Archived: Alternative House Care Home Blackburn

Feng Shui House (Blackburn) is a residential care home providing accommodation and personal care to up to 16 people in one adapted building. At the time of our inspection there were 15 people using the service.

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

There were not always sufficient staff deployed to meet people's needs. People did not receive the support they required in a timely manner. Improvements had been made to the building, furnishings and decorations. The required health and safety servicing and certification had taken place, but checks undertaken by managers and the provider had not identified shortfalls found during the inspection. These included; dirty and untidy laundry, unsafe storage of combustible materials, risks to people’s health and safety in relation to blocking of the means of escape in case of fire, and hazardous substances being accessible to people who used the service. People’s dignity and privacy was not always respected or promoted. Further improvement was needed to systems for auditing, assessing, monitoring and improving the quality and safety of the service.

We have made recommendations about ensuring training records are accurate and ensuring appropriate activities are taking place.

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. Records indicated that people's consent to care and support was sought. Care records showed people, and where appropriate their representatives, had been involved in decisions about their care. Where appropriate those with legal authority were involved in decisions.

There were safe systems of recruitment in place. Person centred risk management plans were in place to guide staff on the action to take to mitigate risks and records. Communal areas and bedrooms were clean and tidy.

Staff told us they felt supported and they received supervision. People were supported with their health care needs. People’s nutritional needs were met and people were positive about the food.

Staff and manager’s we spoke with knew people well. They spoke in kind and caring terms about the people they supported.

Care records were person centred and gave sufficient information to guide staff on the support people needed and how support should be provided. There was a system for managing complaints. People told us they could raise any concerns.

Prior to our inspection the provider had identified some shortfalls and had employed a support manager temporarily to help with the required improvements. The support manager and manager were very honest, open and responsive during our inspection. They took immediate action to resolve concerns. People told us the manager was approachable. Policies and procedures were available to guide staff on what was expected of them in their roles.

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 7 April 2022) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

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.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement and Recommendations

We have identified breaches in relation to staffing, health and safety, dignity and respect and governance at this inspection. We have also made 2 recommendations.

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 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.

The overall rating for this service is ‘requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'inadequate' in any Key Question over 2 consecutive inspections. The ‘inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement 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. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

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 it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Feng Shui House (Blackburn) is a residential care home providing accommodation and personal care to up to 16 people. At the time of our inspection there were 13 people using the service.

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

Systems in place for staff recruitment were not sufficiently robust. Staff files did not all contain the required pre-employment checks to ensure fit and proper people were employed. Health and safety checks were being carried out, but we found areas of the home that were not properly maintained or cleaned. Training records did not all accurately reflect training that staff had completed and staff had not received all the training required to undertake their duties effectively.

We observed some staff wearing face masks inappropriately whilst supporting people who used the service. We found that not all staff had received PPE or COVID-19 training. There was a range of audits and monitoring in place, but they were not sufficiently robust and systems for ongoing quality monitoring had not identified the breaches of regulation found during the inspection.

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.

There were sufficient staff to meet people’s needs. People felt safe living at the home, staff knew how to raise concerns. Medicines were managed and administered safely. Risks to people were identified and reviewed regularly.

The provider was managing the risks associated with COVID-19. Regular COVID-19 testing was taking place. There were supplies of personal protective equipment (PPE) readily available to staff and visitors. People were supported to have visitors as per government guidance. The service was meeting the requirement to ensure non-exempt staff and visiting professionals were vaccinated against COVID-19. People’s needs were assessed before they started to live at the home. People were positive about the food provided.

People and their relatives said the care and support people received was caring and kind and the home has a ‘family’ feel to it. We observed staff supported people respectfully and with kindness. Staff were very positive about the provider and the new management team. Staff spoken with said managers of the service and the provider are very approachable.

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 17 February 2020 ).

