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Inspection carried out on 28 October 2019

During a routine inspection

About the service

Bluebells Care Home is a residential care home providing personal care, but not nursing care, to nine people aged 65 and over at the time of the inspection. The service can support up to 13 people in one bungalow.

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

At the June 2019 focused inspection we found audits and checks had improved in some areas but had not fully identified where there were issues with information in people’s records and medicine records. At this inspection, we could see changes had been made to drive up improvements and provide a caring and safe place for people to live in.

Care records clearly outlined people’s needs and personal preferences. Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Medicines were managed safely and people received their medicines as prescribed.

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.

People living at Bluebells Care Home received safe care from skilled and caring staff. Staff understood their responsibilities to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Complaints were handled and responded to in line with the provider's complaints policy. People and their relatives could give their views on 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 last rating for this service was requires improvement (published 22 July 2019 ). We carried out a focused inspection in June 2019 and prior to this a comprehensive inspection in October 2018 (where the service was first rated requires improvement). The provider completed action plans after the two inspections to show what they would do and by when to improve. At this inspection improvements had been made and the provider was no longer in breach of a regulation.

Why we inspected

This was a planned inspection based on the previous rating. The overall rating for the service has changed from requires improvement to good. 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 Bluebells Care Home on our website at www.cqc.org.uk.

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.

Inspection carried out on 12 June 2019

During an inspection looking at part of the service

About the service

Bluebells Care Home is a residential care home providing personal care, but not nursing care, to nine people aged 65 and over at the time of the inspection. The service can support up to 13 people in one bungalow.

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

At the October 2018 inspection we found audits and checks did not effectively identify issues or record action taken to make changes and drive improvements. At this inspection we found some improvements had been made, however the quality checks had not identified the issues we found at this inspection.

Improvements had been made to how medicines were managed and audited. However, we identified areas for improvement which had not been identified through the providers own quality assurance systems. For example, clear guidance for staff to inform them when to give people their ‘as required’ medicines.

We have made a recommendation about the management of some medicines.

People’s care plans, risk assessments and guidance on how to support people highlighted the majority of their needs and some information was person-centred. However, improvements were needed to ensure all information was detailed, accurate and complete to inform staff on how to safely support people.

People told us they felt safe living in the home and were protected from abuse and avoidable harm. The provider had reported any concerns or allegations to the local authority and to the Care Quality Commission when it was identified.

Systems were in place to ensure people were protected from the risk of infection.

People were supported by a consistent team of staff who knew them well. There were enough staff working in the home and staff had gone through recruitment checks.

Incidents and accidents were recorded so that any trends could be easily identified and improvements could then be made.

The management team promoted staff development and staff told us they all worked well as a team. Staff worked in partnership with other agencies. Feedback from healthcare professionals was positive informing us that staff understood people’s needs well.

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.

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 November 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvements had been made in some areas, however, the service remains rated requires improvement and the provider was still in breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We undertook this focused inspection to check the provider 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 and Well-led which contain those requirements. 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.

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

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

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.

Inspection carried out on 25 October 2018

During a routine inspection

The home was previously inspected 23 March 2016 where it had been rated Good. This unannounced inspection was carried out on 25 October 2018. This is the first time the service has been rated Requires Improvement.

Bluebells Care 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.

Bluebells Care Home can accommodate up to 16 older people in one building. There were ten permanent people using the service and one person was on respite at the time of the inspection.

There was a registered manager 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.

Although there were various audits and checks in place these had not effectively identified issues that we found during this inspection. Improvements needed to be made with ensuring there were robust processes in place to manage medicine audits, analysing information such as incidents, accidents and ensuring all audits were taking place and recorded.

There was one breach 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.

Employment checks were in place to obtain information about new staff before they were allowed to support people. However, unexplained gaps in applicant's employment histories had not always been explored and recorded.

People told us they felt safe living at the home. Risks to people’s well-being were assessed and managed safely to help them maintain their independency. Staff were aware of people’s needs and followed guidance to keep them safe. Although two people commented that staffing levels could be increased, especially at night, other feedback from people said there were enough staff to meet their needs and we saw people did not have to wait to be supported.

People had their needs assessed prior to living at Bluebells Care Home to ensure staff were able to meet people’s needs. Staff worked with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner.

People told us they felt well cared for by staff who treated them with respect and dignity. People were supported to meet their nutritional needs and maintain an enjoyable and varied diet.

Information for people could be provided in an accessible format to help people understand the care and support that was available to them.

