Bluebell Nursing & Residential Home

Bluebell Nursing and Residential Home is a care home providing the regulated activities of personal and nursing care to up to 80 people. The service provides support to older people, people living with dementia and those people who require nursing care. At the time of our inspection there were 80 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support:

Improvements were required to assess people’s mental capacity, supporting decision-making and best interest decision-making. We have made a recommendation about this. Staff supported people to take part in social activities. People benefitted from an environment that met their needs. Staff communicated with people in ways that met their needs. Staff supported people with their medicines in a way that promoted their health outcomes.

Right Care:

Information about risks for people using the service were not routinely identified but there was nothing to suggest the lack of information impacted on the delivery of care provided. People had a care and support plan. Staff understood how to protect people from abuse and harm. Staff had received training on how to recognise and report abuse. There were enough appropriately skilled and competent staff to meet people’s needs. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. People were protected by the service’s infection, prevention, and control of infection arrangements.

Right Culture:

Governance processes were generally effective, but improvements were required to ensure shortfalls were identified and addressed at the earliest opportunity. The registered manager had the skills, knowledge, and experience to perform their role. Staff gave honest information and suitable support, and applied duty of candour where appropriate. Feedback and complaints were dealt with in an open, transparent, and timely way. The provider sought feedback from people, those important to them, staff and professionals and used the feedback to develop 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 the service under the previous provider was Good, published on 25 July 2021.

Why we inspected

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. 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.

Bluebell Nursing and Residential Home is a residential care home providing personal and nursing care to people aged 65 and over. At the time of the inspection there were 64 people living at the service. The service can support up to 80 people. The care home accommodates people in one adapted building.

The care home accommodates people across three separate floors, each of which has separate adapted facilities. The ground floor unit caters for people who require residential care. The first-floor unit provides accommodation for people with nursing care and complex needs. The second floor specialises in providing care for people living with dementia.

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

Quality assurance and governance arrangements at the service had improved since our last inspection in June 2019. Improvements were required to some aspects of medicines management, staff training and staff’s practice relating to offering people choice and treating them with dignity and respect when assisting people to eat.

Risks were identified and recorded. People told us they were safe and suitable arrangements were in place to protect people from abuse. Staff understood how to raise concerns and knew what to do to safeguard people. People were protected by the service's prevention and control of infection practices and from the risk of transmission of COVID-19 and other infectious diseases. The environment was clean and well maintained. Lessons were learned and improvements made when things went wrong.

Most staff received mandatory training. Staff felt valued and supported by the management team and received regular supervision. The dining experience for people was good and people received enough food and drink of their choice to meet their needs. People were supported to access healthcare services and receive ongoing healthcare support. The service worked with other organisations to enable people to receive effective care and support. 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.

Staff had a good rapport and relationship with the people they supported, and observations demonstrated people received a good level of care. People’s care and support needs were documented in an individual plan. Staff had a good understanding and knowledge of people’s needs and the care to be delivered.

We have made a recommendation about choice and dignity.

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 September 2019) and there were four breaches of regulation. 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 these regulations.

You can see what action we took at the end of the report.

Why we inspected

This was a planned inspection based on the previous rating.

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.

We undertook this focused inspection to check they 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 of Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved 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 Bluebell Nursing & Residential Home on our website at www.cqc.org.uk.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bluebell Nursing and Residential Home is a residential care home providing personal and nursing care to people aged 65 and over. At the time of the inspection there were 68 people living at the service. The service can support up to 80 people.

The care home accommodates people in one adapted building. The care home accommodates people across three separate floors, each of which has separate adapted facilities.

The ground floor unit caters for people who require residential care. The first floor unit provides accommodation for people with nursing care and complex needs. The second floor specialises in providing care for people living with dementia.

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

Not all risks for people using the service were identified and staff’s practice did not ensure people’s safety and wellbeing. Though people and their relatives told us there were not always enough staff available, staffing levels were appropriate during both days of inspection. Further action was still required to make sure the premises was clean.

Not all staff employed at the service had received appropriate training or felt their induction was robust. Staff supervision and support was not consistent since January 2019. Though people received enough food and drink, the dining experience across the service was variable. The service monitors people’s healthcare needs but not consistently follows-up on issues identified. The premises meets people’s needs but improvements are required on the Memory Unit on the second floor to comply with the Accessible Information Standard.

People and relative’s comments about the quality of care received was variable across the service. Our findings suggested people were not always treated respectfully. Staff do not sit and talk with people for a meaningful length of time or always explain things clearly.

Though each person had a plan of care detailing their care needs and how these were to be met by staff, shortfalls were identified in the information recorded. People’s end of life care plans were poorly completed and not all staff were aware of who had been assessed as requiring end of life care support. People are not always supported to follow their interests or to take part in social activities. The service is not fully compliant with the Accessible Information Standard to ensure it meets people’s communication needs. There was a low incidence of complaints and people were assured any concerns voiced would be listened to and actioned.

Governance arrangements were not reliable or effective and improvements were required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was requires improvement (published November 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made and the registered provider was still in breach of regulations.

The service remains rated requires improvement. The service has been rated requires improvement for the last two consecutive inspections.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

This inspection was completed on the 5 and 6 September 2018 and was unannounced. At the time of the inspection, there were 71 people living at Bluebell Nursing and Residential Home.

