Blossom House Residential Home

Blossom House Residential Home is a residential care home providing personal care for up to 40 people within one large, adapted building. The service provides support to younger and older people who may have physical disabilities, some of whom may be living with dementia. At the time of our inspection, 31 people were living at the home.

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

At this inspection, we found the registered manager and provider had made significant improvements to the service, and they were now meeting the regulations. People received personalised care, shaped around their individual needs, choices, and preferences. People’s care plans reflected their individual needs and were kept under regular review. People’s end of life wishes were consistently recorded. The registered manager and provider’s quality assurance together with recruitment of staff, such as a person-centred lead had enabled them to drive improvement in the service people received.

People were supported by staff who had received training in, and understood, how to protect them from avoidable harm, discrimination, and abuse. The staffing levels maintained at the home ensured people’s individual needs could be met safely and flexibly. Systems and procedures were in place to ensure people received their medicines safely and as prescribed, and to protect people from the risk of infection. Accidents and incidents involving people living at the home were analysed by the management team to stop things from happening again.

People’s needs and choices were assessed in order to develop effective care plans and achieve positive outcomes for people. Staff received effective induction, training, and support to enable them to fulfil their duties and responsibilities. People were supported to have a balanced diet and any risks associated with their eating and drinking were assessed and managed. Staff and management worked collaboratively with external professionals, team, and agencies to ensure people received coordinated care. Measures were in place to continue with refurbishment and redecoration of the premises to meet the individual needs of the people living at the home.

Wherever possible, people's consent was gained before any care was provided. People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff treated people in a kind and caring manner and took the time to get to know them well. People’s privacy and dignity was promoted and respected by staff and management. Staff promoted people’s lifestyle choices and assisted people to retain their independence. People were encouraged and supported to express their views about the service.

Staff supported people’s participation in a range of things to do for fun and interest. People were supported to fulfil their ambitions and follow their individual interests. People and their relatives had accessible information in how to raise a complaint and the provider had procedures to identify any causes and opportunities for improvement.

The registered manager and provider were keen to promote a culture of support for staff where learning was promoted, and improvements continued to flourish. Staff were clear about their responsibilities and felt able to approach management for any additional support needed. The management and staff team worked in partnership with other professionals and the local community to achieve good outcomes for people.

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 8 May 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

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

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.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Follow up

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

Blossom House Residential Home is a residential care home providing personal care to 24 people at the time of the inspection with one person in hospital. The service can support up to 40 people in an adapted building with additional extensions.

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

Improvements had taken place in the notifying of authorised Deprivation of Liberty (DoLS) since the last inspection.

People’s care and support needs were not always recorded and followed through to ensure identified needs were met. Care plans were not always accurate or updated to reflect changes. Improvements were needed to ensure governance arrangements were fully effective to provide high quality and person-centred care. Risks involving people’s care and support needs were assessed however these were not always update or conflicted.

People felt safe living at the home and staff were aware of their responsibility to protect people against potential abuse. Equipment was tested and serviced to ensure it was safe to use. Accidents and incidents were reviewed to reduce the risk of reoccurrence. People received their prescribed medicines and lived in a clean environment. Sufficient staff who had undertaken a recruitment process were employed to care and support people.

People’s needs were assessed prior to moving into the home and healthcare needs were met by visiting professionals. Staff were knowledgeable about how to meet people’s needs although some areas of refresher training needed to take place. People were pleased with the food provided. The provider planned to make further improvements to the environmental standards of the home. 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.

Staff communicated with people in the ways they preferred and encouraged them to make decisions about their care. People received care from staff who promoted their dignity and independence.

People were able to participate in activities and could see their friends and family when they wanted. Systems were in place to respond to any concerns or complaints and learn from these.

People were complimentary about the registered manager who wish to make improvements in the quality of the care provided.

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 25 February 2019). Since this rating was awarded the provider has changed the name of the location to Blossom House. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection. This service has been rated requires improvement for the last two consecutive inspections.

Enforcement

We have identified two breaches in relation to person centred care and the governance of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Why we inspected

This was a planned inspection based on the previous rating.

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

Gold Hill 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.

Gold Hill accommodates up 40 people in an adapted property. There were 25 people living at the home at the time of the inspection.

The provider did not have a registered manager in place. A new manager had commenced working at the home seven weeks prior to our inspection. The manager had made an application to the Care Quality Commission (CQC) to become registered. 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 the last inspection of the service on 25 and 26 October 2017 the service was rated as ‘Requires Improvement’ overall. The key questions Safe and Well led were rated as Requires Improvement. On this inspection we found improvements had taken place in the areas identified on the previous inspection. However, we identified other areas requiring improvement. Therefore, the rating remains as ‘Requires Improvement.’

Since our previous inspection improvements have taken place regarding infection control procedures and the cleanliness of the home.

The provider had not ensured all statutory notifications were sent to the Care Quality Commission in a timely way. The provider had failed to notify us of Deprivation of Liberty Safeguarding authorisations as they are required to do by law.

People were cared for by the staff who had knowledge of how to keep people safe and what to do if they believed people to be at risk. People’s wishes were taken into account to ensure people’s preferred life styles were met.

