About the service: Blackwood provides accommodation with personal care for predominately older people, who may have physical disabilities or are living with dementia. The service is registered to accommodate up to 47 people, and was providing personal care to 42 people at the time of the inspection. Any nursing needs were provided by community nursing services.

People’s experience of using this service: People, relatives, staff and professionals all told us improvements had been made to the running of the service. There was a stable management team and staff morale was good. Improvements had been made to records relating to people’s care.

People were provided with safe care because staff received regular supervision, training and support from management. Staffing levels had been increased and there were enough staff on duty to meet people’s needs and keep them safe.

People were involved in their day to day lives through being empowered to make their own choices about where they spent their time, who with and how. Their independence was promoted and staff actively ensured people maintained links with their friends and family.

People were relaxed and comfortable with staff, and had no hesitation in asking for help from them. Staff were caring and spent time chatting with people as they moved around the service. People and their relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, “I wouldn’t go anyway else to live” and “I really enjoy living here and have made good friends.”

A programme to provide meaningful and individualised activities for people had been developed and was on-going.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Staff were informed about people’s changing needs through effective shift handovers and by accessing up-to-date electronic records of people’s care via handheld devices.

People and their families were given information about how to complain and details of the complaints procedure were displayed at the service. The service sought the views of people, families, staff and other professionals and used feedback received to improve the quality of the service provided.

Rating at last inspection: Requires Improvement (report published on 9 March 2018). The service had been rated as Inadequate at the previous inspection in October 2017.

Why we inspected: This was a planned inspection based on the rating at the last inspection to check if the required improvements had been made. We also checked if the positive conditions applied to the provider’s registration were met. Positive conditions were applied at a previous inspection in October 2017 and remained in place after the inspection in February 2018. At this inspection the service had embedded changes sufficiently to improve the overall rating to Good and the conditions were met.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The full details can be found on our website at www.cqc.org.uk

We carried out this unannounced comprehensive inspection of Blackwood on 5 and 6 February 2018. The last inspection took place on 11 October 2017 when the service was not meeting the legal requirements. There were eight breaches of the regulations and two were repeated breaches from a previous inspection in March 2017. These breaches were in respect of risk management, medicines management, recruitment practices, staff training and support, seeking people’s consent, treating people with dignity and respect, providing individualised activities, the cleanliness of the environment and the oversight of the service. Enforcement action was taken against the provider and the service was placed into Special Measures after a rating of Inadequate. A condition of registration was imposed that the provider must have a system for monitoring the quality of the service provided and send monthly reports to the Care Quality Commission stating the improvement actions taken at the service.

Following our last inspection the provider wrote to us detailing the actions they planned to take to ensure they were meeting the requirements of the regulations. In addition the provider sent us monthly reports, about the progress of the improvement actions they had taken, as was required by the condition of registration imposed. We undertook this inspection to check if they had carried out the actions detailed in the action plan and monthly reports.

Blackwood is a ‘care home’ that provides care for up to a maximum of 47 predominately older people. 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. At the time of the inspection there were 40 people living at the service. Some of these people were living with dementia.

The service is required to have a registered manager and at the time of the inspection there was no registered manager in post. The manager who was in charge of the day-to-day running of the service had applied to become the registered manager. At the time of this inspection their application was being processed. 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.

At the last inspection we found that while there were systems in place to monitor the quality of the service provided, these systems had failed to identify the concerns found at that inspection. At this inspection improvements had been made to the auditing systems and this meant the monitoring processes were more effective in identifying where action needed to be taken. We found improvements had been made in relation to risk management, medicines management, recruitment practices, staff training, seeking people’s consent, treating people with dignity and respect and the cleanliness of the environment. This meant the service had met seven of the eight outstanding legal requirements from the last inspection.

At this inspection we found there were some areas where improvements to the running of the service had been identified but plans to carry out those improvements were still in progress. A programme to carry out regular one-to-one supervision with staff had started. However, only 14 out of 60 staff had met with a manager at the time of this inspection. This meant most staff had not had the opportunity to be supported in their role and discuss their training and development needs.

In order to address the concerns from the last inspection the provider had introduced many new systems and processes for care staff to follow. For example, a new system for allocating staff to work with specific people on each shift had been introduced

This comprehensive inspection took place on 11 October 2017 and was unannounced.

The service was last inspected in March 2017. At that time we identified concerns in relation to risk management, medicines management and recruitment practices. The service was in breach of the regulations. Following the inspection the provider sent us an action plan outlining how they would address the issues highlighted in the inspection report.

