Blossom HCG Ltd

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were not always supported by staff that had the right skills or knowledge to keep them safe. Staff had not received regular supervision sessions with their manager and further training was required in key areas. Safeguarding measures were not always robust and as a result put people at risk of harm. The provider had not developed an open culture to share and learn lessons from incidents and safeguarding matters. People were not always supported to identify the least restrictive measure when supporting them and as a result in some cases people’s care was being restricted. The principals of the Mental Capacity Act were not followed when making decisions with people.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives felt they were able to raise concerns and felt listened to. One relative said, “The management team and caring staff at Blossom HCG are always available to talk to by telephone or emails, and reply very quickly to any questions that may arise.”

There was not always a culture of reflecting on safety and learning. We found examples where staff shared incidents had occurred and there was not always openness, transparency and learning from events that put people and staff at risk of harm. The provider confirmed this as said, “There was not always a culture of reflecting on safety and learning. We found examples where staff shared incidents had occurred and there was not always openness, transparency and learning from events that put people and staff at risk of harm. The nominated individual said, “We don’t have a working system of learning for the staff team. the service managers didn’t use things like incidents to develop the learning culture and keep people safe. We had the policies but they were just not used. This is something we will be changing in the future."

The provider did not have a proactive and positive culture in which concerns about safety were listened to and responded to promptly and robustly. There were no indicators of lessons learnt from previous inspection processes and embedding of good practice. Managers did not routinely ensure lessons learned were shared with staff and embedded into practice to help mitigate future risks. This meant opportunities for learning and improvements to people’s care were sometimes lost or delayed. The lack of shared understanding of issues and learning from when things go wrong meant the team did not have a shared vision and direction to support with improvements to the service. We raised this with the provider and showed them examples where opportunities to develop their learning culture were missed. The provider agreed that improvements were required and sought support from a management consultancy and local training organisation to redevelop their approach to shared learning and review.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and those who matter to them had safeguarding information in a form they could understand and felt comfortable to raise concerns when they did not feel safe. Relatives told us they felt their family member received good care, one relative said, “I do feel [Relative] is safe and is supported in accordance to their support plans & risk assessments. Staff do listen to [relative] and wherever possible meet their requests.” However, we identified and observed where peoples experience was not positive. For example, we saw examples where people were unlawfully restricted. Where incidents occurred there was a lack of involvement with people and staff to learn lessons from the event to reduce the risk of recurrence. This meant people continued to experience aggressive incidents that impacted their daily lives.

Staff had knowledge of how to who to contact if they suspected safeguarding concerns, however staff were unable to demonstrate their understanding of what constitutes a safeguarding concern. For example, one staff member told us, "There has been no safeguarding concerns, if there was any concern I would contact a manager and they would listen." We saw from records that a safeguarding concern had been raised previously, and we identified a safeguarding concern at this service during our visit. Staff gave examples of where people have been restrained against their care plans and approved methods, however, did not correlate this to a safeguarding concern. Restraint is only ever used as a last resort; but we were unclear from records and staff feedback if this was safe and necessary to do so. Staff said that where safeguarding concerns or incidents did occur there were no formal debriefs or lessons learned to share and learn from the experience. Staff who said they had raised a safeguarding previously where not aware of the outcome of lessons that arose from these.

Safeguarding was not always raised appropriately where safeguarding concerns occurred to the local safeguarding team as required. For example, fracture to a thumb in January 2024, or an incident of restraint in March 2024 both were not reported to the local authority safeguarding team or CQC as legally required. Prompt action was not taken to investigate the incidents and where they were, these lacked insight or appropriate actions. Restraint or restriction was not monitored by management. We came across three recent incidents. One restraint of staff holding, lockable bed rails on a bed and choices around food. Incidents, restraint, safeguarding concerns were not monitored for themes or trends to enable management to monitor each service and take proactive action to keep people safe. People's rights under the Mental Capacity Act 2005 were not fully supported. There was a lack of understanding amongst staff and local management regarding people's mental capacity and decisions people could make for themselves. It was clear that the service was operating with elements of a closed culture. Examples of this were the systems and processes did not ensure all statutory regulations were met. When staff used restraint, this was not appropriately documented and reported to the appropriate body. Restraint and restrictions of people’s freedom of choice was not routinely monitored through embedded governance systems. We found the provider was in breach of regulation 13 [Safeguarding] of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider during this assessment began to review people's care needs, increased their monitoring of the service and developed systems to monitor trends and themes around safeguarding concerns. They engaged a management company and training provider to support with developing a new framework to keep people safe and share identify and report concerns quickly and appropriately.

