Archived: Blackwood Residential Care Home

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.

People’s experience of using this service: People, relatives, staff and professionals all told us improvements had been made to the running of the service. There was a stable management team and staff morale was good. Improvements had been made to records relating to people’s care.

People were provided with safe care because staff received regular supervision, training and support from management. Staffing levels had been increased and there were enough staff on duty to meet people’s needs and keep them safe.

People were involved in their day to day lives through being empowered to make their own choices about where they spent their time, who with and how. Their independence was promoted and staff actively ensured people maintained links with their friends and family.

People were relaxed and comfortable with staff, and had no hesitation in asking for help from them. Staff were caring and spent time chatting with people as they moved around the service. People and their relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, “I wouldn’t go anyway else to live” and “I really enjoy living here and have made good friends.”

A programme to provide meaningful and individualised activities for people had been developed and was on-going.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Staff were informed about people’s changing needs through effective shift handovers and by accessing up-to-date electronic records of people’s care via handheld devices.

People and their families were given information about how to complain and details of the complaints procedure were displayed at the service. The service sought the views of people, families, staff and other professionals and used feedback received to improve the quality of the service provided.

Rating at last inspection: Requires Improvement (report published on 9 March 2018). The service had been rated as Inadequate at the previous inspection in October 2017.

Why we inspected: This was a planned inspection based on the rating at the last inspection to check if the required improvements had been made. We also checked if the positive conditions applied to the provider’s registration were met. Positive conditions were applied at a previous inspection in October 2017 and remained in place after the inspection in February 2018. At this inspection the service had embedded changes sufficiently to improve the overall rating to Good and the conditions were met.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The full details can be found on our website at www.cqc.org.uk

Following our last inspection the provider wrote to us detailing the actions they planned to take to ensure they were meeting the requirements of the regulations. In addition the provider sent us monthly reports, about the progress of the improvement actions they had taken, as was required by the condition of registration imposed. We undertook this inspection to check if they had carried out the actions detailed in the action plan and monthly reports.

Blackwood is a ‘care home’ that provides care for up to a maximum of 47 predominately older people. 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. At the time of the inspection there were 40 people living at the service. Some of these people were living with dementia.

The service is required to have a registered manager and at the time of the inspection there was no registered manager in post. The manager who was in charge of the day-to-day running of the service had applied to become the registered manager. At the time of this inspection their application was being processed. 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 and associated Regulations about how the service is run.

At the last inspection we found that while there were systems in place to monitor the quality of the service provided, these systems had failed to identify the concerns found at that inspection. At this inspection improvements had been made to the auditing systems and this meant the monitoring processes were more effective in identifying where action needed to be taken. We found improvements had been made in relation to risk management, medicines management, recruitment practices, staff training, seeking people’s consent, treating people with dignity and respect and the cleanliness of the environment. This meant the service had met seven of the eight outstanding legal requirements from the last inspection.

At this inspection we found there were some areas where improvements to the running of the service had been identified but plans to carry out those improvements were still in progress. A programme to carry out regular one-to-one supervision with staff had started. However, only 14 out of 60 staff had met with a manager at the time of this inspection. This meant most staff had not had the opportunity to be supported in their role and discuss their training and development needs.

In order to address the concerns from the last inspection the provider had introduced many new systems and processes for care staff to follow. For example, a new system for allocating staff to work with specific people on each shift had been introduced a few days before our inspection. While there were clear benefits to this system, in terms of helping to ensure people received timely care, the way in which it had been implemented was poorly managed. Some staff’s perception and understanding of the reason for these changes were negative and morale was very low. Other staff were less concerned about the changes, but all staff commented that there had been a lot of new systems to take on board. Comments from staff included, “The changes weren’t explained very well. We were just expected to understand them straight away”, “There have been loads of changes”, “The new allocation system is more structured now but with less flexibility for staff to respond to residents.” There had been regular staff meetings where information about systems updates were discussed. However, the lack of one-to-one supervisions for most staff meant the opportunity for staff to be supported through the changes individually was missing.