Why we inspected

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We received concerns in relation to recruitment processes, training records, unclean environment and poor care. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Feng Shui House (Blackburn) 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 identified breaches in relation to premises and equipment, staff recruitment, staff training and systems of governance for the monitoring and oversight of the service at this inspection.

We have taken enforcement action. 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 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.

We found that the service had not implemented the recently updated Government guidance on visiting in care homes, which advises that from 8 March 2021, people can receive regular visits from a nominated family member or friend. The home had remained Covid-free during the pandemic and the registered manager had restricted visiting during the national lockdown in an effort to keep people safe. He understood our concerns and implemented the guidance shortly after our inspection.

We found the following examples of good practice:

Staff wore appropriate personal protective equipment (PPE) to ensure people were protected as much as possible from the risk of cross infection. There were a number of PPE stations located around the home and staff had completed training on how to put on and take off PPE safely. Enhanced cleaning was being completed to ensure the home remained clean and the risk of cross infection was reduced. Regular infection prevention and control (IPC) audits were being completed to ensure appropriate standards of hygiene were being maintained at the service.

People living at the service and staff were being tested for Covid 19 regularly, to ensure that appropriate action could be taken to keep people safe if anyone contracted the virus. Contingency plans were in place to manage any outbreaks appropriately.

Feng Shui House Blackburn is a residential care home providing personal care to 12 people aged 65 and over at the time of the inspection. The service can support up to 16 older people. Accommodation is provided in a detached house with bedrooms on two floors.

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

People felt safe in Feng Shui House Blackburn and had no concerns about the care they received. There were enough staff to meet people’s needs and staff had time to engage then in conversation. Medicines were managed safely and the home was clean. The provider had systems to assess and manage risks. People had personal pendant alarms to alert staff if they needed support.

People were supported by staff who were skilled and knowledgeable about their needs. Staff told us they felt well supported by the registered manager and received the training they needed. People told us they liked the food and the registered manager had systems to assess and monitor people’s nutritional needs. 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 told us staff were kind, caring and respectful towards them. Relatives also confirmed they found staff to be very caring and treated people as if they were part of their family. Staff encouraged people to be as independent as possible and involved them in decisions about their care.

People told us staff knew how they liked to be supported and offered them choices. Care plans contained information on people’s health and communication needs as well as their family background, spiritual needs and social interests. The registered manager reviewed all care plans at least monthly to ensure they accurately reflected people’s needs. Activities were available for people to participate in if they wished.

The provider had systems to assess and monitor the quality of the service. The registered manager carried out regular audits to ensure appropriate levels of safety and quality were maintained at the home. Staff told us the home was well-led and that the registered manager treated everyone equally and fairly.

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 13 February 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information, we may inspect sooner.

Feng Shui House (Blackburn) is a 'care home'. 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. Feng Shui House (Blackburn) is registered to provide accommodation for up to 16 people who require support with personal care. On the day of our inspection there were nine people living in the home.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, we therefore reviewed what actions the provider had taken to improve the service.

Since the last inspection, a registered manager had been appointed. A registered manager is a person who has registered with CQC 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 registered manager demonstrated a commitment to continuous improvement in the service.

Since the last inspection, the provider had received considerable support under the local authority's Quality Improvement strategy. They had been required to complete an action plan which had been closely monitored through this quality improvement process. As a result of this input, we found significant work had taken place since our last inspection to improve the safety, effectiveness and quality of the service; this meant the provider was no longer in breach of any of the regulations we reviewed. However, the provider needed to continue to embed the learning from the advice they have received from professionals and demonstrate the improvements made could be sustained over time.

Improvements were still required in respect of how the learning from accidents and incidents was shared across the staff team. The provider also needed to further develop their system for monitoring and recording the service’s compliance against all required regulations. Since the service is no longer rated as inadequate overall, or in any of the key questions, it is therefore out of Special Measures. The service has an overall rating of requires improvement.

The provider had improved their systems to monitor the quality and safety of the service through regular audits and spot checks. However, we were told there were no formal reports completed by the provider to assure themselves of the service's compliance against all the regulations.

