Blackwater Mill Residential Home

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.

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 53 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 July 2021 we found quality assurance systems had not been used effectively to identify areas for further improvement we noted during this inspection. At this inspection breaches of regulations were found including repeat breaches in relation to quality assurance, risk management and notifications. The key question Safe has consistently been rated requires improvement for the past 6 inspections.

The provider had failed to ensure CQC was notified about all incidents as required and the Duty of Candour had not been fully followed.

Individual risks to people had not all been assessed, recorded and updated. Environmental risks had also not all been fully assessed and actions identified to manage environment risks had not always been followed.

Systems were in place so that medicines were administered safely and as prescribed although we identified some further areas for improvements.

There were enough staff [care and ancillary staff] to support people's needs in a timely and unhurried way. Appropriate recruitment procedures had been followed to help ensure only suitable staff were employed. Staff had received training and support to enable them to carry out their role safely.

Infection prevention and control measures were in place and followed government guidance.

There were appropriate policies and systems in place to protect people from the risk of abuse and the registered manager and staff understood the actions they should take to keep people safe.

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.

People and their family members gave us positive feedback about the home and told us that staff were kind and caring. We observed positive interactions between staff and people.

People, their family members and external professionals said the registered manager was approachable and supportive. Staff were also positive about the registered manager.

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 11 August 2021) and there were breaches of regulation. The service remains rated requires improvement.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in July 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve risk management, governance and to ensure CQC were notified about all incidents as required.

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 Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same Requires Improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Blackwater Mill Residential Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to quality monitoring, risk management, notifications and Duty of Candour at this inspection.

We have added a condition to the providers registration requiring them to undertake regular formal quality monitoring and submit a monthly audit and action plan to CQC.

Please see the action we have told the provider to take at the end of this report in respect of the failure to notify CQC of injuries which required medical attention and failure to follow the Duty of Candour.

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

Blackwater Mill 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 54 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

Not all individual risks to people were assessed, recorded and updated when people's needs changed. This included risks resulting from people’s known health and care needs.

The provider’s quality assurance systems had not always been used effectively to either identify areas for improvement and/or to bring about effective improvement.

Appropriate recruitment procedures were in place however two references had not always been sought prior to staff commencing employment. There were enough staff to support people's needs. Staff had received training and support to enable them to carry out their role safely.

There were appropriate policies and systems in place to protect people from the risk of abuse and the management team and staff understood the actions they should take to keep people safe. However, not all safeguarding concerns had been reported as required to the local authority safeguarding team or to CQC.

People were supported to take their medicines safely and as prescribed. Infection prevention and control measures were in place and followed government guidance.

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.

People and their family members all gave us positive feedback about the home and told us that staff were kind and caring. We observed positive interactions between staff and people.

People, their relatives and external professionals said the management team were approachable and supportive. Staff were also positive about the management team.

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 Good (published 5 June 2019). At this inspection the overall rating has changed to Requires Improvement.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. 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 Blackwater Mill Residential Home on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of the service and the management of individual risks for people at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

Blackwater Mill is a residential care home that provides accommodation and personal care to 60 older people. Blackwater Mill provides a service for people living with dementia and or a physical disability who do not require nursing care.

People’s experience of using this service:

People were happy living at Blackwater Mill. They told us their needs were met by staff who were kind and caring. People were treated with dignity and respect.

Most individual risks were managed appropriately, however we identified some concerns in how risks to people were being recorded and acted upon by staff.

Medicines were usually managed safely and people received the personal care they required. They were involved in the development of their personalised care plans that were reviewed regularly. Staff worked with local health and social care professionals to ensure health care needs were known and met.

People could make their own choices and decisions and their legal rights and freedoms were upheld. When people lacked the ability to make their own decisions, systems were in place to ensure these were made legally and in their best interests.

There were sufficient numbers of staff who had received necessary training, worked well together and received formal and informal supervision from senior staff.

The management team continually considered ways to improve the service for the benefit people living there. Where we identified areas for improvement, they acted immediately.

The service met the characteristics of Good in most areas and is rated Good overall. More information is in the full report.

Rating at last inspection:

The service was rated as Requires Improvement at the last full comprehensive inspection, the report for which was published in May 2018.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Follow up:

We will continue to monitor the service.

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

This inspection took place on 7 and 8 March 2018 and was unannounced.

The home accommodates up to 60 people and at the time of our inspection 55 people were living at the home. The home was based on three floors connected by two passenger lifts. There was a choice of communal spaces where people were able to socialise and all bedrooms had en-suite facilities.

There was a registered manager in post at the service. 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.

There were quality assurance systems in place based on a range of audits. However, we found these had not always been effective in ensuring compliance with the regulations. We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

People and their relatives had mixed views about the staffing levels. Staff aimed to answer people’s call bells within seven minutes, but the provider was unable to provide assurance that this was quick enough when people had activated an alarm mat and had moved to an unsafe position.

Appropriately arrangements were in place to manage medicines safely. However, we found staff did not always record the use of topical creams.

Effective systems and processes in place to protect people at risk of abuse. However, two staff members we spoke with did not understand their safeguarding responsibilities.

Most areas of the home were clean and there were systems in place to protect people from the risk of infection, although there was a build-up of potentially contaminated linen in the laundry that posed a risk of cross infection.

New staff did not always receive appropriate training to equip them for their roles until they had worked at the home for over six months. However, experienced staff were competent, received regular training and were supported appropriately.