At the last inspection we found that while group activities were being offered not everybody was able to participate due to their physical or cognitive needs. At this inspection a programme to provide individualised activities, to meet the needs of each person living at the service, had started. Life histories had been completed, or were in the process of being completed, to help understand people’s wishes and interests. As often as possible the activities co-ordinator and care staff spent one-to-one time with people who either did not want to or were unable to take part in group activities. A post for another activity co-ordinator had been advertised but was vacant at the time of the inspection. We have made a recommendation about this.

We found that some shifts did not have enough staff on duty to meet people’s needs in a timely manner. There had been a period of high levels of sickness at the service and when it was not possible to find cover for late notice sickness the shift ran under staffed. This meant that on these occasions the numbers of staff on duty were lower than the number the service had assessed as needed to meet people’s needs. This was particularly difficult if sickness occurred at weekends because managers were not available to help provide care for people. The number of staff on each shift was to be increased once newly recruited staff had completed the recruitment and induction process.

Where people were assessed as needing to have specific aspects of their care monitored staff completed records to show when people were re-positioned, their skin was checked or their food and fluid intake was measured. Monitoring records were kept in people’s rooms, or close to where they spent their time, so staff were able to access them easily at the point when care was delivered. We found there were gaps in some of these records which meant it was not possible to be sure if the appropriate checks had taken place.

On the day of the inspection there was a calm and relaxed atmosphere at the service. We observed that staff interacted with people in a caring and compassionate manner. Staff asked people for their consent before providing care for them. People who were able to talk to us about their views of the service told us they were happy with the care they received and believed it was a safe environment. Comments from people and their relatives included, “Yes, I’m very happy here and I feel safe here”, “I feel happy here and I like the people who are here too; there’s no one that I don’t like”, “I couldn’t want for anything better” and “Staff are very good.”

Where people were unable to tell us about their experiences we observed they were relaxed and at ease with staff. People’s behaviour and body language showed that they felt cared for by staff.

Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

Since the last inspection housekeeping hours had been increased and cleaning schedules developed to help ensure the service was clean and to reduce the risk of cross infection. We found the environment was clean, well maintained and there were no unpleasant odours. Risks in relation to people’s care and the environment were assessed and safely managed.

People received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard.

The service worked closely with healthcare professionals such as district nurses, dementia liaison nurses, speech and language therapists and GPs to help ensure people’s individual needs were met. Incidents and accidents were recorded, appropriate action had been taken and where necessary changes made to learn from the events.

Staff received appropriate training so they had the knowledge to meet people’s needs and staff knew how to recognise and report abuse. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. New employees completed a thorough induction which incorporated the care certificate.

Care records were personalised to the individual and detailed how people wished to be supported. They provided clear information to enable staff to provide appropriate and effective care and support.

Staff supported people to maintain a balanced diet in line with their dietary needs and preferences. Where people needed assistance with eating and drinking staff provided support appropriate to meet each individual person’s assessed needs.

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff demonstrated the principles of the MCA in the way they cared for people. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements. Applications for DoLS authorisations had been made to the local authority appropriately.

We found two

The service was last inspected in March 2017. At that time we identified concerns in relation to risk management, medicines management and recruitment practices. The service was in breach of the regulations. Following the inspection the provider sent us an action plan outlining how they would address the issues highlighted in the inspection report.

Blackwood is a care home which offers care and support for up to 47 predominately older people. At the time of this inspection there were 43 people living at the service. Some of these people were living with dementia.

The service is required to have a registered manager. At the time of the inspection there was no 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe, and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. 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 is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s risks were not safely managed at the service. One person had sustained an injury to their leg. This had been noticed by staff in the morning when they had assisted the person with a bath, but not reported to the district nurse service until the afternoon. When the person was seen by a nurse in the afternoon, staff were advised that the person should have had their leg elevated during the day to prevent further skin damage.

We found concerns relating to hazardous items in the environment. Kettles in the kitchenettes were accessible by people. Some people living at the service were physically mobile and had cognitive impairments. The kitchenettes were not always staffed. People were at risk of burning themselves on these appliances. We found that these had been used and were hot during the inspection.

