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Inspection carried out on 14 August 2019

During a routine inspection

About the service

Blackwells is residential care home providing personal care for up to seven people who have learning disabilities, aged up to 65 and over at the time of the inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to seven people. Seven people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People's individual risks had been assessed and action taken to mitigate them to ensure people stayed safe.

Staff administered people's medicines safely. Staff provided people with support to have the medicines they needed to remain well, and people's medicines were regularly reviewed and checked.

People were supported to enjoy a wide range of activities which reflected their own personal interests and enhanced their lives.

People, their relatives, staff and other health and social care professionals worked together to assess people's needs and plan their care. This was done so people's support and preferences would be met, and they would enjoy an enhanced sense of well-being.

People were supported by staff to make decisions about their care and support. Staff used their knowledge of people's preferred ways of communicating, to assist people to make their own choices.

Staff promoted people's right to independence, dignity and respect.

People, their relatives and staff were encouraged to make any suggestions for developing the care provided further.

The provider and registered manager checked the quality of care provided through quality audits.

Rating at last inspection

The last rating for this service was Good [published in 10 February 2017]

Why we inspected

This was a planned inspection based on the previous rating.

For more details, please see the full report which is on the CQC website at

Inspection carried out on 18 January 2017

During a routine inspection

Blackwells is located in Hereford, Herefordshire. The service provides accommodation and care for up to seven adults with physical disabilities, learning disabilities, mental health conditions and autistic spectrum disorders. On the day of our inspection, there were seven people living at the home.

The inspection took place on 18 January 2017 and was unannounced.

There was a manager in post, who had applied to the Care Quality Commission to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 were involved in decisions made about keeping them safe. The manager and staff understood the importance of looking at ways of minimising restrictions on people's freedom. Where safe to do so, people were given the option of administering their own medicines.

People enjoyed a varied diet and were involved in planning and choosing their meals. Where people needed specific assistance with eating and drinking, this was provided. People received specialist input from a range of health professionals in order to maintain and improve their health and wellbeing.Staff were skilled in supporting people with a range of behaviours and worked with people to reduce these.

People enjoyed their relationships with staff. People were involved in decisions about their care and support, including being involved in reviews of their care. People were treated with respect, and their right to privacy was upheld. People's individual communication needs were known by staff, and staff knew how to communicate with people in ways which would not result in frustration or anxiety.

People's individual needs, preferences and personalities were known and embraced by staff. Ways were found to maintain people's cultural and social identifies. People were encouraged to provide feedback and suggestions, and were also made aware of their right to raise a formal complaint.

There was a positive culture at the home, with a focus on people's independence and freedom. People's opinions and ideas were sought about the running of the home, and acted on. There were systems in place to monitor the quality of care provided and ensure that high standards were maintained.

Inspection carried out on 13 January 2015

During a routine inspection

The inspection took place on 13 January 2015, it was unannounced.

The home provides accommodation and personal care for up to seven people who have a learning disability or mental health needs. At the time of the inspection seven people were living at the home.

It is a requirement that the home has a registered manager. There was a registered manager in post who was registered with us in February 2014. 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 and their representatives were involved in planning and reviewing care arrangements. Professional advice had been appropriately sought in several cases to assist in care planning.

People liked the staff that supported them and they felt safe and relaxed at the home. Staff knew people well and understood their methods of communication and responded to these. Staff respected people’s differences and treated them with respect. People felt staff were caring when they were ill. They were supported to make choices about how they wanted to spend their time and communication aids were used to help people understand information.

The registered manager had acted in accordance with the Mental Capacity Act 2005 and when people lacked capacity care decisions had been made in their best interest. They had also acted in accordance with the Deprivation of Liberty Safeguards (DOLS). Some restrictive practices that had been in place for a long time had been ended and people were empowered to be more independent. People were supported to make choices about what they ate and to be involved in making their own meals and drinks. A healthy diet was encouraged. They were enabled to access health services including routine preventive health checks.

People were supported by a sufficient number of staff that they liked and found helpful. The background of new staff were checked before they were employed and staff induction and training was provided to help them meet people’s needs. Staff knew how to support people and help them stay safe. They understood their responsibility to protect people from harm and how to report any abuse. People’s safety and risks were considered when their care was planned and their medicines looked after.

People felt the service was well run and they were asked their views. They and staff felt able to raise any issues with the registered manager and provider. There was a clear management structure in place and the provider was monitoring the service. The environment had been improved during 2014 and people were involved in decisions about the service. Complaints were taken seriously and responded to.

Inspection carried out on 3 July 2013

During a routine inspection

People told us they felt safe in the home and were well supported. We found that people were supported to be independent, be involved in activities of their choice and access local community facilities.

The majority of the staff team knew people and their preferences well. People�s wellbeing and any concerns were taken seriously. Information was shared effectively between staff.

People were being supported safely with their medicines.

People were complimentary about the service and felt they could raise any concerns with staff or the manager. The staff were suitably trained and felt supported. The team sought input from external professionals when needed and worked closely with them taking on their advice.

