Blossom Place

Blossom Place is a care home providing personal care and accommodation to up to 14 adults with mental health needs. The location consists of three buildings, each of which has its own separately adapted facilities. At the time of the first day of inspection, 10 people were using the service and there were nine people using the service on the second day of the inspection.

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

The quality assurance system and processes had failed to identify and correct issues we found at the inspection. However, we found some improvements as well, in relation to risk assessments, using personal protective equipment, and respecting people’s equality and diversity. People received their prescribed medicine. However, we found concerns around allergy to particular medicines and their effects on people.

People were safeguarded from the risk of abuse. Staff had received safeguarding training and knew the actions to take to report abuse. There were enough staff available to support people safely. People were protected from the risk of infection. The provider had a system to manage accidents and incidents.

Staff received support through training, supervision, and staff meetings to ensure they could meet people’s needs. Staff showed an understanding of equality and diversity. Staff respected people’s choices and preferences. People were treated with dignity; their privacy was respected, and they were supported to be as independent in their care as possible.

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’s consent was sought for the care and support they received.

People’s needs were assessed, which covered a range of people’s needs. People and their relatives were encouraged to participate in making decisions about their care and support. Care plans were up to date and reflected people’s assessed needs. People and their relatives knew how to raise complaints about the service. The registered manager responded to complaints appropriately in line with the provider's procedure. The registered manager knew what to do if someone required end of life care.

There was a management structure at the service and staff were aware of the roles of the management team. The registered manager and staff worked with other external professionals to ensure people were supported to meet their needs.

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 15 February 2022). At that inspection we found breach of regulations in relation to dignity and respect, safe care and treatment, and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations 10 and 12. However, we found the provider remained in breach of regulation 17. The service remains rated requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and recommendations

We have identified one breach in relation to good governance at this inspection and we made one recommendation about management of medicines.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Blossom Place is a care home providing personal and accommodation to up to 14adults. The location consists of three buildings, each of which has its own separately adapted facilities. At the time of the inspection, 10 people were using the service.

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

The quality of the service was not always assessed effectively. We noted shortfalls in the service that had not been identified by the inhouse quality assurance process. Staff did not always promote people’s dignity and privacy. The management of medicines was not safe. Risks to people were not managed effectively to reduce harm to them. There were not always management plans to provide guidance to staff to reduce risks to people. Staff did not always follow safe infection control practices reduce the risk of outbreaks of COVID-19 or any other type of infection.

People were safeguarded from the risk of abuse. Staff had received safeguarding training and knew the actions to take to report abuse. Incidents and accidents were reported, and the registered manager reviewed, analysed and took actions to ensure learning from them. There were enough staff available to support people safely. Staff felt supported in their roles and records showed they received regular supervisions, training and appraisals.

Care plans were up to date and reflected people’s needs. People’s end-of-life wishes were documented in their care plans and followed. People were engaged in activities to occupy them. People’s needs were assessed in line with best practice guidance and covered a range of people’s needs. People’s nutritional and hydration needs were met. People had access to healthcare services they needed to maintain good health; and staff liaised effectively with other services.

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’s consent was sought for the care and support they received.

The service complied with the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Relatives and healthcare professionals were involved in making decisions for people in their best interests where this was appropriate.

People and their relatives knew how to raise complaints about the service. The registered manager responded to complaints appropriately in line with the provider’s procedure. The provider worked in partnership with other organisations and services to develop and improve 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 (and update) - The last rating for this service was inadequate (published 29 May 2021). The service was put into Special Measures. At that inspection we found breach of regulations 9, 10, 12, 13 and 17. We issued a warning notice on the breach of regulation 17.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations 10, 12 and 17. Their rating has changed from inadequate to requires improvement. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at 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. This included checking the provider was meeting COVID-19 vaccination requirements.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Blossom Place 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.

Blossom Place is a care home providing personal and nursing care to up to 14 people aged 18 and above. The location consists of three buildings, each of which has its own separately adapted facilities. At the time of the inspection, 14 people were using the service.

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

People were at risk of avoidable harm because individual risks were not adequately assessed and managed. People were not safeguarded from the risk of abuse as safeguarding procedures were not followed. Medicines were not managed safely, and appropriate actions were not taken to ensure lessons were learnt from incidents and accidents when things went wrong.

