally caring service that met their individual care and support needs. The staff had good working relationships with the people they looked after. People said they were well looked after and this was also confirmed by visitors we spoke with. There were many examples of where the staff had gone that extra mile to meet people’s social and emotional needs which had resulted in improved well-being. People were able to participate in a range of different meaningful activities, both in Blossom Fields and in the local community.

People received an exceptionally responsive service. There was a person-centred approach to care planning and where possible they were involved in making decisions about how they were looked after. Care plans were well written and provided very personalised information about how the person wanted to be looked after and how their care was to be delivered. People were encouraged to have a say about things that mattered to them and to raise any concerns they may have.

There was also a person-centred approach to meeting people’s social care needs. There was a programme of group activities however specific arrangements would be made on a one to one basis with an individual. People were supported to access the local community and enabled to independently go shopping with back-up support as necessary. People were encouraged to speak up and say how they wanted to be looked after, to have a say about things going on in the service and to raise any concerns they may have.

People were living in a care home that was well managed and where there was good leadership and management in place. The provider was actively involved in the service and continued to make further improvements to enhance people’s lives. They used a quality management system to audit and monitor the quality and safety of the service. Action plans were developed where shortfalls were identified so that improvements could be made. The provider continually looked to make things work better so that people benefitted from an improved service. Any planned improvement actions were followed up to ensure they were implemented.

Blossom Fields is a care home with nursing for up to 43 predominately older people. People have either general nursing care needs or are living with dementia. The home has three units over three floors with a 16 bedded dementia care unit being on the middle floor. The building is a purpose built care home designed around the needs of the older person and in particular those people with dementia or cognitive impairment. There was one passenger lift and three secured staircases which meant all parts of the home were accessible for people with impaired mobility.

Level access into the home was from the car parking area. The front of the property looked out on to the main Winterbourne road. To the rear of the property there was a secure courtyard area, where people could sit out in the warmer weather. To the side of the property the provider had developed a Memory Lane. This was a mock 1950’s street created within the grounds of the home, providing a unique place where people who lived in the home could spend time with the aim of sparking memories of their younger days. The lane included a greengrocers, a Post Office, a pub, a telephone box and a bus stop with a seat where people could relax. The Memory Lane had featured on local and national News and most recently on Songs of Praise because of the services innovative approach to the care of people living with dementia.

The provider was forward thinking and innovative in their approach to providing the best possible care and had signed up for the dignity pledge and the dementia pledge. The service and staff demonstrated their commitment to care for people with dignity, to further improve and to follow best practice for the care of people living with dementia. They ensured they kept up to date with current practice and linked with care provider forums and support groups. They ensured people had access to the local community and their facilities and the community was invited to enter the home and participate in social activities. The service had a good reputation within the local community and also with health and social care professionals.

The manager was newly registered with CQC but had been at the home as manager since September 2015. 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 were kept safe. Any risks to people’s health and welfare were well managed. The premises were well maintained and staff were trained in how to move people requiring assistance from one place to another safely. Staff received safeguarding adults training and were knowledgeable about safeguarding issues. They knew what to do if concerns were raised and who to report the concerns to. Pre-employment checks were robust and ensured that unsuitable workers could not be employed to work in the service. The management of medicines was in line with good and safe practice.

Staffing levels for each shift were calculated to ensure each person’s care and support needs could be met. The numbers were adjusted as and when people’s needs changed. All staff were provided with the training they needed to carry out their roles and responsibilities effectively. The provider placed great emphasis on giving those staff who had proved themselves, extra responsibility. These staff members had taken lead roles in key areas. New staff to the service were well supported and had an induction training programme to complete. They were supported by a buddy and a mentor until they had settled in to their role. All other staff had a programme of refresher training to complete. Care staff were encouraged to complete nationally recognised qualifications in health and social care.

People were supported to make their own choices and decisions where possible. Staff understood the need for consent and what to do where people lacked the capacity to make decisions. We found the home to be meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were provided with the food and drink they liked to eat. There was a real commitment by the catering staff and the care team to ensure that people enjoyed their food and received a balanced diet. Where there were risks of malnutrition or dehydration there were plans in place to reduce that risk. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

People received a service that was caring and met their individual care and support needs. The staff were aware of the need for good working relationships with the people they looked after. People said they were well looked after and this was also confirmed by visitors we spoke with. There were many examples of where the staff had gone that extra mile to meet people’s social and emotional needs which had resulted in improved well-being. People were able to participate in a range of different meaningful activities, both in Blossom Fields or The Grove (a residential care home run by the same provider) next door and in the local community.

Care planning processes ensured that each person was provided with person-centred care and where possible had been involved in drawing up their care plans. Care plans were well written and provided detailed information about how the person wanted to be looked after and how their care was to be delivered. People were encouraged to have a say about things that mattered to them and to raise any concerns they may have.

The provider used a quality management system to audit and monitor the quality and safety of the service. Action plans were developed where shortfalls were identified so that improvements could be made. The provider continually looked to make things work better so that people benefitted from an improved service. Any planned improvement actions were followed up to ensure they were implemented.

People received the care and support they needed because assessment and care planning arrangements took account of each person's needs, choices and preferences. There were good processes in place for the management of medicines.

Staff completed safeguarding training and had good awareness of safeguarding issues and reporting procedures. The manager had an action plan in place to ensure that any concerns were reported in a timely manner.

People were cared for in a clean, hygienic environment. There were high standards of cleanliness in all areas of the home. The facilities at Blossom Fields were designed around the needs of the older person and in particular those people with dementia or cognitive impairment.

People who used the service, their representatives and staff were asked for their views about the care and support and they were acted upon. Any complaints made about the service were handled appropriately.

Ms Nichols no longer works at the home but her name has not yet been removed from the register. Ms Burch is the registered manager.

The area manager and manager were available throughout the day and were knowledgeable about people in their care, policies, procedures and systems in place to ensure the continued smooth running of the home.

Some people had a diagnosis of dementia which meant that they were sometimes confused about the questions we asked them. We spent time in communal areas and individual bedrooms so that we could observe the direct care, attention and support that people received. There was constant interaction between staff and people in the home. Everyone was relaxed, happy and comfortable in each other's company.

People who had capacity shared with us their experiences and we spoke with four people at length. Everyone expressed positive comments. People told us, "I couldn't wish for a better place, I am very happy the staff are wonderful", "Staff are very kind and I have never had any problems" and 'I am fairly independent and don't require much help, I am always very impressed when I watch staff care for people with patience and kindness".