People were supported to have their medicines and checks were undertaken to ensure these were administered as prescribed. Healthcare professionals were consulted and involved in people’s care as needed to maintain their wellbeing.

People’s needs were assessed before they moved into the home and these were reviewed as to ensure they could be met. Staff ensured people had enough to eat and encouraged people to drink. Most people were complimentary about the food provided.

Staff received the training they needed to provide the care and support people required to keep them safe and maintain their wellbeing.

People were supported to have maximum choice about their lives and were supported in the least restrictive way possible. Staff spent time with people talking about important things in their life and had developed a caring relationship. People were encouraged to make decisions about their day to day life. People’s privacy and dignity was respected.

People were encouraged to take part in fun and interesting things while at the home. People were confident their views would be acted upon.

The provider and manager were working to make improvements in the home in areas such as refurbishment and decoration of the home environment and the heating facilities.

People who lived at the home as well as relatives felt able to approach the manager at any time. The manager was responsive during our inspection and gave assurances of their determination to make improvements including those needed to remedy shortfalls identified as part of the inspection. They had an ambition to achieve an outstanding rating to benefit people who lived at the home.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Further information is in the detailed findings below.

Gold Hill provides accommodation, and personal care for a maximum of 40 older people. On the day of our inspection there were 27 people living at the home. Bedrooms, toilets and bathrooms were situated over four floors with stairs and a passenger lift providing access to all floors.

There was a new manager at this home who was in the process of applying to be registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 inspection in April 2017 we found the provider needed to improve how they supported people in a safe way and how they ensured people received person centred care. We also found the provider did not have effective arrangements in place to monitor and improve the quality and safety and welfare of people using the service. This was a breach in Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to tell us how they were going to make these improvements.

At this inspection we found improvements had been made however these had not been fully completed or sustained.

We found some areas of the home were not suitably clean. For example the kitchenette used for food preparation by staff and people living at the home was not regularly deep cleaned. We saw areas needed cleaning to ensure people were not put at risk of infection. The new manager responded straight away and took appropriate action to ensure improvements were made and implemented regular checks to sustain an improved environment.

People told us they felt safe because staff knew them well and were available when they needed them. Staff understood how to recognise potential abuse and where they needed to report any concerns to. People had risks to their wellbeing identified and staff knew how manage these risks to people’s safety. People told us there were sufficient staff to meet their needs. The provider used safe systems to recruit new staff. People’s medicines were stored securely and administered as prescribed. Staff had been trained and observed safe practice when administering medicines.

People told us they enjoyed the food and were offered healthy choices. We saw people were offered visual prompts to support their decisions about their meal choices. Staff adapted how they communicated with people to ensure they understood the choices they were offered.

People were asked their permission before they were supported and their wishes respected. Where people needed support with some decisions the new manager involved appropriate people who had the person’s best interests at heart. The new manager had regular meetings to ensure they maintained an over view to identify and changes in people’s needs.

People and their relatives were assured that health and social care professionals were involved when they were needed. The district nurse we spoke with said appropriate referrals were made and staff followed their guidance.

People had caring relationships with staff, and they knew each other well. People enjoyed the company of other people living at the home and staff supported them to do this. Opportunities for people to follow their own interests and social activities had increased, however this was still under development by the management team.

People had their individual needs met, and staff responded to changes in their care needs appropriately. People felt they were listened to and the management team had made improvements. Relatives were confident to report concerns and felt they were actioned appropriately. There were systems in place to manage people’s concerns and complaints and we saw these were completed and outcomes shared with staff. The new manager actively sought information about any concerns or suggestions for improvements and took action in a timely way.

People were regularly asked for their views about how the service could be improved, they told us they were happy at the home and staff met their needs.

The provider had made improvements to the systems to monitor the quality of care provided. However shortfalls in the cleanliness were not consistently identified and actioned. Improvements to the monitoring of the quality of care were still in their infancy and had not been sustained.

The new manager sought feedback from people living at the home and their family and friends. The responses were overall positive and any suggestions were actioned to drive up standards of care.

Gold Hill provides accommodation, and personal care for a maximum of 40 older people. On the day of our inspection there were 29 people living at the home. Bedrooms, toilets and bathrooms were situated over four floors with stairs and a passenger lift providing access to all floors.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 inspection in April 2016, we found the provider needed to establish quality assurance systems to ensure people received a quality service. At this inspection we found further improvement was necessary.

The provider’s systems to avoid preventable accidents for people were not consistently effective. We saw staff practices were inconsistent when identifying preventable accidents.

People told us they felt safe because they felt staff knew them well and were available when they needed them. Staff understood how to recognise potential abuse and where they needed to report any concerns to. People had some risks to their wellbeing identified and staff knew how manage these risks to people’s safety. We saw when specialist equipment was needed to support a person’s mobility it was available to staff and they had been trained to use it. We saw there were plans in place to guide staff with these risks. People’s medicines were stored securely and administered as prescribed. Staff had been trained and observed safe practice when administering medicines.