Blackwood is a care home which offers care and support for up to 47 predominately older people. At the time of this inspection there were 43 people living at the service. Some of these people were living with dementia.

The service is required to have a registered manager. At the time of the inspection there was no registered manager in post. 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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe, and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s risks were not safely managed at the service. One person had sustained an injury to their leg. This had been noticed by staff in the morning when they had assisted the person with a bath, but not reported to the district nurse service until the afternoon. When the person was seen by a nurse in the afternoon, staff were advised that the person should have had their leg elevated during the day to prevent further skin damage.

We found concerns relating to hazardous items in the environment. Kettles in the kitchenettes were accessible by people. Some people living at the service were physically mobile and had cognitive impairments. The kitchenettes were not always staffed. People were at risk of burning themselves on these appliances. We found that these had been used and were hot during the inspection.

We saw some positive interactions between people and staff. However, some interactions were concerning. Some people who called out repetitively were ignored by staff. This impacted on the people concerned and those around them who were becoming frustrated with the noise. Some people’s privacy was not protected. Staff carried out care duties in a way that was not discreet. Staff did not seek people’s consent before carrying out care duties or interact with people whilst assisting them. People’s dignity was not always upheld. Some people were given the wrong clothing to wear. One person reported being given someone else’s trousers which were clearly too big and fell down. People were not always treated with dignity and respect.

Where people expressed a wish to leave and live somewhere else, this had not been addressed by staff. Some people were seen to be distressed, asking for help or say

Blackwood is a care home which offers care and support for up to 47 predominately older people. At the time of the inspection there were 44 people living at the service. Some of these people were living with dementia.

We carried out this comprehensive inspection on 13 and 15 March 2017. The service was last inspected in October 2016. At that time we identified concerns in relation to risk management, staffing levels, the provision of meaningful activities for people and the effectiveness of the systems in place to monitor the quality of the service provided. The service was in breach of the regulations. Following the inspection the provider sent us an action plan outlining how they would address the issues highlighted in the inspection report.

The service is required to have a registered manager and at the time of our inspection there was no registered manager in post. 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. The service was being overseen by Cornwall Care’s peripatetic manager who was applying to be the permanent registered manager at Blackwood. They had a good understanding of the service and people, relatives and staff told us the way Blackwood was managed was “much improved.”

The service was arranged over two floors. Each floor had a dining and lounge area and access to kitchen areas where drinks could be prepared. A large kitchen on the ground floor was used to prepare meals. Checks of the environment were carried out regularly and the premises were in a good state of repair.

Arrangements for the management, storage, administration and recording of medicines were not robust. Medicine Administration Records (MAR) were not consistently completed. One person was frequently asleep when staff attempted to support them to take a prescribed medicine used to help prevent infections. No action had been taken to change the time the medicine was prescribed in order to help ensure the person was protected from an identified risk to their health.

Some people had been identified as being at risk of poor nutrition. One person had been prescribed a food supplement to protect them from this. The type of supplement provided had been changed to one which was lower in calorific value. No adjustment to the amount given had been made to ensure the person received the recommended calorie intake. Monitoring records in respect of people’s weight were not consistently completed. Some people were not being weighed as often as directed in their care plan. This meant people were not protected from the risks associated with poor nutrition.

There were sufficient staff to provide care and support effectively and in line with people’s needs. Staff were deployed effectively throughout the premises. People’s needs were met promptly and staff were caring, patient and compassionate in their approach to people. Staff responded quickly to any requests for support or when they heard people becoming anxious.

New staff completed an induction before starting to work directly with people delivering personal care. Recruitment checks were carried out to help ensure new staff were suitable to work in the care sector. Two members of staff only had one reference on record. This was contradictory to Cornwall Care’s policy and meant people may not have been protected from the risk of being supported by staff who were unsuitable for the role.

Training was updated and refreshed regularly. Staff told us the training they received was good and equipped them to carry out their roles effectively. Staff had received safeguarding training and knew how to recognise and report the signs of abuse. They were confident any concerns would be dealt with.

People were assessed in line with the

This comprehensive inspection took place on 19 and 21 October 2016 and was unannounced. The last inspection took place on 10 June 2015 when we identified a breach of the legal requirements relating to the management of medicines. Gaps in Medicine Administration Records (MAR) meant we were unable to establish if people were receiving their medicines as prescribed. Following the inspection in June 2015 the provider sent the Care Quality Commission an action plan outlining how they would address the identified breach.

Blackwood is a care home which offers care and support for up to 47 predominately older people. At the time of the inspection there were 44 people living at the service. Some of these people were living with dementia.

