Blair House Care Home

We identified prior to the inspection that no people living in the service had tested positive for COVID-19 in the last 14 days.

There had been some service users positively previously and one member of staff had recently tested positive as a result the service had made the decision no new admissions would be undertaken until advice from local infection prevent control team had agreed.

People were supported to understand and comply with visiting and social restrictions in line with all best practice guidance and this was communicated and updated as needed.

The service supported people to follow social distancing, isolating and hygiene practices as much as possible.

The provider demonstrated a good understanding of what and how to access local IPC resources (e.g. local health protection team) when they need advice and support.

Where the provider is responsible for cleaning, there are clear schedules in place, which include the frequency of cleaning of high touch areas. Records show compliance with the cleaning schedule.

Risk assessments were in place for service users who did not wish to be vaccinated and for those service users who access the community.

Staff are trained and know how to immediately instigate full infection control measures to care for a person who develops symptoms, who tests positive or who has been exposed to the virus to avoid the virus spreading to other people and staff.

Blair House is a care home that provides nursing care and support to people with mental health needs. The home is registered for 41 people.

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

At our last inspection the service was in breach of regulation in relation to safe care and treatment. At this inspection, however, the registered provider had made improvements and was no longer in breach of regulation.

Staff used creative, personalised methods and strategies to inspire and encourage people to get the most out of their support at Blair House. People felt consulted with, listened to and empowered. The service had gone the extra mile to spend time finding out what people liked. The service was exceptional at supporting people to follow their likes and interests, which led to them having increased confidence. The service worked effectively with other professionals to meet people’s health and care needs in sensitive, personalised ways People’s journeys and personal achievements were captured in case studies people had written themselves with help from their relatives or staff members. Outcomes and achievements were celebrated.

Information was sourced and available at Blair House which took into account people’s varying levels of understanding. Communication preferences were given great consideration.

Staff engaged and supported people with enriching and culturally relevant activities. The registered manager had reached out to the local community. This allowed people to grow in confidence and engage with the wider community. There was a complaints process in place which outlined response times and procedure. End of life care was discussed sensitively and with care and compassion.

People were protected from avoidable harm and abuse. Relatives told us they felt their family member was safe and well protected. There were enough staff on duty with the right mix of skills to support people safely and effectively. Staff were recruited and selected safely. Medications were safely managed, administered and stored. Infection control and prevention was managed well at the service. Incidents, accidents and near misses were recorded and monitored to ensure there was opportunity for lessons learned.

People were assessed before they came to the home by the registered manager, and their outcomes and choices were recorded and monitored to ensure consistency and good practice. Staff were supported and supervised, trained, and suitably skilled to meet the requirements of their role. People were supported by staff to have sufficient food and fluid intake throughout the day and night. There was a clear process for referring people to external services were required and this was applied consistently to ensure care was safe. The service fully met and complied with the principles of the MCA and no one was being unlawfully deprived of their liberty.

Staff treated people with respect, kindness, equality and dignity. Relatives spoke positively about the staff. People were included as much as possible in their day to decision making and choices. People’s privacy and independence was encouraged, family relationships and friendships were respected and promoted.

The registered manager promoted a positive ethos and culture, which was centred around personalisation and inclusion. The registered manager and provider understood their responsibility to inform people when care fell short or did not meet expected standards. Risks to people’s health, safety and wellbeing was effectively managed through ongoing monitoring of the service. The registered manager had a clear understanding of their role and responsibilities in line with regulatory requirements. The service was open and inclusive and fully considered people’s equality needs. There were effective systems in place for checking and improving the quality and safety of 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 service was last rated requires improvement. (Report Published 2 February 2019).

Why we inspected

This was a planned inspection in line with the last 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.

Blair House is a residential ‘care home’ which provides accommodation and personal care for up to 41 people, including people living with complex mental health conditions. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement.

The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home is a large detached property set in a residential setting fairly close to Southport Town Centre. A the time of the inspection there were 40 people living at the home.

A registered manager was in post.

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 home was last inspected in December 2016. The home was rated as good overall. We found during this inspection a breach of legal requirement, and the home is now rated as ‘requires improvement’ overall.

Risk assessments were in place for people who lived at the home and the majority of risks were well assessed and reviewed regularly. However, we did see that one person’s risk assessment did not contain enough information for staff to follow to keep the person safe. There is an ongoing police investigation in relation to this incident which will not be reported upon.

There were quality assurance procedures in place which checked service provision however, they were not always effective. We saw that quality assurance systems were mostly robust. We did see however, that some of the processes with regards to service provision, such as the risk assessments required further improvements.