People told us the structure of the home was supportive of their needs. However, we found excessive noise levels in the dining room, where many people spent a lot of their time. There was a risk that these could adversely affect people living with dementia.

Staff followed legislation designed to protect people’s rights. However, were not aware of the people whose freedom had been restricted by law. This posed a risk that restriction might inadvertently be applied to other people.

Most people told us staff cared for them in a compassionate way, but we found this was not the case in two instances we observed. However, at all other times staff interacted positively with people.

Some staff built positive relationships with people and their families. They used appropriate techniques to communicate effectively, promoted independence and involved people in decisions about their care.

With the exception of one person whose needs staff were struggling to meet, all other people received personalised care that met their needs. Care plans contained detailed information and were reviewed regularly.

Staff demonstrated a good awareness of people’s needs and responded promptly to any changes. People’s nutrition and hydration needs were met and people were supported to access a range of activities.

Staff supported people to access healthcare services, including when they were admitted to or discharged from hospital. People were supported at the end of their lives to have a comfortable, dignified and pain-free death.

Risk assessments had been completed for individual and environmental risks to people, together with action staff needed to take to reduce the risks. The provider had a contingency plan to deal with foreseeable emergencies. Staff knew what to do in the event of a fire and had been trained to administer first aid.

People enjoyed living at Blackwater Mill and felt the service was run well. The provider sought and acted on feedback from people. A complaints procedure was in place and people felt able to raise concerns.

There was a clear management structure in place. Staff were organised and completed delegated tasks in an efficient and effective way. Appropriate recruitment procedures were in place and followed.

Visitors were made welcome at any time. Staff acted in an open and transparent way when accidents occurred and the registered manager notified CQC of all significant events.

There was a registered manager in place. 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 our last comprehensive inspection, we identified there were not enough staff deployed to meet people’s needs. We issued a warning notice and told the provider to make improvements. We followed this up at a focused inspection in April 2016. At that time, we found some improvements had been made, but there were still not enough staff deployed to meet people’s needs at all times. We issued a requirement notice and the provider sent us an action plan telling us how they would meet the regulation.

At this inspection, we found there were enough staff deployed to meet people’s needs and call bells were answered promptly. However, the service experienced a high level of staff turnover during the past year and needs to demonstrate that it can sustain an appropriate level of staffing to enable them to meet people’s needs consistently.

There were appropriate arrangements in place for the safe handling, storage and disposal of oral medicines. However, topical creams were not always managed safely. Some were out of date or not available and records indicated they had not always been applied.

Most people were positive about the standard of care delivered. However, some were critical of the communication skills of staff whose first language was not English. We were not assured that all staff were able to understand people’s needs and communicate with them effectively.

People were complimentary about the meals and most people’s nutrition and hydration needs were met. Staff monitored the amount people ate and drank and took action if their intake was not sufficient. However, people’s preferred foods were not always provided when they declined the food that was offered.

Staff followed legislation to protect people’s rights and freedom, although applications to restrict the liberty of two people had not been submitted in a timely way. This meant they were subject to restrictions that had not been authorised.

People were cared for with kindness and compassion. We observed positive interaction between people and staff. Staff supported people to build friendships and maintain relationships that were important to them. They respected people’s privacy and involved them in planning the care and support they received.

People told us they felt safe at Blackwater Mill and recruitment practices helped ensure only suitable staff were employed. Staff knew how to identify and report safeguarding concerns.

Individual and environmental risks to people were managed appropriately. There were plans in place to deal with foreseeable emergencies. Staff knew what action to take in the event of a fire and fire safety systems were tested regularly.

Staff received appropriate training and support for their roles. New staff followed a comprehensive induction programme and all staff were supported to obtain relevant qualifications.

People were supported to access healthcare services and staff followed medical advice. Care plans were comprehensive and reviewed regularly. Staff demonstrated a good awareness of people’s individual support needs and responded promptly when people’s needs changed.

Staff encouraged people to make choices about every aspect of their lives. People had access to a wide range of activities, including one-to-one activities with dedicated activity coordinators.

People were positive about the management of the home. There was a clear management structure in place. Staff were organised and understood their roles. Senior staff were experienced and demonstrated a commitment to providing high quality, compassionate care to people.

There was an effective quality assurance process in place to assess and monitor the service. The provider sought and acted on feedback from people to improve the service and there was an appropriate complaints procedure in place.

There was an open and transparent culture. Visitors were welcomed at any time. Managers were visible and notified CQC of all significant events.

We found staffing arrangements had improved, but there were still insufficient staff deployed to meet the needs of all people all of the time.

The home provides accommodation and personal care for up to 51 people, including people living with dementia. There were 49 people living at the home when we visited. Accommodation is spread over three floors, connected by two passenger lifts and stairwells. All rooms have en-suite toilet and washing facilities. There is a dining room on the ground floor and a selection of lounges on other floors.

There was a registered manager in place. 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 relatives had mixed views about the availability of staff. Whilst some felt they were adequate, others felt there were not enough staff to ensure their needs were always met in a timely way. Two people said they had not received the help they needed to get to the bathroom in time. Another person said they were not supported to bathe as frequently, or at the times, that they preferred.

Care staff felt that staffing levels had improved and that they were able to meet people’s needs at all times. The registered manager based staffing levels on the needs of people and an analysis of when accidents occurred. As a result, they had increased the number of care staff at certain times to enable them to better meet people’s needs.

Safe recruitment processes were in place and the provider conducted essential pre-employment checks to help make sure staff were suitable to work at the home.

We identified a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.