The service is required to have 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. At the time of the inspection the service was being overseen by an interim manager. We discussed the arrangements for the management of the service in the future and were satisfied appropriate measures were being taken to help ensure the service was well managed.

Before the inspection we had concerns about how people were protected from harm. We checked to see if the service was safe. We found some people sometimes acted in a way which could put staff and other people at risk. Although this had been identified and risk assessments were in place there were occasions when people felt unsafe. Risk assessments did not accurately reflect the actions staff were taking to keep people safe.

We looked at how medicines were managed and administered. We found Medicine Administration Records (MAR) showed people were receiving their medicines as prescribed. Systems for the administration of medicines were not robust and we have made a recommendation about this in the report.

The service had identified the minimum numbers of staff required to meet people’s needs, these were not being consistently met. Staff told us they often felt rushed and were not always able to meet people’s needs, particularly social needs, in a timely manner.

Staff were supported by a system of induction, training and supervision. All staff had recently completed safeguarding training or were booked to do so in the near future. Training to support people when they were agitated and might behave in a way which was difficult for staff to manage, was not routinely provided. Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

The interim manager had an understanding of the requirements laid down in the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). They were taking action to check applications for DoLS authorisations were made appropriately. Decisions regarding the administration of covert medicines were not consistently made and recorded in line with the legislation and we have made a recommendation about this in the report.

People and relatives told us staff were caring and supportive. Staff spoke fondly of people and demonstrated a concern for their well-being. People’s dignity and privacy was respected and care was taken to protect people’s personal information.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

People did not have access to meaningful activities in line with their interests and preferences. Although events were arranged for special occasions such as Halloween there was no day to day schedule of activities in place.

Prompt action was not always

This inspection took place on 10 June 2015 and was unannounced. The last inspection took place on 22 January 2015 when we identified a breach of the legal requirements relating to the safety and suitability of the premises. Parts of the building required updating and people’s needs had not been taken into account when the building was decorated. Following the inspection in January 2015 the provider sent the Care Quality Commission an action plan outlining how they would address the identified breach.

Blackwood is a care home which offers care and support for up to 46 predominately older people. At the time of the inspection there were 43 people living at the service. Some of these people were living with dementia.

We looked at how medicines were managed and administered. We found gaps in people’s records which meant it was not always possible to establish if they had received their medicine as prescribed.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. However staff and relatives told us staff were rushed and not always able to meet people’s needs, particularly social needs. We saw one person was shouting for assistance for a long period of time. Staff did not respond until the person started to bang on a door. Relatives told us clothing and items such as reading glasses and hearing aids often went missing. They said staff did not have the time to spend locating these. We have made a recommendation about the way staff are deployed in the service.

Improvements had been made to the environment and more were planned. Some areas had been recently decorated, carpets and flooring cleaned or replaced and bathrooms upgraded. The building was light and clean.

Staff were supported by a system of induction training, supervision and appraisals. More specialised training specific to the needs of people using the service was being widened out to all staff. Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy. The registered manager had plans to improve the dining areas and introduce visual aids to support people to make meaningful choices about what they ate.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

Relatives told us access to activities had improved in recent months. An activity co-ordinator was employed to co-ordinate organised visits from outside entertainers. There were also regular trips out to local events and landmarks. People were supported to use the garden which was pleasant and well-tended. There was seating available for people to spend time there if they wished.

The registered manager was supported by higher management at Cornwall Care. Managers meetings took place on a monthly basis. One of the organisations Head of Services visited regularly to carry out quality audits.

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

We gathered evidence against the outcomes we inspected to help answer two of our five key questions: Is the service safe? Is the service responsive? We gathered information from people who used the service by talking with them.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, observing interactions between staff and people, and from looking at records.

Is the service safe?

The service was safe.

However the environment was in need of improvement. Some areas of the building required updating.

People told us they felt safe. We spoke with two people who used the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, "I have no problems and no complaints".

Is the service responsive?

The service was not responsive. People’s needs had not been taken into account when the building was decorated.

People did not always have access to meaningful activities.

Care plans were updated regularly.

The inspector gathered evidence against the outcomes we inspected to help answer one of our five key questions: Is the service safe? We gathered information from people who used the service by talking with them.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe. We spoke with two people who used the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, “I have no problems and no complaints”.

Complaints and reporting procedures were robust. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

There was a complaints procedure for people who used the service, their relatives, friends and other professionals involved with the service. Where shortfalls or concerns were raised these were taken on-board and dealt with.