We saw some positive interactions between people and staff. However, some interactions were concerning. Some people who called out repetitively were ignored by staff. This impacted on the people concerned and those around them who were becoming frustrated with the noise. Some people’s privacy was not protected. Staff carried out care duties in a way that was not discreet. Staff did not seek people’s consent before carrying out care duties or interact with people whilst assisting them. People’s dignity was not always upheld. Some people were given the wrong clothing to wear. One person reported being given someone else’s trousers which were clearly too big and fell down. People were not always treated with dignity and respect.

Where people expressed a wish to leave and live somewhere else, this had not been addressed by staff. Some people were seen to be distressed, asking for help or saying they were frightened. This was not responded to by staff.

People were not protected from the risks associated with cross infection. Parts of the service were visibly dirty. Bins in bathrooms and toilets were overflowing throughout the day. Cleaning schedules were inconsistently completed. There was a heavily stained carpet along one of the corridors which was very sticky. Staff told us it had been like this for some time. Furniture was stained with food ground into it.

People had minimal access to personalised activities. There was an activities coordinator, who worked part time, but activities were basic and more group focussed. The activity schedule on display was not accurate. People’s care records contained minimal personalised information about the person’s background, history, likes and dislikes. Staff did not always know the needs of the people they supported.

The service was not compliant with the Mental Capacity Act (MCA). An internal audit had highlighted areas of concern, which were being addressed. However, even in the records which had been reviewed, we saw concerns such as a lack of best interest processes and people and relatives consenting to elements of people’s care without the correct legal authority to do so.

Feedback on the food was mixed. The lunchtime experience was not sociable. Tables were not laid with table cloths or condiments. Staff did not know what type of soup they were serving which meant it was not possible to offer people choice.

Staff training had lapsed in a number of mandatory subjects such as safeguarding, MCA and fire safety for a number of staff members. Staff told us they were not receiving regular supervision or appraisals. Recruitment practices were not safe. We saw an example where a staff member had not undergone all of the pre-employment checks required.

There was an inconsistent management team, with numerous managers coming into post, before leaving over the course of the past two years. Communication between managers and staff was poor. Staff did not know that a new manager had been appointed. People living at the service did not know who the manager was. Staff felt disempowered.

There was minimal opportunity for people and relatives to offer suggestions or provide feedback on the service. Residents’ and relatives’ meetings were not taking place. Staff meetings had started to take place, however staff told us that this had been inconsistent up until now.

People’s medicines were generally safely stored, administered and disposed of. However, audits which were required to be undertaken daily were happening less frequently. We saw an example where a medicines error had not been identified as there was no audit on that day.

Some staff were kind and compassionate and committed to improving standards. We witnessed some examples of positive interactions between people and staff. Some staff shared appropriate humour and affection with people.

People had access to a range of healthcare professionals. There were comprehensive daily handovers. Kitchen staff were aware of people’s health concerns and any dietary requirements

People and their families were given information about how to complain. There were quality assurance systems in place to make sure that any areas for improvement were identified and addressed. However, these had been ineffective and had not highlighted all of the issues raised in 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.

We carried out this comprehensive inspection on 13 and 15 March 2017. The service was last inspected in October 2016. At that time we identified concerns in relation to risk management, staffing levels, the provision of meaningful activities for people and the effectiveness of the systems in place to monitor the quality of the service provided. The service was in breach of the regulations. Following the inspection the provider sent us an action plan outlining how they would address the issues highlighted in the inspection report.

The service is required to have a registered manager and at the time of our inspection there was no 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 and associated Regulations about how the service is run. The service was being overseen by Cornwall Care’s peripatetic manager who was applying to be the permanent registered manager at Blackwood. They had a good understanding of the service and people, relatives and staff told us the way Blackwood was managed was “much improved.”

The service was arranged over two floors. Each floor had a dining and lounge area and access to kitchen areas where drinks could be prepared. A large kitchen on the ground floor was used to prepare meals. Checks of the environment were carried out regularly and the premises were in a good state of repair.

