This inspection took place on 18 December 2018 and was unannounced. A second visit was carried out on 19 December which was announced.

Blackwell Vale 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. Blackwell Vale provides nursing and personal care to 60 older people. The home has two floors, the upper floor accommodates people who have a dementia related condition and the ground floor accommodates people who have general nursing and personal care needs. There were 44 people living at the home at the time of the inspection.

At our previous inspection in January 2018, we found two breaches of the Health and Social Care Act 2008. These related to good governance and staff competencies. We rated the service as requires improvement.

Following the inspection, the provider formulated an action plan to address the breaches. At this inspection, we found that sufficient action had been taken to address those breaches. Continued improvements were still required in some areas of the service.

Since the last inspection the acting manager had registered as the manager. 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.

During this inspection we identified some practices that required attention, for example keeping the kitchen door locked, and gaps in daily temperature records and fire drills. Action was taken to address these issues.

People said they felt safe and comfortable at the home. Risk assessments were in place about people’s needs and about the premises. The home was comfortable, clean and maintained. Medicines were managed in a safe way but there were some shortfalls in relation to recording.

People who could express a view told us they received a “good service”. Staff had opportunities for relevant training. Staff supervisions had not always been carried out because of the previous gap in the management arrangements, but staff said they felt supported.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005 and best interest meetings had been held to make sure people were not restricted unnecessarily. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service to support this practice required further development. We made a recommendation about this.

People received the right support with their nutrition and hydration needs. Risks to people’s nutritional well-being were assessed and managed. People said they enjoyed the meals and the quality of food was good.

Before people moved to the home their needs were assessed to check if the home could provide the right care for them. The home worked with other health services to make sure people were supported with their health needs.

People and relatives told us staff were kind and caring. Staff were considerate, respectful and helpful when assisting people. There were friendly relationships between staff and the people who lived there.

There was a welcoming atmosphere in the home. Staff supported people to make their own individual choices and used different ways to help them do this.

Staff were knowledgeable about people’s individual care needs and how they wanted to be assisted. People had opportunities to join in activities and go out into the local community.

People had information about how to make a complaint. They were asked for their views and these were acted on. The registered manager had an open-door policy and made themselves available

This inspection took place on 18 January 2018 and was unannounced. This meant that the provider and staff did not know we would be visiting. We carried out a further announced visit to the home on 19 January 2018 to complete the inspection.

Blackwell Vale Care 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. Blackwell Vale Care Home provides nursing and personal care to 60 older people. The home has two floors, the upper floor accommodates people who have a dementia related condition and people who have general nursing and personal care needs lived on the ground floor. There were 44 people living at the home at the time of the inspection.

At our previous inspection in September 2017, we found six breaches of the Health and Social Care Act 2008. These related to safe care and treatment, safeguarding people from abuse and improper treatment, meeting nutritional and hydration needs, receiving and acting on complaints, staffing and good governance. We took urgent enforcement action and imposed conditions upon the provider’s registration to minimise the risk of people being exposed to harm. This included the suspension of new admissions to the home. We also asked the provider to assess the competency of the registered manager. We rated the service as inadequate and placed the service in 'special measures.' This meant the service was kept under continuous review.

Following the inspection, the provider formulated an action plan and sent us regular updates in response to the breaches and concerns we had identified.

We carried out this inspection to check whether the provider had complied with the imposed conditions and had met the breaches which were identified at our last inspection. We also brought our inspection forward, following the receipt of a notification of an incident which had occurred at the service. This incident is being examined outside of this inspection process; however, we wanted to ensure that people were receiving a safe and suitable diet.

At this inspection, we found that the provider was taking action to address the previous concerns we had raised. Further improvements were still required. We considered however, that sufficient action had been taken to ensure people's safety. We agreed that the conditions imposed upon the provider's registration could be removed. The service was also taken out of special measures.

There was a registered manager in post. They were not present at the time of the inspection. The deputy manager who we refer to as the acting manager throughout the report was managing the service in the registered manager’s absence. 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 and associated Regulations about how the service is run.

