Blackwater Mill Residential Home

Updated 19 August 2023

The inspection

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.

Inspection team

The inspection was completed by one inspector and an Expert by Experience who made phone calls to relatives of people living at the service. 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

Blackwater Mill Residential Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Blackwater Mill Residential Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the start of our inspection there was a registered manager in post, however they had been absent from the service. Therefore, the day to day running of the service was being managed by the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Notice of inspection

This inspection was unannounced. Inspection activity started on 27 July 2023 and ended on 11 August 2023. We visited the location on 27 July and 2 and 4 August 2023.

What we did before the inspection

We reviewed the information we held about the service, including the previous inspection reports and the action plans the provider was required to send us monthly, as part of the conditions added to their registration following the last inspection. We also reviewed any notifications we had received about the service. Notifications are information about specific important events the service is legally required to send to us.

We used the information the provider sent us in the provider information return (PIR). 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 this information to plan our inspection.

During the inspection

We spoke with 14 people who used the service about their experience of the care provided and 17 relatives. We also spoke with 14 members of staff including the nominated individual, deputy manager, 2 support managers, 2 members of the housekeeping team, 2 members of the kitchen team and 6 care staff.

We observed the care provided and also 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 reviewed a range of records, including 8 people's care records in detail, and specific areas of 6 other people's records. Three staff files were reviewed in relation to recruitment. A variety of records relating to the management of the service, including audits, training, staff rotas and policies and procedures were also reviewed. We received feedback from 3 healthcare professionals and 3 social care professionals.

Updated 19 August 2023

About the service

Blackwater Mill Residential Home is a care home providing accommodation for up to 60 people in one building, some of whom are living with dementia. At the time of our inspection, there were 51 people living in the service. Blackwater Mill provides all single bedrooms and a range of communal facilities.

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

Whilst improvements had been made since the previous inspection in January 2023, we found quality assurance systems had not been effective to ensure all areas that required improvement were identified and acted upon.

Individual risks to people were not always safely managed and we could not be assured risks to people were mitigated effectively. Specific risk assessments in relation to people’s health conditions had not always been developed. In addition, information in people’s care records was confusing and contradictory at times. People received their oral medicine appropriately; however, we could not be assured prescribed topical creams and ointments were applied as needed. Action was taken immediately by the management team to address these issues.

Environmental risks were monitored and managed safely. Appropriate recruitment procedures were in place and there were enough staff to support people's needs. There were appropriate policies and systems in place to protect people from the risk of abuse and for the management of infection, prevention and control which were followed by the staff team.

Some action had been taken to support people living with dementia or poor vision. However, we recommended the registered person seek advice and guidance from a reputable source to ensure additional adjustments would be made to the environment to support the people living there.

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 received appropriate training and support to enable them to carry out their role safely. People were supported to eat a varied and nutritious diet based on their individual preferences and had access to food and drink throughout the day and evening.

People were happy living at Blackwater Mill and people and relatives were complimentary about the service, describing the staff as kind, caring and responsive. People's needs were met in a personalised way. Apart from some needs relating to people’s health, staff knew the people well and had a good understanding of their needs and wishes. People were supported to partake in a range of activities centred around their interests.

CQC were notified of all significant events that occurred in the service and the previous performance rating was prominently displayed on the premises as per requirements. The service worked in collaboration with all relevant agencies, including health and social care professionals. This helped to ensure there was joined-up care provision.

Throughout the inspection the management team showed a commitment to wanting to provide people with person centred, safe and effective care. They were open, transparent and responsive throughout the inspection.

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 requires improvement (published 30 March 2023) and there were breaches of regulation. Due to the breaches identified CQC added conditions to the providers registration requiring the provider to send us monthly action plans. Although these action plans had been received as required, at this inspection not enough improvement had been made and the provider was still in breach of regulations. The service remains rated requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, management of health needs and the cleanliness of the home. A decision was made for us to inspect and examine those risks.

Following our inspection, we have found evidence that the provider needs to make improvements and the overall rating for the service has remained requires improvement.

Enforcement and Recommendations

At this inspection we identified 2 repeat breaches of regulation including, Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

We have also made 1 recommendation in respect of ensuring additional adjustments would be made to the environment to support the people living there.

Additionally, the key question Safe has consistently been rated requires improvement for the past 7 inspections, this has been considered in CQC’s regulatory response.

We will continue to monitor the service through the conditions we imposed on the provider’s registration at our last inspection requiring the provider to send us monthly improvement plans.

Follow up

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 continue to request and review the monthly action plans from the provider in line with their conditions of registration. We will continue to monitor information we receive about the service, which will help inform when we next inspect.