Although accidents and incidents had been recorded. There was no evidence that any learning from these had been shared within the staff team. The registered manager assured us a system would be put in place to analyse themes and trends from accidents or incidents and ensure any lessons learned were always shared with staff.

Staff had received training to ensure they were able to support people to mobilise safely in the home. The provider had ensured the necessary equipment was in place to ensure people’s needs could be safely met. Care plans and risk assessments provided guidance for staff on how to safely meet people’s needs; these were regularly reviewed and updated when people’s needs changed.

There were policies and procedures in place regarding safeguarding adults. Staff were able to tell us the correct action to take should they witness or suspect abuse. They told us they were confident the registered manager and provider would listen if they raised any concerns.

Staff had been safely recruited and there were enough staff on duty to meet people’s needs in a timely manner. We saw that staff regularly sat with people during the inspection to engage them in activities and general conversation. People told us staff were always kind and caring towards them and they had no concerns about the care they received.

Medicines were safely stored and managed. Records we reviewed showed people had received their medicines as prescribed.

The home was clean and appropriate arrangements were in place to manage the risk of cross infection. Materials hazardous to health were stored securely.

The registered manager and staff understood the principles associated with the Mental Capacity Act 2005 (MCA) and acted according to this legislation. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's consent to various aspects of their care was considered and was clearly documented in their care records. Where people lacked the capacity to make decisions about their care, the service had taken appropriate action in line with the Mental Capacity Act 2005.

Staff had completed an induction when they started work and completed regular training to keep their knowledge and skills updated. Staff received regular supervision which was used by the registered manager to discuss training needs and provide feedback on staff performance.

People told us the quality of food provided in the home was good; this was confirmed by our observations during the inspection. Appropriate arrangements were in place to assess and meet people’s nutritional needs. Staff had regular contact with health professionals to ensure people received the treatment they needed.

A range of activities were provided to help maintain people’s sense of well-being. The registered manager had developed links with a local nursery which had proved to be beneficial for people who lived in the home and the children who visited.

People had opportunities to comment on the care they received. The registered manager told us they planned to develop a satisfaction survey to gain feedback from people who lived in the home and their relatives. People were aware of how they could raise a complaint or concern if they needed to and had access to a complaints procedure.

We received positive feedback about the new registered manager and their impact on the running of the home. Staff told us they enjoyed working in the home and felt fairly treated. Records showed regular staff meetings took place. The registered manager told us they intended to improve how these meetings were recorded to demonstrate the impact of any suggestions made by staff on the way the service was run.

Following the inspection in February 2018 we received concerns regarding the management of risks. The team therefore inspected the service on 14 May 2018 against two of the five questions we ask about services: is the service safe and is the service well–led? The inspection revealed that improvements needed to be made to the processes in place when people were unable to consent to taking their prescribed medicines and in pre-recruitment checks the provider made for care staff.

At the May 2018 inspection the rating for the key question - is the service safe? had deteriorated to ‘Requires improvement’ but the overall rating for the service remained ‘Good’.

This inspection on 1 August 2018 was undertaken to check on concerns we had received about the service in relation to people’s safety and moving and handling practices and inappropriate care planning. We conducted a comprehensive inspection so that we could ensure that people were safe and to re-inspect the service and provide a new rating.

Feng Shui House (Blackburn) is a ‘care home’. 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. Feng Shui House accommodates up to 16 people. On the day of our inspection there were 12 people using the service.

The registered provider was an individual who also managed the home on a day-to-day basis. Registered providers 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. As the registered provider was also responsible for managing another care home, they were supported in the day-to-day running of the home by a deputy manager.

During this inspection we found that the service was in breach of regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to care planning and risk assessing and a series of other safety issues; including poor moving and handling practices and poor medicine’s control. This meant that people were at risk from injury. We also found that the service to be in breach of five other regulations These breaches were in respect of a lack of person centred care, failure to obtain consent, inappropriate supervision and support of staff, the employment of fit and proper persons and failures to demonstrate oversight and compliance with the regulations by the registered provider. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals are concluded.