At this inspection, we found that some improvements had been made with regards to the premises, infection control and medicines management. However, we identified several new and ongoing shortfalls and omissions. Following our visits to the home, the regional manager sent us an update to inform us that these issues had been addressed. Whilst we were satisfied that action had been taken to address the concerns we raised; we considered that an effective system was not fully in place to monitor the safety of the service.

People and relatives told us that people were safe. Staff informed us they were now more confident that any safeguarding issues they reported would be dealt with appropriately. The local authority informed us that safeguarding reporting had improved.

We found there were sufficient staff deployed. Two nurses were normally on duty through the day. Agency

This inspection took place on 26 and 28 September, 2 and 11 October 2017. The visit on the 26 September was unannounced. This meant that the provider and staff did not know we would be visiting. Subsequent visits were announced.

Blackwell Vale Care Home is a 51-bed home providing residential, nursing and dementia care. There were 49 people living at the home at the time of the inspection.

A registered manager was in post and our records showed she had been registered with the Care Quality Commission [CQC] since 2010. 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 and associated Regulations about how the service is run.

We found concerns with the safety and security of the premises. We accessed the top floor of the building via an open fire door early in the morning. We also found a number of hazardous items and equipment that were accessible to people throughout the home, including those living with dementia.

Infection control was poor and we found dirty bedding and equipment which was so heavily contaminated it had to be cleaned or discarded during our inspection. Bathrooms and toilets were not fit for purpose. A number were used as storage, or were damaged and unable to be used. Toilets were positioned on raised plinths which were damaged, unsightly and were not impermeable to urine meaning they could not be effectively cleaned. Some posed a risk to people due to sharp edges.

Personal Emergency Evacuation Plans (PEEPS) were in place for people who had died, and a number were missing for people that had moved into the home. These were updated during our inspection. Individual risks to people were assessed, but care plans developed to mitigate risks were not always followed; in relation to choking for example.

We found medicines were not safely managed. Records were not accurately maintained and we found a medicine error following a review of stock levels. Guidance was not fully in place to describe how medicines given as and when required should be administered. Prescribed medicines were not always made available to people in a timely manner. The registered manager carried out a full audit of all medicines following the concerns we raised and found some further discrepancies which they put plans in place to correct.

Records did not support that staff had received the training they required to carry out their role safely. Nursing competency and clinical training records were not up to date and could not evidence that nursing skills were being maintained and monitored. It was difficult to ascertain from training records, the percentages of staff that had received up to date training. Staff told us they received regular supervision and that they felt well supported.

Sufficient numbers of suitably qualified staff were not always deployed effectively in the home. The provider was having difficulty in covering shifts due to staff absence at short notice particularly at the weekends.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes.

People were not always supported to have choice and control of their lives. Records did not demonstrate that staff supported them in the least restrictive way possible and contained conflicting information. The policies and systems in the service did not always support this practice.

There were complaints about the quality and variety of food provided and meetings were taking place to address this at the time of the inspection. We fou

This inspection took place on the 22 and 25 January 2016 and was unannounced.

Blackwell Vale Care Home provides nursing and personal care to 60 older people. The home has two floors, the upper floor accommodates people with dementia type illnesses and the ground floor is designated to people who require general nursing and residential care. Both floors have separate dining and communal areas and all of the bedrooms in the home are for single occupancy.

The home was last inspected in December 2014. At this inspection we rated the service as inadequate. The home was in breach of the following regulations of the Health and Social Care Act (HAS) 2008 (Regulated Activities) Regulations 2010:

Regulation 22 HSCA 2008 (Regulated Activities) Regulations 2010 Staffing.

Regulation 13 HSCA 2008 (Regulated Activities) Regulations 2010 Management of medicines.

Regulation 14 HSCA 2008 (Regulated Activities) Regulations 2010 Meeting nutritional needs.

Regulation 23 HSCA 2008 (Regulated Activities) Regulations 2010 Supporting staff.

Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 Care and welfare of people who use services.

Regulation 10 HSCA 2008 (Regulated Activities) Regulations2010 Assessing and monitoring the quality of service provision.

The above regulations have now been replaced with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the home was no longer in breach of any of the above regulations and met all of the 2014 Regulations.