Everyone we spoke with told us that they felt safe living at Blair House.

A medicines inspector looked at how medicines were managed in the home. We looked at storage, records and administration and found that medicines were managed safely.

Medicine audits demonstrated that changes and learning took place to improve procedures and staff confirmed this. There was a good culture for reporting errors and we saw evidence of analysis and changes made to improve the service.

Staff were able to describe how they ensured people were kept safe from harm or abuse. Staff discussed the actions they would take to report actual or potential abuse, which included reporting to the registered provider or registered manager, the local authority or the police.

Staff were recruited safely to enable them to work with vulnerable people. We saw that each staff member had been subject to a Disclosure and Barring service (DBS) check.

Staff rotas and our conversations with staff evidenced that there was mostly enough staff employed to work at the service and on shift to support people appropriately. Some staff had worked at the home for a number of years. There was however, some use of agency staff in the home, which some people said they did not like. We saw that the registered manager was trying to decrease their usage of agency staff, which had been successful in the last months.

The home was clean and tidy. There were hand washing facilities and hand sanitizers found throughout the home. Personal protective equipment (PPE) was available and we staff using these when they served people’s food.

The training matrix and examination of staff training certificates showed that all mandatory training was in date, and had been completed by staff. We saw that specialised training was taking place to support people living with complex mental health conditions. The registered manager informed us during our inspection, that more training had been arranged for the staff.

Staff we spoke with confirmed they received regular supervision and appraisal. The induction process for staff who had no previous experience of working in health and social care settings was aligned to the principles of the Care Certificate.

People were appropriately assessed prior to being admitted to the home. The initial assessment process focused on people's needs and choices while taking into account the type of treatment and support they required.

The service was working within the principles of the Mental Capacity Act (MCA). Additionally, we checked to see whether the conditions identified in the authorisations to deprive a person of their liberty were being met.

The service was actively encouraging people to partake in decisions around their own care by presenting information in different formats to support people's understanding.

People we spoke with told is they enjoyed the food.

People were supported to access medical care when they needed it. Each person’s care plan contained a record of professional’s visits. These were completed by staff following each appointment people attended, including the reason for the appointment and the outcome.

The home was decorated to a pleasant standard with further plans on-going. There was directional signage and notice boards in place with activities and upcoming events so people knew what was going on each day at Blair House.

Staff we spoke with described how they protected people's privacy during personal care.

Our observations at lunch time showed that people were being treated with compassion and dignity.

All of the staff we spoke with told us they enjoyed working at Blair House and liked spending time with the people who lived there.

Care plans were signed by people who were able to do so. For people who were not able to sign their own care plans we saw this had been done via a best interest processes.

There was information provided for people with regards to the local advocacy agency.

Consideration had been given to different formats and communication methods people may require. There was some information made available in accessible formats in line with the accessible information standard.

The care records that we viewed were sufficiently detailed regarding peoples likes and dislikes and contained person-centred information. We saw that people were getting the care and support which was right for them and specific to their assessed needs. People were referred to dieticians and the Speech And Language Therapy (SALT) team when needed. .

The service was respecting and encouraging people’s diverse needs and human rights.

The service had a complaints procedure clearly displayed in the communal areas of the home. This was also available in easy read and pictorial format.

There was a full and varied programme of activities at the home. There were numerous photos which were full of recent activities people had partook in. Days out were often arranged, and people partook in in- house activities.

There was end of life training programme for the staff; this ensured that people received dignified support at the end stages of their life. and

There was a registered manager in post who had been at the service for over 18 months.

All of the staff we spoke with said they enjoyed working at the home and the culture was friendly and homely. We observed this over the course of the three days we were at Blair House.

The registered manager had a good working relationship with the Local Authority and hospitals to support planned discharges for people into Blair House.

Feedback forms had been gathered from people who lived at the home, we reviewed a sample of these forms and they contained very positive comment and compliments about the service in general.

Team meeting and resident meetings were regularly taking place. We saw a sample of minutes from these. Agenda items such as the menus and activities were discussed.

We saw that the CQC had been notified appropriately of incidents and events which occurred at the service, as legally required by law. The rating for the last inspection was clearly displayed in the communal area of the home and on the registered providers webpage.

Blair House provides nursing and personal care for people who have mental health needs. It is registered to provide 41 places. The home is a large detached property set in a residential setting fairly close to Southport Town Centre.

A registered manager was in post.

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 home was last inspected in September 2015. The home was rated as ‘requires improvement’ and we found a breach of regulation relating to staffing as staff were not always trained and supervised appropriately. We told the provider to take action. The provider wrote to us following this inspection and told us what action they were going to take to ensure they met this breach.