Care and support was not always planned and delivered to meet people’s individual needs. People’s communication needs were not assessed, and information was not always presented in formats that met individual needs. .

People’s independence was not always promoted. People were not always supported and encouraged to do things for themselves. People’s cultural and religious preferences were not promoted.

The service was not well-led. The culture of the service did not promote safe care and positive outcomes for people. The quality of the service was not assessed, monitored and reviewed to ensure they were safe and effective. The registered manager had not notified the Commission with reportable incidents and events as required with their registration.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People told us there were enough staff around to support them. Record showed staff received training, supervision and appraisals. People were supported to access healthcare services they needed. People’s nutritional needs were met. People were supported to maintain relationships which mattered to them.

There were systems in place to control the risks of infection and staff followed this.

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 good (published 24 November 2017).

Why we inspected

We undertook a targeted inspection to review infection prevention and control procedures in the home. We found there were concerns relating to restrictive practices and medicine management. A decision was made to widen the scope of the inspection to a comprehensive inspection covering all five 5 key questions.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to inadequate. 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 Blossom Place on our website at www.cqc.org.uk.

Enforcement: We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, safeguarding, dignity and respect, person-centred care and good governance at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our inspection on 3 September 2015 the service was rated Good. At this inspection we found the service remained Good. The home demonstrated they continued to meet the regulations and fundamental standards.

The home had 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 told us they felt safe living at the home. There were safeguarding and whistle blowing procedures in place and staff had a clear understanding of these procedures. People said there was enough staff on duty to meet their care and support needs. Robust recruitment procedures were in place. Medicines were managed appropriately and people were receiving their medicines as prescribed by health care professionals.

People’s needs were assessed and care files included detailed information and guidance for staff about how their needs should be met. Staff had completed training specific to people’s needs, for example, mental health awareness, anxiety and depression. Action was taken to assess any risks to people using the service. People had crisis plans in place with information for staff about actions to be taken to minimise the risk of relapse in their mental health. Staff monitored people’s mental and physical health and where there were concerns people were referred to appropriate health and social care professionals. Staff encouraged people to be as independent as possible.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. People knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The provider took into account the views of people using the service, staff and health care professionals through surveys. There were regular residents and staff meetings where people using the service and staff were able to talk with the registered manager about what was happening at the home. The provider recognised the importance of regularly monitoring the quality of the service they provided to people using the service. Staff said they enjoyed working at the home and they received good support from the registered manager.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. Staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. One recent application had been submitted and proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. We found staff had a good understanding about adult safeguarding and they told us they would always escalate any concerns. A safeguarding policy was in place and staff attended regular training sessions.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff they understood people's care and support needs and they knew them well. One person told us. "I like it here, I feel safe.' Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. We observed during our visit staff managing challenging behaviour in a calm and professional manner. One person told us 'the staff are nice they help you.' Another person said' the staff talk to me, they make me feel better.'

Is the service responsive?

People's needs had been assessed before they moved into the home. People told us they were happy with the care they received. Records confirmed people's preferences, history and diverse needs had been recorded and care and support had been provided which met their wishes. People had access to activities. People told us they went to a community group and one person said' the hairdresser comes to the home and the staff take us to our appointments to see the doctor.'

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. We found people were asked for their views through an annual survey and regular meetings. The provider had responded to feedback on the need to widen the menu choices and to improve individual access to preferred activities. Staff told us the new manager had an open door policy and they could raise any issues. Staff said they had regular team meetings where they could raise issues. Staff felt there was good team work.

We found where people did not have the capacity to consent, the provider acted in accordance with legal requirements. Some people were restricted from going out of home and the reasons for these restrictions had been explained to each individual, and / or their consent sought. People received freshly cooked food on a daily basis. All staff had regular supervision and appraisal. The provider had notified the Care Quality Commission of reportable incidents.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We found people's care and support needs were assessed and regularly reviewed. Staff understood people's care needs and knew how to protect them from risk and harm. However, we found that the provider had not always correctly assessed people's capacity to make decisions. Some people were restricted from going out of the home and the reasons for these restrictions had not been explained to each individual, or their agreement sought. People did not receive freshly cooked food on a daily basis. Some staff had not received regular supervision and appraisal. In some cases the provider had not notified CQC of reportable incidents. There was evidence that quality monitoring audits have taken place on a regular basis and appropriate changes had been implemented to ensure people received consistent care.