At the last inspection in December 2014, we asked the provider to take action to make improvements in the areas outlined above. This action has now been completed.

The service had a registered manager. 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.

The service had sufficient staff on duty to meet people’s needs at the time of our inspection.

The staff knew how to identify abuse and protect people from it.

The home was clean and odour free.

The service had carried out risk assessments to ensure that they protected people from harm and minimised any risks identified.

Medicines were ordered, stored, administered and disposed of correctly.

Staff had been trained to an appropriate standard.

The service co-operated with other providers of health and social care.

There were systems in place to make sure people had a good diet and were adequately hydrated.

Staff had developed caring relationships with people who used the service.

Support plans were written using a person centred approach, relatives and staff had noticed an improvement in person centred care since our last inspection.

There was a complaints process in place.

There was a robust quality assurance system in place which meant that the registered manager, her deputy and area manager were aware of areas that required improvement in the service. This included management of the team and helping staff to maintain good standards of personal care for people who used the service.

During our visit we looked at the records and care plans of ten people living at Blackwell Vale. Where it was deemed that people lacked capacity to agree to care and treatment we saw that some individuals' relatives had been asked to make decisions on their behalf. However, appropriate checks to ascertain whether relatives could make decisions for people using the service had not been carried out. This meant people may be at risk of others not acting in their best interest.

We saw that new systems had been put in place since our last visit in July 2013 for the monitoring of records within people’s care plans. This meant that the quality monitoring of the records would identify that if actions were required to improve the records these could be implemented quickly. This meant that records kept about people living at Blackwell Vale may protect them from the risks of unsafe or inappropriate care and treatment because records were appropriately maintained.

We spoke with two people about their medicines and the care they received. One person said “The staff are great and I get all my medicines regularly”. Another person said “I like the staff. If I want my painkillers I just ask them and they bring them to me. I prefer to put my creams on myself so I just ask for them when I need them”.

Overall, we found that medicines were handled safely and people received their medicines when they needed them.

People we spoke with were very happy with the care and support they received. One person told us, I’m looked after very well and get on very well with all the staff.’’ Another person told us, ‘’I have lived here a long time and I’m very happy here.’’

The home had a range of equipment to support people who lived there. People benefitted from having the equipment they needed to ensure they received the support they required in a safe way.

We spoke to a number of staff on duty during our inspection. All the staff we spoke with told us they felt there had been recent changes which meant there was sufficient staff available to provide the care people in the home needed.

People were asked their views about the service provided and these were taken into account of. They were asked about their care and treatment in an annual survey.

The records we looked at in people’s rooms were not up to date nor did they reflect what was occurring in the practical care being delivered.

The care plans we looked at had written confirmation that people had been consulted about their care. One person told us,” I can do what I want, if I want to stay in bed I can do.” Another person said, “We have a good laugh, the staff seem very well trained.” We found that dining tables were nicely laid and there was adequate space in the downstairs unit. People could also choose to eat in their own rooms. However on the upstairs unit the tables were not laid and when fully occupied the dining room was very crowded. People told us; "The foods not bad." "There is always a choice if we don't like the menu we can have whatever else we want." One person said; "I feel fine here. If I don't like something I will tell the staff." Although there was a choice of meals we did not see staff asking what people wanted to eat or reminding people of what they had ordered and if that was still acceptable to them.

Review of care plans showed that risk assessments were in place to safeguard people’s safety in the home. There were procedures in place to monitor the quality of the care and service being provided. Regular audits were being completed by the manager monitoring the homes environment, care plan records, medication procedures, maintenance of the building, staff training, infection control and handling of complaints. Where issues had been identified the manager had produced an action plan with timescales set for improvements to be made.

We conducted this inspection as a result of concerning information which was sent to us regarding staffing arrangements in the home. The concern detailed that staff were expected to work 24 hour shifts when there were staff shortages.

On the day we inspected the home we found there were enough qualified, skilled and experienced staff to meet people's needs.

People who used this service told us there is always plenty of staff on duty and they are available when they need them. We were told: "There seems to be plenty of staff around." Another person told us: "Staff are a decent lot, I am well fed and well provided for. It's great living here".

