We carried out a review of the data available to us about Blair House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Blair House, you can give feedback on this service.
Blair House is a residential care home providing accommodation and personal care for up to 29 people. At the time of the inspection there were 21 people living in the service. People were living with a range of needs associated with dementia and mental ill health.
People’s experience of using this service and what we found
People were protected from the risk of abuse. Staff were aware how to recognise and report any concerns. People living at Blair House were supported by staff who had been safely recruited and had completed training. New staff had an induction and spent time working with current staff.
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 received their medicines in a safe manner. Staff administering medicines received training and had their competencies assessed.
Care plans and risk assessments were in place. Staff knew people well and emphasis was placed on supporting people to maintain their independence wherever possible. For those who required more support due to their dementia or mental health needs, staff provided this with respect and dignity.
Infection control procedures were being followed and the home was clean and tidy. Staff and management were aware of any actions to follow in the event of any outbreaks of COVID19.
People’s views had been sought. People told us they had been involved in discussions about the redecoration. Relatives spoke positively about the recent changes. One told us, “I was concerned at first when I learnt there would be a change of manager, but my fears were soon allayed when I saw the calm manner that [managers name] was assuming her role. Within a short time, she had implemented improvements, by getting management to arrange for decorating to be done throughout, along with new curtains and bedding. The lounge and dining room were altered around, which makes for a more comfortable environment.”
Staff, resident and relative meetings were taking place and surveys had been completed. All feedback received was being used to implement further changes to improve the home.
Quality assurance checks had been completed. The manager had implemented a new programme of auditing. This was used to identify areas for improvement and learning. Actions had been highlighted and work had taken place to implement improvements. Although some improvements were recent, the positive impact on people and staff of these improvements was evident.
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 25 September 2019).
Why we inspected
The inspection was prompted in part due to concerns received in relation to documentation and management of the service. As a result, we undertook a focused inspection to review the key questions of safe 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 remained as good, based on the findings of this inspection.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice.
People were supported to maintain contact with their family and friends. In line with government guidelines single named visits into the home had commenced. Where people were considered to be end of life, they were able to receive regular visits from family in their bedrooms.
All visitors were required to have a rapid Covid-19 test before they met with their loved ones. During the visit they were required to wear the appropriate personal protective equipment (PPE).
As far as possible, social distancing was maintained. Due to their dementia some people were not able to understand the need for social distancing. Therefore, staff encouraged people to regularly wash their hands.
Staff had access to PPE. They had received infection control and specific Covid-19 training, and this included guidance for staff about how to put on and take off PPE safely. Regular testing for people and staff was taking place.
The home was clean and tidy. There was a cleaning schedule and this included regular cleaning of high touch points such as door handles and light switches. This cleaning was not always recorded. The registered manager told us that this recording would be introduced immediately. The registered manager told us they were confident that this cleaning did take place.
Blair House is a residential care home providing personal care to 19 older people at the time of the inspection. The service can support up to 29 people. People were living with a range of needs associated with dementia and mental ill health.
People’s experience of using this service and what we found
We found improvements had been made to record keeping and the quality assurance systems. The provider was no longer in breach of regulation. However, we found further time was needed to ensure these improvements were fully embedded into daily practice. There was a quality assurance system, but this had not identified the shortfalls we found. We made a recommendation about this.
People were supported by staff who treated them with kindness and compassion. Staff understood people’s needs, choices and knew what was important to each person. People were enabled to make their own decisions and choices about the care and support they received.
People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff working to provide the support people needed. Recruitment procedures ensured only suitable staff worked at the service.
Risk assessments provided guidance for staff about individual and environmental risks. Staff understood the risks associated with the people they supported. People were supported to receive their medicines when they needed them.
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 received training and support that enabled them to deliver the care that people needed. People's health and well-being needs were met. They were supported to see their GP and access healthcare services when they needed them. People's nutritional needs had been assessed and action had been taken to ensure they received the correct food and drink. They were supported to eat a range of meals, drinks and snacks each day.
People were supported to take part in a variety of activities that they enjoyed and were meaningful. People received support that was person centred, and staff knew them well. Complaints had been recorded, investigated and responded to appropriately.
The registered manager was committed to developing and improving the service. They were supported by a second registered manager and the provider.
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 10 September 2018).