Blackwood had regular support from the district nursing team and GPs from the six local GP practices. This ensured people received appropriate care in a timely way.

Staff told the inspector that Blackwood was a happy place to work and that the manager and deputy manager were supportive. They said the staff team was a “good team”.

The inspector gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe? People told us they felt safe. Complaints and reporting procedures were robust. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

People were not put at unnecessary risk, but also had access to choice and remained in control of decisions about their care and lives. The registered manager wrote the staff rotas and took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. Blackwood alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Blackwood had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). This helped to ensure that people’s needs were met.

We inspected Blackwood’s medication systems and found them to be in order. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective? People’s health and care needs were assessed with them, although it was not always clear that they were involved in writing their plans of care. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs.

Specialist dietary needs had been identified where required. Care plans were not always up-to-date. People who used the service, and their representatives, were not always involved in their care plan reviews. We saw people, or their representatives did not consistently sign care plan reviews to show they had read and agreed to the content of the care plan.

We saw that there was good liaison and communication with other professionals and agencies to ensure people’s care needs were met.

Is the service caring? We spoke with four people who used the service and four visiting relatives. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, “the staff are fantastic”, they’re [the staff] lovely”. When speaking with staff it was clear that they genuinely cared for the people they supported.

There was a complaints procedure for people who used the service, their relatives, friends and other professionals involved with the service. Where shortfalls or concerns were raised these were taken on-board and dealt with. People’s preferences, interests, aspirations and diverse needs had usually been recorded although this was not always evident.

Is the service responsive? Many people who lived at Blackwood had complex health needs and were either not able, or not inclined, to join in group activities. The care records did not always evidence the lifestyle of these people, or show that they were routinely offered one-to-one or group activities.

People knew how to make a complaint if they were unhappy. Complaints were investigated and appropriate action taken as necessary. The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led? Blackwood had regular support from the district nursing team and GPs from the six local GP practices. This ensured people received appropriate care in a timely way.

We saw minutes of regular meetings held with the staff. This showed the management consulted with staff regularly to gain their views and experiences and used their views to improve support for people who lived at the service. Staff told the inspector that Blackwood was a happy place to work.

The service had a quality assurance system, and staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

We observed how people were being cared for, talked with two people who used the service, two staff and the deputy manager, and checked records. Some of the people who used the service were not able to comment in detail about the service they receive due to their healthcare needs so we also used our SOFI (Short Observational Framework for Inspection) tool for approximately one hour in a lounge/dining area. The SOFI tool allowed us to spend time watching what was going on and helped us record how people spent their time, the type of support they got and whether they had positive experiences.

We saw people’s privacy and dignity being respected and staff being helpful. We saw people were spoken with in an adult, attentive, respectful, and caring way. We saw staff respond appropriately and respectfully to requests for assistance.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service were protected from the risk of abuse, because the staff were confident in their knowledge of the safeguarding process.

We saw there were sufficient staff to meet people’s care needs, although there were a number of staff off sick at the time of the inspection.

Staff received professional development and supervision, and had good access to training opportunities.

Blackwood operated effective systems for monitoring the quality of the service provided.

Some of the people who used the service were not able to comment in detail about the service they receive due to their healthcare needs. We spoke to two visitors who told us that they were pleased their relative lived at Blackwood House. We spoke to people and spent time observing people and staff over a meal period. We saw people’s privacy and dignity was respected and staff were helpful. We saw people chatted with each other and with staff.

People experienced care, treatment and support that met their needs and protected their rights.

People we spoke with said that they enjoyed the food they received. We were told the food was of a good standard, and we saw the food provided at lunch was hot, well presented and in sufficient quantities. We saw people were offered choices at meals.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found staff received appropriate professional development and supervision.

We had conversations with people who reside at Blackwood House, and with a visiting District Nurse. We used observations and information received before and after the visit to decide whether the service meets peoples’ preferences and choices. We observed that privacy and dignity were respected during our visit. We saw that people get visitors frequently. We observed people moving around the home with no restrictions. People were seen to interact with staff and each other in a free, spontaneous manner.

We spoke with some people who were able to talk to us about the service and about how they make choices in the care they receive. The people who were more able told us that they were generally happy with the standard of care at Blackwood House; they thought that the food was good, staff were kind and there were no rules about times to go to bed or get up. However, we found from what we saw and what we were told, that records do not always show that people who needed help with eating and drinking were receiving the support or the monitoring they needed.

People said they were satisfied with the care provided and the kindness and politeness of the care workers.

A representative from the Department of Adult Care and Support (DACS) told us that “there are no current concerns about this service”.