At the last inspection on 26 and 27 April 2017, the service was rated ‘Requires Improvement’. One breach of regulation was highlighted and this referred to Regulation 12 [Safe care and treatment]. The breach of regulation specifically related to poor medication practices and procedures. At this inspection we found that medication practices and procedures had improved and compliance achieved.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines. This meant people received their prescribed medicines as they should and in a safe way. The registered provider had made the required improvements since our last inspection to the service in April 2017.

Current national guidance and standards in relation to infection control required improvement. Improvements were also required to the physical environment of the service as some areas relating to the environment required redecoration and improvement. The Memory Unit had not been adapted to meet people’s needs, particularly for people living with dementia. Not all people’s care and support needs were sufficiently detailed or accurate, however we recognised this was a records-based issue and there was no impact to demonstrate people’s care and support needs were not being met.

The service 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 the service was a safe place to live and there were sufficient staff available to meet their care and support needs. Appropriate arrangements were in place to recruit staff safely. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed to ensure their safety.

Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs to ensure theirs’ and others’ safety.

Staff received opportunities for training and this ensured staff employed at the service had the right skills and competencies to meet people’s needs. Newly employed staff received a robust induction based on their level of experience in a care setting. Staff felt supported and received appropriate supervision at regular intervals and an appraisal of their overall performance. Staff demonstrated a good understanding and awareness of how to treat people with respect, dignity and to maintain their independence.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The registered manager was working with the Local Authority to make sure people’s legal rights were being protected. People who used the service and their relatives were involved in making decisions about their care and support.

Where people were at risk of poor nutrition or hydration, this was monitored, and appropriate healthcare professionals sought for advice and interventions. People had their nutritional and hydration needs met. People told us that their healthcare needs were well managed. Staff were friendly, kind and caring towards the people they supported, and care provided met people’s individual care and support needs.

People and their relatives told us that if they had any concern they would discuss these with the management team or staff on duty. People were confident that their complaints or concerns were listened to, taken seriously and acted upon.

Quality assurance arrangements at the service were satisfactory and although issues relating to the environment and infection control required improvement, action was taken by the registered manager to address these.

We have made a recommendation about the premises, particularly for people living with dementia.

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

The inspection was completed on the 26 and 27 April 2017 and was unannounced. At the time of the inspection there were 73 people using the service.

The service had a registered manager in post at the time of our inspection. 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 arrangements for the effective management of medicines required improvement as not all people who used the service received their prescribed medication and staff’s practice relating to the administration and recording of medication was not safe.

Although quality assurance systems were in place to assess and monitor the quality of the service provided, improvements were required to ensure that where issues were highlighted and required addressing, action plans were devised and completed to show that these were acted upon in a timely manner. Whilst people were positive about the management arrangements at the service, suitable arrangements were required to ensure that ‘on call’ systems and the day-to-day management of the service when the registered manager is on annual leave or has an extended period of leave is clear and roles and responsibilities of people in charge defined and not ambiguous.

People told us the service was safe and relatives told us they had no concerns about their member of family’s safety. Staff were able to demonstrate a good understanding and knowledge of a person’s specific support needs, so as to ensure their and others’ safety. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow.

People told us there were sufficient staff available to meet their needs. Suitable arrangements were in place to ensure that the numbers and skills of the staff team were effective in meeting the needs of the people they supported. Appropriate arrangements were in place to recruit staff safely so as to ensure they were suitable to work with and support people in their care.

People benefitted from a staff team that were trained to meet the needs of people using the service. We saw from their interactions, facial expressions and mannerisms that people were content, comfortable and relaxed in staffs company. Staff were seen to be warm and caring towards the people they supported and were treated with compassion. People confirmed they were also treated with respect and had their privacy and dignity upheld at all times.

Care plans were sufficiently detailed and provided an accurate description of people’s care and support needs. Risks to people’s health and wellbeing were assessed, managed and revised where appropriate. Suitable assessments had been carried out where people living at the service were not able to make decisions for themselves and to help ensure their rights were protected.

People were supported to be able to eat and drink sufficient amounts to meet their needs. The dining experience was positive. People’s healthcare needs were supported and people had access to a range of healthcare services and professionals as required.

There was an effective system in place to respond to comments and complaints.

Bluebell Nursing and Residential Home provides accommodation and personal care for up to 80 people who require nursing care and people living with dementia. The service is situated over three floors and includes a residential unit on the ground floor, a nursing unit on the middle floor and a dementia unit on the top floor.

A registered manager was 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 suitable arrangements were in place to manage the majority of identified risks, improvements were required in relation to the pressure mattress settings so as to ensure that these were aligned to people’s weight.

Improvements were required to show that the provider’s own quality assurance systems effectively analysed and evaluated information so as to identify where quality or safety for people using the service was compromised and to drive improvement. The management team were not aware that several members of staff had not received up-to-date manual handling training or training relating to the management and prevention of falls.

The service managed incidents and accidents well in an open, transparent and objective way. There was no evidence to suggest that where incidents and/or accidents had occurred, all appropriate steps had not been taken to try and safeguard people for their health and wellbeing. Although there were some occasions whereby staffing levels were not maintained, there was no evidence to show that this impacted on the safety of people using the service nor did reduced staffing levels correlate with any significant incidents or accidents.

Where people could become anxious or distressed staff supported them to manage their behaviour and care plans provided appropriate guidance for staff to follow to ensure theirs and other’s safety and wellbeing.