People, their relatives and staff told us they felt Bluebells Care Home was well run. The registered manager and management team promoted a positive and open culture and staff told us they all worked well as a team.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People using the service were asked for their feedback on the service and their views were listened to and valued.

People were supported by staff that had the right skills and knowledge to fulfil their roles effectively. Staff told us they were well supported by the management team.

People were provided with information about how to make a complaint and these were managed in accordance with the provider's complaints policy. The registered provider had informed the CQC of all notifiable incidents.

Inspection carried out on 23 March 2016

During a routine inspection

This inspection took place on 23 March 2016 and was unannounced. Bluebells Care Home provides care for up to 16 older people requiring personal care. On the day of our inspection 13 people were living at the service.

There was a registered manager 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.

People’s safety was protected as risk assessments were in place which followed management plans. Accidents and incidents were investigated so the information could be used to reduce the risk to people's well-being. People received their medicines as prescribed. Medicines were stored and handled in a safe way.

People told us they felt safe living at the home. There were systems and processes in place to protect people from the risk of harm. People were supported by staff that had completed safeguarding training and understood their responsibilities in relation to keeping people safe.

There were sufficient levels of staff on duty to meet people’s needs. The service followed safe recruitment processes to ensure that people were supported by staff of a suitable character. Staff received regular training and were knowledgeable and skilled to carry out their roles. Staff spoke positively about the support they received from the management. Staff told us the management was approachable and there was a good level of communication within the service.

The registered manager and staff were aware of their responsibilities under the Mental Capacity Act (MCA) 2005. MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.

People received a choice of food that they enjoyed. Their weight and nutritional needs were monitored and appropriate action was taken when necessary.

We observed staff supporting people in a caring, professional and friendly manner. People had their independence promoted as much as possible while staff were taking into consideration their abilities and any risks associated with their needs. People told us they were happy with the service and how their support was provided. Staff ensured they treated people with dignity when providing personal care and they respected people’s privacy.

People’s needs had been assessed before they moved into the service to ensure the team at Bluebells was able to provide the support people required. People and their relatives had been involved in planning their care. Care records reflected people’s needs, choices and preferences and there was evidence these were reviewed on regular basis. People were provided with the information they needed if they wished to make a complaint and the complaints policy was available and displayed in the entrance area of the home.

The service was led by a registered manager and a team of committed staff. There was a clear staffing structure in place and staff were aware of their roles and responsibilities. The manager and staff told us they wanted to provide good quality care for people.

There were a number of quality assurance processes in place that regularly assessed the quality and effectiveness of the service.

Inspection carried out on 28 April 2014

During a routine inspection

One inspector visited the home and answered our five questions, Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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, other professionals and from looking at records.

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

Is the service safe?

Care plans instructed staff how to meet people�s needs in a way which minimised risk for the individual. People's diversity, values and human rights were respected. People were treated with respect and dignity by the staff.

Mental Capacity Act assessments were included, as appropriate in all plans of care. Staff understood mental capacity, consent, choice and deprivation of liberties safeguards (DoLS). The home had not made any Deprivation of Liberty Safeguards referrals in 2013 or 2014.

The manager and staff made sure that home was kept clean and hygienic. They made sure that they used methods to minimise the risk of infections and of controlling the spread of infection.

Medication was administered safely and at the correct times to ensure people�s health and well-being.

There were enough staff to ensure people were safe and comfortable. The manager was able to make decisions about staffing numbers on a day-to-day basis. They regularly reviewed staffing levels and had the authority to make any adjustments that were necessary to ensure people�s comfort or safety.

Systems were in place to make sure that the manager and staff continually monitored the quality of care offered to people. Health and safety was taken seriously by the home and all the appropriate safety checks had been completed. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People told us that they were happy living in the home. Relatives told us that they were very happy with the standard of care their family members received. They commented, ��we are very pleased with the care��.

People�s health and care needs were assessed with them, and/or their relatives, as appropriate. Care plans were detailed and clearly identified people�s needs and how they should be met. They were reviewed regularly and changes were made to meet people�s changing needs. People and their relatives told us that their healthcare needs were very well met. One person said: ��any of my health problems are dealt with promptly��.

The home made sure that staff were well trained and there were enough staff on duty to meet people�s individual needs.

Is the service caring?

We saw that the home had worked with other healthcare specialists to improve the lifestyle of people with physical and mental health needs.

People were supported by kind, caring and patient staff. We saw that care staff responded quickly and sensitively if people asked for help. People told us that staff were ��always there to help us��.

People�s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people�s wishes.

Is the service responsive?