People enjoyed the food they ate and told us they were consulted about changes with the menu. We saw people were offered visual prompts to support their decisions about their meal choices. Staff adapted how they communicated with people to ensure they understood the choices they were offered.

People were asked before they were supported and their wishes respected. Where people needed support with some decisions the registered manager involved appropriate people who knew had the person’s best interests at heart. The registered manager had a plan to increase care staff understanding of how people’s rights needed to be upheld and this would support her to monitor people’s capacity to make decisions effectively.

People and their relatives were assured that health and social care professionals were involved when they were needed. The nurse practitioner we spoke with told us staff made appropriate referrals to support people’s well-being.

People had caring relationships with staff, and they knew each other well. However staffing arrangements and lack of leadership had impacted on how people were supported to spend their day. Opportunities for people to follow their own interests and social activities were limited and often cancelled because of a lack of commitment to meet these needs.

The provider had not ensured everyone living at the home had hot water when they needed it. Some people had to wait for over 20 minutes before the water in their rooms ran hot. The provider was aware of this concern and had made some improvements, however some people continued to be delayed with having their needs met.

People felt they were listened to and the registered manager ‘tried hard’ to make improvements. Relatives were confident to report concerns and felt they were actioned appropriately. However sometimes the concerns returned and needed to be dealt with again. There were systems in place to manage people’s concerns and complaints and we saw these were completed and outcomes shared with staff.

People were regularly asked for their views about how the service could be improved, they told us they were happy at the home and staff tried hard to meet their needs. Relatives said they were listened to however some improvements took time to be completed.

The provider had systems in place to monitor the quality of the care provided which were not always effective and maintained. When improvements were made they were not consistently sustained. Staff worked within a culture of complacency which did not continually drive up standards of care.

The provider had not demonstrated effective leadership to keep up to date with developments across the care community relating to health and safety to ensure people were provided with high quality safe care.

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

The inspection took place on the 12 and 13 April 2016 was unannounced. At our last inspection on 29 July 2015 we asked the provider to take action to make improvements to protect people who lived at the home. The provider was not meeting three of the Regulations of the Health and Social Care Act 2008 (RA) regulations 2014. Care staff were not putting training into practice to ensure the safe care and treatment of people living at the home. The provider did not have sufficient numbers of suitable staff deployed effectively to meet people’s needs, and did not have effective arrangements in place to monitor and improve quality. Following this inspection the provider sent us an action plan to tell us what improvements they were going to make. At this inspection we saw that the actions required had been completed and these regulations were now met. However the systems for monitoring and improving the quality of care provision were not established at the time of our inspection therefore we were unable to see if the improvements could be sustained.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 who lived at the home and their relatives said they felt safe and staff treated them well. Relatives told us their family member was safe. Staff we spoke with understood how to support people in a safe way and to monitor identified risks.. They explained how they kept people safe from potential abuse, and systems were in place to guide them in reporting these concerns.

Staff were trained and there was an on-going program to keep training updated. The registered manager had implemented a system for monitoring staff competencies to ensure they delivered effective care. Staff were knowledgeable about how to manage people’s individual risks. The registered manager was monitoring staffing levels and reviewing people’s dependency levels, to ensure there were consistently sufficient suitable staff available. People were protected against the risks associated with medicines because the registered manager was embedding appropriate arrangements to monitor the management of medicines.

People were supported to make their own choices, and where possible involved in making decisions about their care. People received support with their decisions when they needed to. Applications had been submitted to the local authority for the people living at the home where their liberty was restricted, to ensure care was delivered in the least restrictive way. We saw staff treated people with dignity and respect whilst supporting their needs. People were supported with a balanced and healthy diet. People and their relatives told us they enjoyed the food. People were supported to eat and drink well. They had access to health care professionals when they were needed.

People were able to see their friends and relatives as they wanted. People had access to private areas at the home to see their visitors in privacy if they wanted to. People and relatives knew how to raise complaints and the provider had arrangements in place so that people were listened to and action taken to make any necessary improvements. People who lived at the home and staff were involved in regular meetings and one to one’s.

The registered manager was working with support from an external consultant to embed systems to drive up standards of care provision at the home. The registered manager was continuing to review and monitor care provision. However systems recently implemented were still in the process of evolving therefore we were unable to establish their effectiveness.

People expressed their views on how they wanted to maintain their independence. One person we spoke with said: 'I prefer to stay in my room, but that's my choice'. Staff that we spoke with told us they supported people in their choice and they promoted people's privacy and dignity.

People were complimentary about their home and the care and support they received. One person told us: 'The staff look after me'. Another person told us: "I can't find any faults with them. I am lucky".

Staff knew about the needs of the people they were caring for. We looked at care plans for three people and found that these contained guidance for staff on how to meet people's needs. We saw that people's care plans were reviewed regularly.

People told us that they felt safe living at the home and knew who to speak to if they had any concerns. Staff had received training on how to recognise signs of abuse and knew how to report concerns.

People were supported and cared for in an environment that was safe, secure and clean. We saw the provider had carried out improvements to the home and further improvements were planned to be completed.

We looked at audit records which showed that the provider was regularly monitoring the quality of its service.