Arrangements for the management, storage, administration and recording of medicines were not robust. Medicine Administration Records (MAR) were not consistently completed. One person was frequently asleep when staff attempted to support them to take a prescribed medicine used to help prevent infections. No action had been taken to change the time the medicine was prescribed in order to help ensure the person was protected from an identified risk to their health.

Some people had been identified as being at risk of poor nutrition. One person had been prescribed a food supplement to protect them from this. The type of supplement provided had been changed to one which was lower in calorific value. No adjustment to the amount given had been made to ensure the person received the recommended calorie intake. Monitoring records in respect of people’s weight were not consistently completed. Some people were not being weighed as often as directed in their care plan. This meant people were not protected from the risks associated with poor nutrition.

There were sufficient staff to provide care and support effectively and in line with people’s needs. Staff were deployed effectively throughout the premises. People’s needs were met promptly and staff were caring, patient and compassionate in their approach to people. Staff responded quickly to any requests for support or when they heard people becoming anxious.

New staff completed an induction before starting to work directly with people delivering personal care. Recruitment checks were carried out to help ensure new staff were suitable to work in the care sector. Two members of staff only had one reference on record. This was contradictory to Cornwall Care’s policy and meant people may not have been protected from the risk of being supported by staff who were unsuitable for the role.

Training was updated and refreshed regularly. Staff told us the training they received was good and equipped them to carry out their roles effectively. Staff had received safeguarding training and knew how to recognise and report the signs of abuse. They were confident any concerns would be dealt with.

People were assessed in line with the Mental Capacity Act (2005) where relevant and the manager followed the legislation to help ensure people’s human rights were protected. Best interest meetings were held when people had been assessed as not having capacity to make specific decisions. These involved other professional and family members to help make sure people’s voices were heard.

Care plans contained information on how to support people across a range of areas including mobility, communication and nutrition. Information about people’s personal backgrounds and histories was limited. We have made a recommendation about this in the report.

People had access to activities which were organised by care staff. There were plans in place to develop staff skills in providing activities to make them more meaningful for people. Staff recorded when people had taken part in any activities and whether they had enjoyed the experience. This meant staff were able to learn what worked well for people.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff told us they felt well supported and had confidence in the management team and the higher organisation.

People and their families were given information about how to complain. There were quality assurance systems in place to make sure that any areas for improvement were identified and addressed. However, these had not highlighted the issues raised in this report.

We identified breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

Blackwood is a care home which offers care and support for up to 47 predominately older people. At the time of the inspection there were 44 people living at the service. Some of these people were living with dementia.

The 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. 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. At the time of the inspection the service was being overseen by an interim manager. We discussed the arrangements for the management of the service in the future and were satisfied appropriate measures were being taken to help ensure the service was well managed.

Before the inspection we had concerns about how people were protected from harm. We checked to see if the service was safe. We found some people sometimes acted in a way which could put staff and other people at risk. Although this had been identified and risk assessments were in place there were occasions when people felt unsafe. Risk assessments did not accurately reflect the actions staff were taking to keep people safe.

We looked at how medicines were managed and administered. We found Medicine Administration Records (MAR) showed people were receiving their medicines as prescribed. Systems for the administration of medicines were not robust and we have made a recommendation about this in the report.

The service had identified the minimum numbers of staff required to meet people’s needs, these were not being consistently met. Staff told us they often felt rushed and were not always able to meet people’s needs, particularly social needs, in a timely manner.

Staff were supported by a system of induction, training and supervision. All staff had recently completed safeguarding training or were booked to do so in the near future. Training to support people when they were agitated and might behave in a way which was difficult for staff to manage, was not routinely provided. Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

The interim manager had an understanding of the requirements laid down in the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). They were taking action to check applications for DoLS authorisations were made appropriately. Decisions regarding the administration of covert medicines were not consistently made and recorded in line with the legislation and we have made a recommendation about this in the report.

People and relatives told us staff were caring and supportive. Staff spoke fondly of people and demonstrated a concern for their well-being. People’s dignity and privacy was respected and care was taken to protect people’s personal information.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

People did not have access to meaningful activities in line with their interests and preferences. Although events were arranged for special occasions such as Halloween there was no day to day schedule of activities in place.