We saw during this inspection, the provider developed and implemented a new system of training and induction which all staff had undertaken. We saw that staff had been trained to support people with mental health conditions, and all staff had been regularly supervised and had had an appraisal. The provider was no longer in breach of this regulation.

We found during the last inspection that the registered manager had not always informed CQC when reportable incidents had occurred, however they had agreed to do this at the last inspection in September 2015. We saw during this inspection CQC had been advised of all reportable incidents

Everyone told us they felt safe living at the home. People told us the staff made them feel safe as they knew the staff team well.

Medication was managed safely within the home.

Risk assessments were detailed and informative. Risks to people and any triggers were described along with the course of action the staff were required to take to help keep the person safe.

Staff we spoke with were able to describe the course of action they would take if they felt someone was being harmed or abused in anyway.

Recruitment procedures were robust to ensure staff were suitable to work with vulnerable people. Systems were in place to maintain the safety of the home. This included health and safety checks of the equipment and building

People had a plan of care in place which was personalised and contained information such as their likes, dislikes and backgrounds. This was as well as other information relevant to their needs ensuring they received care which met their needs.

The registered manager and the staff had knowledge of the Mental Capacity Act (2005) and their roles and responsibilities linked to this. We saw that capacity assessments had been completed for people which were decision specific and showed how the least restrictive option was chosen.

The home had aids and equipment to meet people’s needs and staff would encourage people to do things for themselves when it was appropriate to promote their independence.

We found the home to be clean, spacious and well decorated.

Food was fresh and home cooked. Everyone we spoke with told us that they enjoyed the food and got enough to eat and drink.

Staff referred to outside professionals promptly for advice and support.

A process was in place for managing complaints and the provider’s complaints procedure was available so people had access to this information.

People and relatives were complimentary about the registered manager, the directors, and the culture of the home in general.

Staff were aware of the provider’s whistleblowing policy and told us they would not hesitate to report any concerns or bad practice.

Systems were in place to monitor the standard of the service and drive forward improvements. This included a number of audits for different areas of practice

There were a new group of directors who had taken over management of the home since our last inspection in September 2015, and staff told us there had been positive changes.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

People living at Blair House Care Home were treated with dignity and had their privacy respected. We observed safeguarding procedures at the home and staff had received relevant training as part of their initial induction process. Recruitment procedures were robust which ensured only those people with the required skills and knowledge were employed which kept people safe. Although no applications had been submitted for Deprivation of Liberty Safeguards, (DoLS) procedures were in place if such an application was necessary when a person was judged to be unable to make informed decisions because they lacked capacity to do so.

Is the service effective?

Before any person was admitted into Blair House, they received a thorough pre-admission assessment which ensured the provider was able to meet their required needs. People and/or their representatives had been involved in the care planning process which meant their needs and wishes were listened to and acted upon. The environment at the care home enabled people to move around freely and safely.

Is the service caring?

Throughout our inspection, we observed people living at the care home being cared for and supported by attentive and dedicated staff members. One person said, "It was the best move I ever made coming here". People living at the care home attended, if they wished, regular meetings and completed surveys and we were told if any concerns were raised they were addressed immediately. People`s wishes were listened to and recorded in their care plans and staff members responded to their wishes to help meet those identified needs.

Is the service responsive?

People at the care home had the opportunity, if they wished, to take part in a range of activities. We observed the pre-arranged activities programme displayed on the wall. People also visited places of interest which had been chosen by them and kept them involved within their local community. A rigorous complaints procedure was in place at the care home and so people were assured that in the event of any complaints being made, they would be investigated and if necessary, action would be taken.

Is the service well-led?

We saw evidence of a multi-agency approach to providing care for people at Blair House which maintained the safety and welfare of all people living there. The provider had several internal and external audit systems in place. This ensured the quality of service being provided to people living at the home was monitored, so it continued to improve. Staff members were clear about their roles and responsibilities which ensured a good quality of care and support was received by all people at the care home.

Care plans were personalised and based on the person's individual assessments and their preferences, providing staff with clear guidance about how to support the person concerned.The atmosphere in the home was calm and relaxed. We observed care and support being delivered and there was good communication between people and staff.

Several people managed some or all of their medication themselves and the home had systems in place to support them to do this safely. We saw that risk assessments were completed and a care plan was signed by the person concerned.

People we spoke with told us that there were always staff available when they needed them. Staff told us that staffing levels and skill mix were appropriate and supported them to carry out their job.

Regular audits were carried out to identify any areas of concern and take appropriate action to improve the quality of the care and support provided. These included audits of the running of the kitchen, the administration of medication and the completeness of care records.