After the last inspection we met with the provider to discuss our concerns. They told us what actions they would be taking to address our concerns.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating and to follow up on action we told the provider to take at the last inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Blair House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
We further inspected in July 2017 where we found significant improvements had been made and the provider was meeting the regulations. The service was removed from special measures. However, we found improvements were needed to ensure people’s meal choices were always supported and food was well presented. We also found that improvements that had been made in relation to management oversight of Blair House needed time to be maintained and managed to ensure it was fully embedded into everyday practice. The home was rated requires improvement to reflect this.
Before the inspection we had been made aware of concerns related to the management of the home. We undertook this unannounced comprehensive inspection to look at these concerns and all aspects of the service. We found some improvements had been made in relation to people’s food choices, however we identified further areas where improvement was required.
Blair House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Blair House provides accommodation and personal care for up to 29 people in one adapted building. At the time of the inspection there were 11 people living there. People living at the home were older people some of whom were living with a dementia type illness or mental ill health. People had a range of needs associated with old age and their health.
There was a registered manager 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 2008 and associated Regulations about how the service is run.
There was a quality assurance system in place, and this was well organised. However, this had not identified all the shortfalls we found. People’s records did not fully reflect the care they required and received. Although there were a range of activities, improvements were needed to ensure people were able to access a variety of meaningful activities throughout the day.
People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. However, mental capacity assessments and best interest decisions were not in place for everyone who needed them.
Staff had the training however competency assessments had not been completed to demonstrate staff had the knowledge and skills they needed.
Staff knew people well. They demonstrated a good understanding of their needs and choices. People were treated with kindness, respect and understanding. They were supported to make decisions and choices throughout the day and their privacy and dignity were respected.
Accidents and incidents were managed safely. Staff understood their responsibility in recording and reporting incidents. There were systems in place to safeguard people from the risks of abuse and discrimination.
Risks were well managed. Risk assessments were in place and staff had a good understanding of the risks associated with the people they looked after.
There were enough staff to meet people's needs. Systems were in place to ensure medicines were ordered, stored, administered and disposed of safely.
People were given choice about what they wanted to eat and drink, and nutritional assessments had been completed. Peoples health and well-being needs were met. They were supported to have access to healthcare services when they needed them.
A complaints procedure was in place and complaints were responded to appropriately.
There was an open culture at the home. All staff were striving to improve and develop the service.
You can see what action we told the provider to take at the back of the full version of the report.
Blair House was inspected in November 2016. A number of breaches were identified and it was rated as inadequate. The Care Quality Commission (CQC) took enforcement action and the service was placed into special measures. Special Measures means a service will be kept under review and if needed could be escalated to urgent enforcement action. CQC issued three Warning Notices after the inspection in respect of safe care and treatment, premises and equipment and good governance. We also found two further breaches in relation to a lack of person centred care and failing to ensure sufficient numbers of appropriately trained and competent staff were in place at all times.
This inspection took place on 24 July 2017 and was a full comprehensive inspection to check the provider had made suitable improvements to ensure they had met regulatory requirements. We found that appropriate actions had been taken and issues had been addressed. The provider was now meeting the regulations and the service no longer required to be in special measures.
Blair House had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 was in day to day charge of the home, supported by the nominated individual working on behalf of the provider.
People told us they enjoyed the meals and people’s weights were monitored. People did not have their choice supported at supper time. Pureed meals were not presented in an appetising way.
Systems to assess and monitor the service provided had been significantly improved. These had been implemented and continued over recent months which demonstrated that improvements had become part of the day to day systems within the home, these now needed to be maintained. This included auditing, provider oversight and an open transparent culture within the home. People spoke positively of the improvements which had taken place. Staff felt supported and people’s views had been sought and responded to.
We found significant improvements to the care documentation and records. Staff had access to relevant information about people; this meant they knew people and their care needs well. People received care which was assessed, planned and reviewed regularly to ensure their needs were met and to reflect their preferences. Individual and environmental risk assessments were in place when risks to people’s safety had been identified. When accidents, incidents or falls occurred clear systems were in place to record and respond appropriately. Referrals were made to other health professionals if needed.
Staff had an understanding of recognising and reporting abuse. Staff had received training and information was available to ensure they understood their responsibility. The registered manager was aware of what was required to be reported and kept a record of when this had taken place. Improvements had been made to ensure people’s dignity and privacy were maintained at all times and care records were stored safely.
There was on-going maintenance and servicing of all areas of the home, including water systems, gas and electrical equipment. Fire safety checks had taken place and information was recorded regarding evacuation and emergency procedures.
