Background to this inspection
Updated
17 November 2022
Inspection team
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by two inspectors and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Blackwood is a ‘care home’. 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 we looked at both during this inspection.
Registered manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was no registered manager in post. There was an interim manager and the post had been advertised.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all of this information to plan our inspection.
During the inspection
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We spoke with the area manager, manager. Three senior staff members. Ten staff including care staff, housekeepers and kitchen staff. We spoke with two visitors and received information from two professionals.
We reviewed a range of records. This included four people’s care records and medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.
Updated
17 November 2022
About the service
Blackwood is a residential care home providing personal care for up to 47 people. The service provides support to people requiring care and assistance. Some people were living with dementia. At the time of our inspection there were 36 people using the service. Blackwood is a two-storey building and had a range of aids and adaptations to support the needs of the people living there.
People’s experience of using this service and what we found
The inspection was prompted following concerns raised to the Care Quality Commission in relation to the management of medicines, consent, governance and people’s welfare needs.
Changes in medicines practices had significantly reduced the level of errors which had been reported. There was additional oversight of medicines taking place weekly. However, where people required medicines ‘when required’ [PRN], records had not always been completed to record why they had been administered. In addition, the monitoring of temperatures of the clinical room and medicines fridge on the ground floor were not consistently completed.
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. One person required a legal condition to support them. Staff were not following this condition.
Concerns had also been raised with the commission about the lack of training and supervision. The interim management team had carried out a review of this and found there were gaps in training and supervision. This was having a negative impact on the staff team. A plan was in place to deliver this, but it had not been implemented at the time of the inspection.
We had received concerns that the service was understaffed, and people were not receiving the support they needed when they needed it. At the inspection, improvements had been made to staffing levels and people’s needs were generally being met. However, staff told us despite improving overall, that staffing levels still fluctuated. Some people told us they still had to wait some time before call bells were answered. This had also formed part of the concerns raised with the commission. The manager was aware of the issues and a call monitoring system had been ordered to monitor call bell response times.
Concerns had been raised about people not being supported to eat and drink. At the inspection we found there was a range of options available to people. The observations made during lunch were positive. Staff supported people individually. There were enough staff to support people in the dining area and in their own rooms.
Care plans were in the process of being reviewed. There had been gaps in reporting on care and risks had not always been reviewed when changes had occurred. Details about how to respond to people’s anxiety had been lacking. Examples of the changes being made, showed improvement. Staff told us information in care plans had improved and staff understood people’s individual needs and how to respond.
Governance systems had not been effective. Auditing processes had not been completed, there had been a lack of oversight. People had not been engaged with. There was no evidence of the service considering people's views. Action was taking place to improve all areas of governance.
People’s health conditions were being managed and staff engaged with external healthcare professionals. Staff were proactive in making timely referrals to health professionals when they had concerns around people’s health and well-being.
Concerns raised by people were being investigated and would be responded to. The management team were continuing to reflect what learning could be taken from the concerns raised and were sharing the findings with staff.
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 (7 March 2019).
Why we inspected
We received concerns in relation to the management of the service, medicines and responding to people’s needs.. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.
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 good to requires improvement based on the findings of this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Blackwood on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 monitor the service and will take further action if needed.
We have found breaches in relation to the management of risk, consent, poor management oversight, inaccurate and incomplete records, staff training and support and a lack of person-centred support at this inspection.
Please see the action we have told the provider to take at the end of this report.
Notice of inspection
This inspection was unannounced.
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 continue to monitor information we receive about the service, which will help inform when we next inspect.