Care plans did not always accurately reflect people’s current needs and had not been sufficiently reviewed. Assessments of people’s needs did not direct staff on how to manage potential risk or how best to support people. Advice and input from external healthcare professionals had not been included in care plans or passed on to staff and had not been followed. Risks or hazards within the environment had also not been considered.

A bedroom shared by two people was dirty and required immediate attention and a thorough clean to prevent the risk of infection.

Medicines were not always stored safely and there was concern over the absence of policies around the use of covert medicines and medicines that were provided on an ‘as required’ basis (PRN).

Inspectors had to intervene with one person who was being helped to eat unsafely and not consistent with the direction from health care professionals.

People had access to harmful substances in an open room and the kitchen was left open with a hot pan on the stove.

Clinical waste was stored in bags and not in bins in an area outside of the home that meant that it was unsafe for people to access that area.

A communal upstairs bathroom window was not restricted and could allow someone to fall and injure themselves and the hot tap water temperature was too hot and presented as a risk of scalding to vulnerable people.

Recruitment systems and processes were not sufficiently robust to ensure appropriate staff were employed to work with vulnerable people. When employing people, we noted that the registered provider had not undertaken sufficient enquiry of previous employers in health and social care.

Consent had not been sought for CCTV monitoring and recording within the home and some elements of the care and support that was being provided was not person centred. People’s consent was not always obtained, and management and staff had misunderstood legislation around this.

Some members of the care staff team were unaware of safe moving and handling techniques and, on occasions, inspectors and external specialists had to intervene to prevent unsafe practices from continuing. Staff training around these matters was poor and some staff hadn’t been trained at all. Records showed and staff confirmed, that they did not have access to regular training organised by the registered provider. Most staff had commenced their national vocational qualification (NVQ) and this was the only training some staff had accessed. Staff did not have access to regular formal supervisions and appraisals.

Although all the people we spoke with told us staff members respected their privacy, we noted some practices that did not respect privacy and dignity especially when personal care was being provided in a shared room setting. The registered provider purchased some screens during the inspection but these were not in use before the inspection. We did observe staff knocking on people’s doors before entering.

We had concerns during this inspection in relation to the day to day running of the service and governance provided by the registered provider. Records that should have been in place did not exist and the registered provider lacked an understanding of the regulations and their responsibility to meet them. There was a lack of monitoring of the service and issues and concerns we raised during our inspection had been missed by the registered provider and senior management staff.

All the people we spoke with told us they felt safe living at Feng Shui House (Blackburn). Relatives were happy with the care and support their family members received.

People we spoke with made some positive comments about the staff team and the care and support they received. We also observed good interactions with people from staff members.

People had access to regular activities to prevent them from becoming bored and in order to stimulate them. Although there was no activities programme, we saw staff engaging with people with meaningful activities throughout the inspection by playing games and quizzes. We also saw photographs of celebrations in the home and special occasions.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measure 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. This service will continue to be kept under review and, if needed, action could be escalated to incorporate urgent enforcement to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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 it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the inspection in February 2018, we received concerns regarding the management of risks, particularly those relating to people’s nutritional needs. The team therefore inspected the service against two of the five questions we ask about services: is the service safe and is the service well –led?

No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection. Although the rating for the Key Question: is the service safe? had deteriorated to Requires improvement, the overall rating for the service remains Good.

Feng Shui House (Blackburn) is a 'care home'. 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.

The care home is a detached building on the outskirts of Blackburn and accommodates up to 16 people in one adapted building. On the day of our inspection visit there were 12 people living at the home.

The registered provider was an individual who also managed the home on a day to day basis. Registered providers 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. As the registered provider was also responsible for managing another care home, they were supported in the day to day running of the home by a deputy manager.

People told us they felt safe in the home. They told us the staff that supported them were kind and caring. Sufficient numbers of staff were on duty to be able to meet people’s needs in a timely way.