There were systems in place to manage people’s medicines safely. Medicines were stored safely and documentation completed accurately regarding prescribed medicines and when they were given.
Recruitment processes were in place, these included checks which took place before people began work at Blair House. Recruitment was on-going. The registered manager worked some care shifts to support care staff and to carry out observations around care provision. New staff had a period of induction. There was an on-going programme of training and supervision for staff.
Mental Capacity Act 2005 (MCA) assessments were completed as required and in line with legal requirements. Staff had attended MCA and Deprivation of Liberty Safeguards (DoLS) training. People were supported to spend their time how they wished, with guidance and prompting provided when needed. People felt involved in choices about how they spent their time, staff were aware that people should be involved in all day to day decisions.
Staff communicated with people in a caring and supportive manner. Staff knew people well and people were treated with respect and dignity. There was a varied activity schedule. People engaged actively in activities and told us they enjoyed them. There was a complaints policy and procedure. People told us they would raise concerns if needed.
Many improvements had taken place since the last inspection and the warning notices and breaches of regulations had been met. At the next inspection we will check to make sure the improvements are embedded and sustained. This is because there are currently nine of a possible 29 people at the home and we will need to see that as people are admitted the improvements continue, which is why the rating is requires improvement despite no breaches having been identified.
This was an unannounced inspection which took place on 14 and 16 November 2016.
Blair House was inspected in September 2015. Two breaches of Regulation were identified in Regulation 15 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured all premises and equipment was properly maintained. The provider did not have systems in place to assess, monitor or improve the quality of service provided.
The provider sent us an action plan stating they would have addressed all of these concerns by October 2016. However, at this inspection we found although some improvements had been made in relation to the premises, new areas of concern were identified. This was a continued breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found that the provider had failed to make adequate improvements to ensure an effective system was in place to regularly assess and monitor the quality of service that people received. This was a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Some further breeches of regulation were also found during this inspection.
People’s level of care and support needs varied. Whilst some people could take care of themselves and were mobile, others used walking frames or required assistance from staff for all personal care and mobility needs. Those who remained predominantly independent required prompting and support at times to ensure they remained safe. Some people had mental health concerns, dementia or memory loss. A couple of people went out alone or with friends and family, whilst others required more assistance with all care needs and remained in bed or in the communal areas of the home as they chose.
Blair House had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 was in day to day charge of the home.
Pre admission assessments did not identify people’s health needs. People with specific health and care needs did not have care plans and documentation in place to inform staff. People with dementia did not have any assessments to identify how this impacted on their daily lives or how their dementia presented in day to day life. People who used continence aids did not have this information included in their continence care plan. Care plans did not routinely include information regarding peoples mental health needs. People who were assessed as requiring pressure care equipment did not have daily checks in place to ensure pressure areas were assessed and monitored to identify concerns. People’s safety was not being fully assessed and maintained. One person who was unsafe to go out alone had the door opened by staff who were unaware they were not safe to leave unaccompanied and they went out.
Some health and safety checks had not been completed since the maintenance employee left in May 2016. This included water temperature, descaling, cleaning and flushing of water systems, fire alarm checks and some day to day maintenance around the home. Infection control measures had not been maintained. We found areas of the home that needed cleaning. There was no designated laundry person and care staff were currently responsible for this. People’s personal items of clothing had not been treated with respect. Laundered clothing had not been folded and stored tidily. Personal and confidential care records had not been safely stored to ensure peoples personal information could not be accessed by others.
Systems to manage and store medicines needed to be improved. Medicines were not safely stored and this could pose a potential risk to people living at Blair House as they were not locked away at all times. Medicine procedures for PRN or ‘as required’ medicines were not consistent. People were risk of being given their medicines in an inconsistent manner.
Procedures to document and report accidents and incidents were not consistently followed. Forms were not always completed or lacked detail. Body maps were not in place for all injuries. Actions taken in the response to accidents and incidents were not documented on the form. The registered manager had not completed an audit/ analysis of accidents and incidents since February 2016. The documentation did not show that people’s safety was being maintained after injuries or accidents occurred.
Mental Capacity Assessments (MCA) had not been completed. Deprivation of Liberty Safeguards (DoLS) applications had been made without underlying information about how this decision had been made. Information regarding people’s capacity, mental health and who was legally entitled to be involved in decisions had not been completed in care files.