Relatives said they felt informed about any risks and how to keep their family members safe. They said they can express if they feel people need support to manage any risk. Relatives felt involved in decisions about people’s care and were kept informed where appropriate. One relative said, “[Person] has received constant support from the first day they arrived at their home. [Person] has been cared for by a team who are professional and caring and friendly and always have their best interests at heart. They have kept them safe both inside and outside the home and always has been treated with respect.”

Staff were aware of peoples individual support needs and were able to explain this. Staff were aware of risks to people and were clear about their role in monitoring and supporting these. We observed when people communicated their needs or when people needed emotional support, staff interacted in a kind manner to try and reduce the persons anxiety. However, this staff knowledge was not always evident in everyday practices as staff had not always managed and taken a proactive, open approach to safe risk management. The management team told us staff had received training in some areas such as epilepsy and autism, but we found additional higher level training was needed to better support staff knowledge. For example, staff had undertaken autism awareness training only, when raised with the provider they acknowledged staff required a higher level of knowledge to support people effectively. The provider also acknowledged manager training lacked key areas, such as investigating safeguarding, which we found had impacted the management of incidents which were found during this assessment.

The risk assessments did not always identify all risks and how to mitigate them and in some cases further development needs to be completed. For example, risks where identified around locking a food cupboard, however there was not the relevant documentation to show this was in the persons best interest. Where a decision is made for a person who may lack the capacity to decide themselves the two stage test of capacity had not been completed and staff did not assess through a best interest decision the least restrictive manner to address this. We found similar concerns with the use of a locking bolt to keep a person in their bed at night. We reviewed people's care records and saw staff had identified the risks associated with transport in a car or use of lap straps, however documentation was not in place to guide all staff how to safely support these risks. This meant without the appropriate guidance people were at a risk of inappropriate or unsafe care and support.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives felt that there were enough staff to meet their needs and felt staff were sufficiently skilled to support their family member. One relative gave an example where staff responded to a person health needs promptly and confidently, but also respecting their dignity during this event. On the day of the assessment, we observed across all the separate supported living houses we visited there to be sufficient staff on duty. Throughout the visit, we observed staff were attentive to people’s needs and responded quickly to requests for support. Staff ensured communal areas were not left unattended and people had staff on hand when needed.

Staff told us they received all the training appropriate and relevant for their role. Some staff spoke about how the management team ensured there was opportunity to have personal development to give opportunities to develop into new roles if they wished. We found that although staff had the training they required for their role, further development needed to be considered to ensure that staff retained the knowledge and were competent in the areas required for their role. On the day of the visits there were appropriate staffing levels and a skills mix which appeared to ensure people received care that met their needs.

Robust recruitment procedures were in place so people were cared for by staff who had been assessed as safe to work with people. The registered manager based staffing on the assessed needs and commissioning arrangements. Where 1:1 or 2:1 support was required this was provided in line with the contract. People had core hours for their care and support and additional hours to engage in activity and community engagement. This was regularly reviewed with the placing social work team to ensure there were enough staff to meet people’s needs. Records showed that staff received training and supervision. However, some staff had not received regular supervisions in line with the provider’s own policy. Most staff had completed training in core areas, for example most staff completed behaviours that challenge. However, there were gaps around areas such as autism awareness, positive behaviour support and safeguarding investigations for managers. Given that the staff support people with learning disabilities and autism, we found the level of training, mostly awareness was not of a level appropriate to the staff role. We raised this with the provider who sought additional training and development from a local training provider.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.