Staff had completed training in safeguarding adults and knew the correct action to take if they witnessed or suspected abuse. They told us they were confident the managers in the service would take action if they reported any concerns to them.

Most people’s medicines were handled safely. However, we noted improvements needed to be made to the processes in place when people were unable to consent to taking their prescribed medicines. These processes help to ensure people’s rights are upheld and decisions are taken, where necessary, in their best interests.

Each person’s care records contained an assessment of the risks relevant to them. We saw that, with one minor exception, care records had been reviewed and updated when people’s needs and risks changed to help ensure they received safe care and treatment.

We noted that people’s nutritional needs were clearly documented. Staff sought and followed advice from relevant health professionals in relation to any identified nutritional risks. We observed that people received appropriate individual assistance to help them safely eat their meals.

Staff recruitment files contained all the required information. However, we noted references for one staff member had not been sought by the home or verified as genuine by the registered provider. One reference for another staff member had not been received until after they had commenced employment at the home. Such pre-employment checks are important to help ensure that people living in the home are protected from the risk of unsuitable staff. We were told no concerns had been raised about the conduct of any new staff employed to work in the home since the last inspection.

People were cared for in a safe and clean environment. Systems were in place to protect people from the risk of cross infection. The registered provider had refurbished parts of the home since the last inspection for the comfort of people who lived there. The registered provider had plans in place to improve the garden areas of the home. They were also in the process of building a therapy centre adjacent to the home which would provide a range of holistic therapies, all of which could be accessed free of charge by people who lived in Feng Shui House (Blackburn).

The registered provider had systems in place to monitor the quality and safety of the service. People who lived in the home and their relatives had regular opportunities to comment on the care provided in Feng Shui House (Blackburn). People spoken with during the inspection told us the home was well run and managed.

Staff told us they enjoyed working in the home and considered the managers always listened to any suggestions they had for improving the service. An on call system helped to ensure staff were able to contact a manager for advice, support and guidance out of office hours.

After the inspection in February 2017, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of regulation. They provided us with an action plan which indicated legal requirements would be met by June 2017.

During this inspection carried out on the 19 February 2018 we found improvements had been made and the registered provider was meeting the requirements of the regulations. We saw applications were made to ensure that where people’s rights were restricted, this was done so lawfully. We saw evidence people’s mental capacity was assessed and people were asked to consent to their care whenever possible. We looked at two recruitment files. We found appropriate recruitment checks were carried out and there was a full employment history on both files. This helped ensure suitable people were employed to work at the home.

Feng Shui House (Blackburn) is a ‘care home’. 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.

The care home is a detached building on the outskirts of Blackburn and accommodates up to 16 people in one adapted building. On the day of our inspection visit there were 11 people living at the home.

The registered provider was an individual who also managed the home on a day to day basis. Registered providers 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. As the registered provider was also responsible for managing another care home, they were supported in the day to day running of the home by a deputy manager. On the day we inspected the registered provider was unavailable however, the deputy manager was present.

At this inspection people told us staff were caring towards them. We observed positive interactions between staff and people who lived at Feng Shui House (Blackburn). There was a culture of promoting dignity and respect towards people. Staff we spoke with understood the importance of high standards of care to give people meaningful lives. One person told us, “I feel quite relaxed and comfortable here, so I am happy where I am.”

We found there were sufficient staff during our inspection visit. They were trained and able to deliver care in a compassionate and patient manner. One person commented, “I don’t use the call bells as there is always a staff member about.”

We checked staff records and noted employees received training appropriate to their roles. One staff member told us, “I had an induction. It was good, I enjoyed it.”

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded.

The registered provider had processes and practices to safeguard people from abuse. Staff had received suitable training and when we spoke with them were able to identify types of abuse and how to react to abusive actions should they occur. Systems were in place to ensure people who lived at the home and required restrictive practices were lawfully deprived of their liberty.