The registered manager had not ensured that staff had the appropriate, skills, knowledge or experience to meet people’s needs. Staff inductions did not show how staff were assessed as confident and competent before working unsupervised. Training records were not up to date to identify who had completed e-learning recently. New staff who had been left in charge of the home did not have a full understanding the homes procedures and reporting systems. Staffing levels had not been assessed in accordance with the needs of people living at Blair House. Dependency assessments had not been completed and staff felt that they needed more staff due to the number of new admissions to the home and people who required a high level of care and support.
An activity schedule was in place including visiting entertainers. However, there was no designated activity person and staff were responsible for providing activities for people at other times. Activities were not individualised and staff told us they did not always have time to do them.
An effective quality assurance systems was not in place. Audits had not identified concerns we found during the inspection. Audits completed by the registered manager and sent to the provider did not correspond with areas of concern we found during the inspection. Some audits were delegated to other staff but had not been checked to ensure they had been completed. The registered manager did not have oversight of all areas of the home and the checks completed.
Staff had an understanding of recognising and reporting abuse. Care staff new to the home were keen to improve and increase their skills and knowledge to enable them to provide the best care they could for people. We saw that care staff spoke to people in a kind and considerate manner. When providing care, staff spoke to people to ensure they were involved and aware of what was happening. For example whilst assisting people to move using a lifting hoist support and guidance was given in a calm and supportive manner.
We received positive feedback regarding the meals. People were offered a choice at mealtimes and could request an alternative if they wished. People had access to hot and cold drinks throughout the day.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
Blair House is registered to provide permanent and respite care for up to 29 older people. There were 10 people living at the home at the time of the inspection. Including one person living at the home for a period of respite care. People required a range of help and support in relation to living with dementia, mobility and personal care needs.
Blair House is owned by Regal Care Trading Ltd. Regal Care Trading Ltd had been in administration since 2012 and was taken over by a new provider in April 2015.
The home is a four storey Georgian building. There was a passenger lift at the home, due to the layout of the building, which included some split levels; a chair lift was in place to rooms which could not be accessed by the passenger lift.
This was an unannounced inspection which took place on 8, 9 and 11 September 2015.
Blair House did not have a registered manager. However, the acting manager was in the process of applying to register as manager with CQC. A registered manager is a person who has registered with the Care Quality Commission (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 acting manager was in day to day charge of the home supported by the registered manager of a nearby sister home. People and staff spoke highly of the acting manager and told us that they felt supported by them and knew that there was always someone available to support them when needed.
The provider had not ensured the home had been properly maintained. The provider had not visited the service to review concerns identified in audits completed by the acting and supporting manager.
There were systems in place to assess the quality of the service. However, when quality and safety issues were identified for example the décor of the home and issues with flooring, the provider had not responded in a timely manner.
The lift was out of order during the inspection, staff and people living at Blair House told us that this had been an on-going issue over many months. There were areas of the building that were in need of repair. This included the flooring in the dining room which could present a trip hazard and areas of redecoration. Due to the fact the lift was currently out of order the dining room was not accessible although people were not currently at risk. The acting manager had implemented safety measures which included moving people to bedrooms accessible without using the lift to minimise the impact on people. People told us they were happy with the measures put in place.
Some areas of documentation needed to be improved this included identifying people’s choice and involvement in decisions, for example bathing and showering. We also found documentation for medicines needed to be improved.
The acting manager carried out a programme of supervision and appraisals for staff. However, the managers had not received any formal supervision or support from the provider.
Staff received training which they felt was effective and supported them in providing safe care for people. Robust recruitment checks were completed before staff began work.
Care plans and risk assessments had been completed to ensure people received appropriate care. Care plans identified all health care needs and had been reviewed regularly to ensure information was up to date and relevant.
Staff demonstrated a clear understanding on how to recognise and report abuse. Staff treated people with respect and dignity and involved people in decisions about how they spent their time.
People were encouraged to remain as independent as possible and supported to participate in daily activities.
People were asked for their consent before care was provided and had their privacy and dignity respected.
People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes.
Referrals were made appropriately to outside agencies when required. For example GP appointments, dental appointments and hospital visits.
Fire evacuation procedures needed to be improved to incorporate different staffing levels at night. Personal evacuation procedure information was in place in event of an emergency evacuation. This information had been updated to ensure that people who had moved rooms due to the lift breakdown remained safe in the event of an emergency evacuation.
Feedback was gained from people this included questionnaires and regular meetings with minutes available for people to access.
Notifications had been completed to inform CQC and other outside organisations when events occurred.
We found breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.