The manager and provider formally monitor the quality of the service. There were effective leadership arrangements in place to manage the care service and monitor health and safety risks.

Inspection carried out on 12 April 2012

During a routine inspection

When we visited the home in September 2011 we had concerns in the five outcome areas we inspected. The registered manager provided an action plan to show improvements would be made. As part of this inspection we looked at how the action taken had led to better outcomes for people living at Blackwells.

At this inspection we met six people who lived at the home and we spent time talking with two of them about their life. We spoke to a relative of one person and two of the care staff on the telephone. We spent time with the registered manager and asked external professionals involved with the service for their views.

We found that people�s diversity, values and human rights were respected. The care staff we spoke with talked about the people in the home in a caring and

respectful way. They understood that people had different needs and could cope with different pressures due to their learning disability or mental health needs. We saw that care staff offered people choices such as how to spend their day, while care staff also encouraging good daily routines such as bathing and changing clothes.

Systems were in place to involve people in decisions about their lives. One example was that each person had two care staff designated as their keyworkers. This role involved meeting with the person who lived in the home at least monthly to check if they had any concerns, goals or ideas they needed support with.

We saw the feedback surveys that had been returned to the home in January and April 2012. The results were positive. The relative of one person who lived in the home had written, �I am very satisfied with the overall care and support my relative receives, my relative always seems happy and content when I visit and always has plenty of activities planned�. A consultant psychiatrist who visits monthly had given positive feedback, for example, they had ticked �consistently high quality performance�, and, �friendly and professional staff�. A visiting health professional had written, �the manager is very committed to providing an excellent service and works well with other agencies�.

One person�s relative told us, �We visit monthly and we always find our relative clean and well dressed, the care is generally good. There seems to be enough staff on duty�.

We found that people were supported in promoting their independence and community involvement. One person we spoke with told us, �The staff are great and I get on well with my keyworker. I am going out more, I went to town yesterday and today. I am cooking my own food now using recipe cards and I am doing my laundry now without staff support�.

The registered manager told us that a lot of work had been done to increase the opportunities provided to people to develop life and independence skills. Examples given were food shopping, drink and meal preparation, carrying plates out after a meal, doing personal laundry or dressing unaided. We saw a sample of care plans and daily records that confirmed this new way of working. Care staff gave us positive feedback about how people�s needs were met. One told us, �We now have enough staff to meet people�s social needs, the care is personalised and we always meet people�s physical care needs. We are definitely working more to develop people�s independence skills�.

One person we spoke with told us, �Yes, I feel safe here and I can lock my bedroom door. I would tell staff the staff if I had any worries�. At the time of our last inspection one person had made a complaint about how they had been treated by a care worker. The registered manager took appropriate action and promptly made a safeguarding alert to the local authority. The care staff we spoke to were aware of their responsibilities and said the culture in the home was one where poor practice would be reported. Safeguarding alerts had been made that demonstrated this.

The registered manager told us that the number of care staff in the team had been increased which made covering for short notice sickness much easier. For a three month trial starting in April 2012 an additional care worker would be on duty at peak times. They felt this would mean each person could be offered an outing each day.

We saw the staff on duty engaging positively with people during our visits. People

seemed relaxed with the care staff and wanted to spend time with them. One person we spoke with told us, �I like all the staff, they know the things I like to do�.

A community based Speech and Language Therapist told us, �The staff at Blackwells have been keen to access training on Total Communication, Dysphagia and Singalong signing�. The registered manager showed us a training chart they used to help monitor each worker�s training needs. This showed that gaps in training needs had been addressed. Care staff had attended training since our last inspection and other courses were booked or were awaiting the next available date.

One person we spoke to said they felt able to tell care staff and the registered manager if they had any problems. When they had raised a concern in September 2011 the registered manager took this seriously and took appropriate action.

One person�s relative told us, �We feel able to raise any issues but have not had any lately�.

Inspection carried out on 19 September 2011

During a routine inspection

People in the home were being well supported with their health needs and health care professionals were being involved when this was needed.

We saw support staff talking to people living in the home in a friendly and helpful way. The people living in the home who spoke with us said they liked the staff.

We saw a support worker make sure a person�s dignity was protected while she assisted them with a personal care task.

Support staff asked people for their views and ideas for meals and activities. People were being encouraged to get involved with some aspects of home life. This may be an area that can be developed.

Some people may benefit from more opportunities to access the community and take part in planned activities based on their interests.

People had free access to their bedrooms which had been nicely personalised and contained hobby items such as stereos and gaming equipment.

The home environment was generally well maintained and the owners had plans to improve the communal areas.

When people living in the home and care workers had raised concerns managers had listened to them and taken action to put things right.

The people in the home were being supported by a team of support staff who had good morale, enjoyed their role and felt well trained and supported.

The level of support staff on duty during the day may need to be increased as the needs of some people in the home were changing and new people had moved in.

The registered manager told us she wants people in the home to have as many freedoms and choices as possible. She took prompt action to address areas on concern we informed her about following our visit.

People in the home were being protected by the company checking the service and introducing changes with the aim to continually improve Blackwells.