Blackwater Mill Residential Home 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 service was last inspected in December 2016 when we identified no breaches of regulation, but rated the service ‘Requires improvement’.

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

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

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

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

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

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

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

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

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

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

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

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

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

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

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

Staff supported people to access healthcare services, including when they were

This inspection took place on 15 December 2016 and was unannounced. The home provides accommodation and personal care for up to 51 people, including people living with dementia. There were 46 people living at the home when we visited. Accommodation was spread over three floors, connected by two passenger lifts and stairwells. All rooms had en-suite toilet and washing facilities. There was a lounge and a dining room on the ground floor, further lounges on the middle and top floors, and bathrooms on each of the floors. A patio was accessible to people via level access from the first floor.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

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

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

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

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

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

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

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

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

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

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

People were supported to access healthcare services and staff followed medical advice. Care plans were comprehensive and reviewed regularly. Staff demonstrated a good aware

We carried this focused inspection on 12 April 2016 to check whether the provider had taken action in relation to a warning notice we issued following our previous inspection in November 2015 when we identified that insufficient staff were deployed to meet people’s needs and pre-employment checks were not always conducted. This report only covers our findings in relation to these topics in the “Safe” key question.

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

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

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

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

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

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

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

The inspection took place on 25 and 26 November 2015 and was unannounced. The home provides accommodation for up to 51 people, including people living with dementia care needs. There were 49 people living at the home when we visited. Accommodation is spread over three floors, connected by two passenger lifts and stairwells. All rooms have en-suite toilet and washing facilities. There is a dining room on the ground floor and a selection of lounges on other floors.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

People and their relatives had mixed views about the availability of staff. Whilst some felt they were adequate, others felt there were not enough staff to ensure people received baths or showers regularly. Staff confirmed that baths and showers were sometimes missed when they were short-staffed and this was confirmed by the care records. Night staff told us that they were not able to support everyone who wanted to get up between 6:00 am and 7:30 am as there were not enough of them.

There was a clear process in place to recruit staff and this helped make sure they were suitable, although the full employment history of staff members was not always recorded. Risk to people were assessed and managed effectively in most cases.

People received personalised care from staff who understood and met their needs well. Staff were responsive to changes in people’s needs and records showed people received all essential care. Most care plans contained detailed information about how people wished to be cared for, although some lacked information about the support needed when they became anxious.

Quality assurance processes had been reviewed and comprehensive audits were being conducted by managers. However, the auditing process for care planning was still being developed and had not identified a lack of information in some care plans as they had not been reviewed.

People told us they felt safe at Blackwater Mill. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. Medicines were managed and administered safely by staff who had been trained and assessed as competent.

People praised the quality of the food. They received appropriate support to eat and drink enough and, in all but one case, action was taken if they started to lose weight.

People received effective care from staff who were suitably trained and supported in their role. Mentors had been appointed to support new or inexperienced staff. Staff followed legislation designed to protect people’s rights and freedom.

People were supported to attend healthcare appointments and to see doctors or community nurses when needed. Changes had been made to the environment to help people navigate their way around the building, which included additional signage.

People were cared for with kindness and compassion and we observed positive interactions between people and staff. People were encouraged to be as independent as possible and their privacy and dignity were protected. People were involved in assessing, planning and agreeing the care and support they received.

An additional activity coordinator had been recruited and a range of appropriate activities was provided. Two activity clubs had been formed which had proved popular with people.

The provider sought and acted on feedback from people, relatives and staff to help improve the service. There was a suitable complaints procedure in place; complaints were investigated thoroughly and promptly.

People and their relatives felt the home was managed well. The managers, senior staff and the mentors were highly experienced and demonstrated a commitment to providing high quality, compassionate care to people. Staff were organised and worked well as a team.

There was an open and transparent culture. Visitors were welcomed and the provider notified CQC of all significant events. There was a development plan in place to open a further nine bedrooms and an additional dining room.

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

We have also made a recommendation about record management procedures.