The home had made changes and improvements as a result of ideas and discussions with people who live in the home and their relatives.

People knew how to make a complaint if they were unhappy. No complaints had been received in 2014. People told us: ��the staff always listen to us and the manager is always about and would listen to us if we had any worries��. Relatives said they were totally confident that ��any concerns, comments or ideas I have would be listened to and any action taken��.

Is the service well-led?

The service has a quality assurance system, records seen by us showed that identified shortfalls were addressed. As a result the quality of the service was being maintained or improved.

Staff told us that they had good training opportunities and were well supported by the team leaders. People who live in the home and their relatives told us that the manager was always around and they could approach him at any time.

Inspection carried out on 1 October 2013

During an inspection looking at part of the service

At the time of our inspection there where thirteen people living in Bluebells care home. We spoke with six people who used the service and five visiting relatives and friends. We also spoke with three staff and the registered manager.

During our previous inspections carried out on the 11th and 26th April 2013 we found that improvements were needed. The provider wrote to us with an action plan stating how these improvements were to be made. During this inspection we found that the provider had taken steps to make those improvements.

We observed staff being responsive to the needs of the individuals. This was in keeping with the guidance in their care and support plans. People could choose to sit in the communal areas or remain in their rooms. There was also access to a secure garden area which some people told us they were able to go and sit out in when the weather was nice.

A relative we spoke with told us that before their family member came to stay at Bluebells they were asked about their preferences, medical history and what they enjoyed doing. They said �they keep us up to date with everything, the staff are angels�. Another relative told us �I�ve hit a gold mine here, I am 99% satisfied with the care they provide.

The provider and staff were aware of their responsibilities regarding protecting people from abuse. The people who we spoke with told us that they felt safe and had confidence in staff�s abilities.

Staff felt supported and the provider had processes in place to ensure that people were assisted and cared for by trained and experienced staff.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Inspection carried out on 11, 26 April 2013

During a routine inspection

We visited Bluebells on the 11 April 2013, the acting manager was not present at the time however we spoke with him about our visit afterwards. We visited Bluebells again as part of the same inspection on 26 April 2013, the acting manager was present throughout the inspection. The registered manager had left Bluebells in mid March 2013. A relative of the provider was acting as manager in the absence of a replacement. The CQC had not been officially notified of the registered manager�s absence, or of the measures the provider was taking to ensure a suitably qualified person was managing the home.

We found that people living at Bluebells and their representatives had not been involved in planning their care. The care plans we saw provided basic details of people's needs and were not person centred. The information in people�s risk assessments were generic and did not clearly define the risk to individuals and measures required to ensure their health and safety.

There were not a great range of activities provided and people felt more could have been offered by the provider.

We found that appropriate checks were undertaken before staff began work and there were effective recruitment and selection processes in place. Staff had also received appropriate induction training.

The provider had effective quality assurance systems in place to monitor the performance of the home. The views of people living there and their representatives were taken into consideration.

Inspection carried out on 17 September 2012

During a routine inspection

People who lived in the home we spoke with told us they were well treated by the staff and had their care and support needs met.

We were told that staff were respectful and friendly and that they were consulted about their needs.

We found that people had personalised support plans in place and that care was planned and increasing needs were identified.

We found that the staffing levels were sufficient but this had at times been maintained by the manager working care shifts. We saw that the home were recruiting additional staff and planning to provide additional support from the provider for the manager.

We saw that the home had safe systems and procedures in place for the administering of medications and that staff were receiving for the appropriate training in relation to this.

We saw evidence that the home had systems in place to seek the views of the people living in the home and to audit and monitor the quality of service provided.

Inspection carried out on 11 April 2012

During an inspection in response to concerns

A concern had been raised with us about the arrangements being made for planning people�s care and for supporting people with their medicines. We were told that this included the arrangements being made for people to receive �end of life� care at the home.

We visited the home and found that improvements were needed in order to ensure there was an effective system in place for planning and evaluating people�s care. Improvements were also needed in the way that medicines were managed.

Inspection carried out on 4 January 2012

During a routine inspection

People appreciated the care and support that they received. We heard positive comments about the home; the care staff, for example, were described as �very helpful� and �approachable�.

When we asked someone if their privacy and dignity were being respected, they replied �absolutely�. A relative of someone who lived at the home felt that the staff were �good listeners�.

Staff told us they helped people to make choices, for example about what to wear and how they would like to spend their time. We observed staff supporting people in a friendly way, while encouraging independence where possible.

People told us that the meals had improved in recent months and overall they felt that Bluebells Care Home was meeting their needs.