We found staffing levels were sufficient for the number of people living in the home. We looked at the staff rosters for the previous two months and found that the home was appropriately staffed and rosters demonstrated that this was always the case.

There was a staffing matrix which was used to identify the minimum number of staff on duty. On review of this matrix and in discussion with the manager we found that the home was staffed according to people's need which was above the minimum required numbers.

We spoke to people about their experiences living in the home and were told the staff team provided sensitive and flexible personal care support and they felt well cared for. They told us routines were flexible and they could get up and go to bed when they wished.

People told us they enjoyed the quality and variety of food being provided and always get plenty to eat.

“Everything is fine, the staff are lovely and work hard.”

“We have a laugh and a joke.”

“Things have changed for the better.”

“We have got to say the girls are wonderful they do a very good job.”

“Things are much improved”

“The foods not bad.”

“There is always a choice if we don’t like the menu we can have whatever else we want.”

“I feel fine here. If I don’t like something I will tell the staff.”

“We are happy at the moment”

Two people told us that on the whole they felt they were 'looked after well.' Others said that staff were very nice but very busy and would attend to them 'soon'. One person told us that staff were ‘very good’ but getting a response to their call bell during the night can be a problem.

Another person said that 'there are blips and the nurse in charge does not always sort out the blips’. Another person told us that if they requested to see their GP it is the ‘nurses’ who usually decide if they ‘need’ to see anyone.

This unannounced inspection took place on 7 and 8 December 2014. This visit was to check if compliance actions from the last inspection had been met and because of concerns about staffing and standards of care that had been raised with us.

We last inspected Blackwell Vale Care Home on 26 March 2014 and at that inspection we had found that the registered provider had not always obtained appropriate information with regard to consent in relation to care and treatment. The registered provider wrote to us and gave us an action plan saying how and by what date they intended to make changes to their systems.

We found that the registered provider had made the improvements needed from the previous visits. However at this inspection we found that there were others breaches of regulations that had an impact on people living in the home.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to making sure there were sufficient staff, with the right skills to meet the needs of people who used the service. We also found that people were not being protected against the risk of unsafe care because the registered provider had not made sure that all aspects of service provision were being regularly monitored for effectiveness. You can see what action we told the provider to take at the back of the full version of this report.

Blackwell Vale Care Home provides nursing and personal care to 60 older people. The home has two floors, the upper floor accommodates people with dementia illnesses and the ground floor is designated to general nursing and residential care. Both floors have separate dining and communal areas and all of the bedrooms in the home are for single occupancy.

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

We found that there were not always staff available on the units to provide support to people to meet all their needs promptly. We also found that training and staff support was not being well monitored so people could be sure all staff had the right skills and experience to support them. Most training was via e-learning and there was a reliance on staff to monitor their own training rather than this be ensured by the registered provider.

The systems used to assess the quality of the service had not identified all the issues that we found during the inspection. Whilst we found that some aspects of the quality monitoring processes were being done well others were less well monitored.

We found that people living at Blackwell Vale Care Home were able to see their friends and families as they wanted. There were no restrictions on when people could visit them. We could see that people were able to follow their own faiths. People living there and visiting relatives told us that staff were “good” and “kind”.

There were areas of the premises and equipment that were in need of improvement and upgrading to meet the needs of the people living there. There was evidence that this had been assessed and action was underway to make improvements to the environment and premises. The work was underway and plans indicated that the improvements would make the environment more supportive of the needs of people with dementia.

People’s needs had been assessed and care plans developed. Although medicines were being stored appropriately they were not always being administered in line with good practice and the home’s policies and procedures.There were suitable hoists and moving aids in use in the home to assist with the different mobility needs of people living there.

There was information in care plans that showed the staff had discussed with people if they wished to be resuscitated should their health conditions change. The service had policies in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, staff and management did not demonstrate a clear understanding of the procedures in regard to a situation regarding a possible deprivation of a person’s liberty that we found during the inspection.

The home had safe systems when new staff were recruited and all staff had appropriate security checks before starting work. The staff employed at Blackwell Vale Care Home were aware of their responsibility to protect people from harm or abuse. They knew the action to take if they were concerned about the safety or welfare of an individual.