Prompt action was not always taken to ensure improvements were made, because the processes and systems used to assess and monitor the quality of care people received, and to determine if people’s needs were being met were not effective. Action was being taken to address these shortfalls. As the systems in place were still being embedded it was too early for us to evaluate their effectiveness at this inspection. The interim manager was supported by higher management at Cornwall Care. Managers meetings took place on a monthly basis. Members of the senior management team visited the service at regular intervals.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the end of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, observing interactions between staff and people, and from looking at records.

Is the service safe?

The service was safe.

However the environment was in need of improvement. Some areas of the building required updating.

People told us they felt safe. We spoke with two people who used the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, "I have no problems and no complaints".

Is the service responsive?

The service was not responsive. People's needs had not been taken into account when the building was decorated.

People did not always have access to meaningful activities.

Care plans were updated regularly.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe. We spoke with two people who used the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, 'I have no problems and no complaints'.

Complaints and reporting procedures were robust. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

There was a complaints procedure for people who used the service, their relatives, friends and other professionals involved with the service. Where shortfalls or concerns were raised these were taken on-board and dealt with.

Blackwood had regular support from the district nursing team and GPs from the six local GP practices. This ensured people received appropriate care in a timely way.

Staff told the inspector that Blackwood was a happy place to work and that the manager and deputy manager were supportive. They said the staff team was a 'good team'.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe? People told us they felt safe. Complaints and reporting procedures were robust. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

People were not put at unnecessary risk, but also had access to choice and remained in control of decisions about their care and lives. The registered manager wrote the staff rotas and took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. Blackwood alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Blackwood had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). This helped to ensure that people's needs were met.

We inspected Blackwood's medication systems and found them to be in order. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective? People's health and care needs were assessed with them, although it was not always clear that they were involved in writing their plans of care. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people's needs.

Specialist dietary needs had been identified where required. Care plans were not always up-to-date. People who used the service, and their representatives, were not always involved in their care plan reviews. We saw people, or their representatives did not consistently sign care plan reviews to show they had read and agreed to the content of the care plan.

We saw that there was good liaison and communication with other professionals and agencies to ensure people's care needs were met.

Is the service caring? We spoke with four people who used the service and four visiting relatives. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, 'the staff are fantastic', they're [the staff] lovely'. When speaking with staff it was clear that they genuinely cared for the people they supported.

There was a complaints procedure for people who used the service, their relatives, friends and other professionals involved with the service. Where shortfalls or concerns were raised these were taken on-board and dealt with. People's preferences, interests, aspirations and diverse needs had usually been recorded although this was not always evident.

Is the service responsive? Many people who lived at Blackwood had complex health needs and were either not able, or not inclined, to join in group activities. The care records did not always evidence the lifestyle of these people, or show that they were routinely offered one-to-one or group activities.

People knew how to make a complaint if they were unhappy. Complaints were investigated and appropriate action taken as necessary. The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led? Blackwood had regular support from the district nursing team and GPs from the six local GP practices. This ensured people received appropriate care in a timely way.

We saw minutes of regular meetings held with the staff. This showed the management consulted with staff regularly to gain their views and experiences and used their views to improve support for people who lived at the service. Staff told the inspector that Blackwood was a happy place to work.

The service had a quality assurance system, and staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

We saw people's privacy and dignity being respected and staff being helpful. We saw people were spoken with in an adult, attentive, respectful, and caring way. We saw staff respond appropriately and respectfully to requests for assistance.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service were protected from the risk of abuse, because the staff were confident in their knowledge of the safeguarding process.

We saw there were sufficient staff to meet people's care needs, although there were a number of staff off sick at the time of the inspection.

Staff received professional development and supervision, and had good access to training opportunities.

Blackwood operated effective systems for monitoring the quality of the service provided.

People experienced care, treatment and support that met their needs and protected their rights.

People we spoke with said that they enjoyed the food they received. We were told the food was of a good standard, and we saw the food provided at lunch was hot, well presented and in sufficient quantities. We saw people were offered choices at meals.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found staff received appropriate professional development and supervision.