We looked around the home and found it had been maintained and was a clean, safe place for people to live. For example, we found equipment had been serviced and maintained as required.

Medication care plans and medicine risk assessments provided staff with a good understanding about specific requirements of each person who lived at Feng Shui House (Blackburn). Staff had relevant training to assist them in the safe administration of medicines.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available for staff to use when required, such as hand gels.

People were supported to have maximum choice and control of their lives and staff helped them in the least restrictive way possible; the policies and systems in the service supported this practice.

We received positive comments about the quality of meals provided. We spoke with the chef who told us, “Whatever people want they can have. It’s their home at the end of the day.” We observed lunch time service and noted people had their meal in the dining room. People told us it was their choice where they ate their meal.

People who lived at the home and their visitors told us they were happy with the activities on offer. We observed people enjoying activities in the afternoon. We observed people choosing not to take part, and staff respected their decision.

There was a complaints procedure which was made available to people and their relatives. People we spoke with told us they were happy and had no complaints.

End of life care had been discussed with some people and their relatives. Staff told us they had the skills, experience and links with local health care professionals to promote a dignified and pain free death.

The management team used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff meetings and daily discussions with people who lived at the home to seek their views about the service provided.

Feng Shui House (Blackburn) is a large detached house which provides accommodation for up to 16 older people in a mixture of single and double en-suite bedrooms. At the time of this inspection there were 10 people living in the home.

The registered provider was an individual who also managed the home on a day to day basis. Registered providers 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. As the registered provider was also responsible for managing the ‘sister’ service in Blackpool, they were supported in the day to day running of the home by a deputy manager.

During this inspection we identified two breaches of Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because recruitment processes were not sufficiently robust to protect people from the risk of unsuitable staff. Required checks had not been carried out when applicants had worked previously with vulnerable adults or children and a complete record had not always been maintained of people’s employment history. In addition the rights of people who were unable to consent to their care in Feng Shui House (Blackburn) were not always properly protected. This was because the required Deprivation of Liberty Safeguards (DoLS) applications had not always been made to authorise any restrictions in place.

Staff had received training in safeguarding adults from abuse. They were able to demonstrate their understanding of the correct action to take if an allegation of abuse was made to them or if they suspected that abuse had occurred. Staff told us they would be confident to use the whistleblowing policy that was in place should they witness poor practice in the service.

We found people were cared for by sufficient numbers of suitably skilled and experienced staff. We saw that staff received the essential training and support necessary to enable them to carry out their role effectively and care for people safely.

People who used the service told us they felt the staff had the skills and experience to meet their needs. People were happy with the care and support they received and spoke positively of the kindness and caring attitude of the staff.

We found the system for managing medicines was safe. Records we reviewed showed staff worked in cooperation with health professionals to help ensure that people received appropriate care and treatment.

The standard of fixtures and fittings in the service was high. Feng Shui principles had been used in the décor of the property to help promote the well-being of people living in the service. All areas of the home were clean and well maintained. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply.

People’s care records contained enough information to guide staff on the care and support required. The care records showed that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate the risk. Care records had been regularly reviewed to ensure they were an accurate reflection of people’s needs.

Systems were in place to help ensure people’s health and nutritional needs were met. People who used the service told us the quality of the food was good. We observed that, where necessary, staff offered people gentle support and encouragement to eat.

Staff told us they enjoyed working in Feng Shui House (Blackburn). They told us the principles on which care was delivered meant people were treated as individuals and staff had the time to promote well-being through discussions and activities which occurred on a daily basis. They told us the registered provider and deputy manager were approachable and supportive. Regular staff meetings meant that staff were able to make suggestions about how the service could be improved. Staff told us their views were always listened to.

Systems were in place to monitor the quality of the service provided. Regular checks were undertaken on all aspects of the running of the home and there were opportunities, such as questionnaires and meetings, for people to comment on the facilities of the service and the quality of the care provided. All the people we spoke with told us they would feel confident to make a complaint although they had not had a reason to do so.