The inspection took place on 27 November 2018 and was unannounced.

The last inspection of the service was on 22 May 2018, when we rated the service requires improvement. We asked the provider to complete an action plan to show us the improvements they were going to make.

Blenheim Care Centre is care home with nursing for up to 64 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. The provider offers a service to younger adults with disabilities and nursing needs and older people, some of whom were living with the experience of dementia. The home is divided into three units. The ground floor provides accommodation to the younger adults and some older people. The first floor is for people who do not have nursing needs but have dementia and the second floor is for people with dementia and nursing needs. At the time of our inspection 54 people were living at the service.

The service was owned and managed by MMCG (2) Limited, part of the Maria Mallaband Care Group, a private organisation providing care services in England. MMCG (2) Limited took over the management and ownership of the service on 4 August 2017.

There was a 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.

At this inspection we found there had been improvements to all aspects of the service. However, further improvements were needed.

Care plans, risk assessments and medicines profiles did not always contain enough detail or information was contradictory. This meant that staff who were not familiar with people's needs may have provided inappropriate care.

The provider ensured people were asked to consent to care and treatment. However, records relating to their mental capacity were not always clear. Therefore, people were at risk of receiving care which was inappropriate or did not meet their needs.

The provider's systems for monitoring and improving the service had been effective in making improvements. However, further improvements were needed to ensure that the risks to people's wellbeing were always mitigated.

The provider did not have specific guidance, training or support for staff to promote an LGBT+ (Lesbian, Gay, Bisexual and Transgender) inclusive environment. We discussed this with the registered manager and they agreed to look at how they could develop this area.

People living at the service had a variety of different cultural and religious needs. There were visitors from religious communities who supported people to celebrate their faith. Care plans included information about specific wishes or needs relating to faith and culture.

People living at the service and their relatives were happy there. They liked the staff and felt they treated them with kindness and respect. Although, we witnessed a few interactions which indicated some staff focussed on the tasks they were performing rather than the person they were caring for. We also witnessed positive interactions where the staff were kind, attentive and caring. The staff knew their individual needs and personalities and met these needs. People felt safe at the service. They said there were enough staff and that they felt secure and well looked after.

The staff were happy working at the service. There were procedures to ensure they were suitable to work there. They had effective inductions and training, so they knew how to provide care which met people's needs. There were good systems for the staff to communicate with one another and learn from incidents.

People had access to healthcare professionals when t

The inspection took place on 22 May 2018 and was unannounced.

The last inspection of the service was on 27 September 2017 when we rated the service Requires Improvement for all key questions and overall. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the service to at least ‘Good’.

At this inspection on 22 May 2018 we found that there had been some improvements. However, the service remains Requires Improvement in all key questions and overall.

Blenheim Care Centre 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 is registered to accommodate up to 64 adults. At the time of our inspection 53 people were living at the service. Accommodation was provided on three floors. Eight younger (under 65 years of age) and ten older adults with physical disabilities and nursing needs lived on the ground floor, 17 older people living with the experience of dementia lived on the first floor and 17 older people with nursing needs were living on the second floor.

The service was owned and managed by MMCG (2) Limited, part of the Maria Mallaband Care Group, a private organisation providing care services in England. MMCG (2) Limited took over the management and ownership of the service on 4 August 2017.

The manager had been in post for two weeks at the time of our inspection. They had started the process of applying to be registered with the Care Quality Commission, by applying for their enhanced check with the Disclosure and Barring Service. The previous registered manager left the service in September 2017. There had been two other interim managers since this time. Neither had applied to be 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 and associated Regulations about how the service is run.

The risks to people's safety and wellbeing had not always been identified, assessed and mitigated. This meant they were at risk of receiving care and treatment which was not appropriate or safe and did not meet their needs.

Medicines were not always managed safely at the home.

The staff supporting people did not always receive the supervision, guidance, support and appraisal they needed to effectively care for people. Their competencies at meeting people's needs were not always being assessed so people were at risk of receiving inappropriate care and support.

People were not always treated with dignity and respect or in a personalised way.

People's care was not always designed in a way to meet their needs and reflect their preferences. Furthermore, they did not always receive care which met their individual needs. For example, people did not always have enough to drink or the support they needed to wash and shower.

People told us that they were lonely and did not have the care and support they needed to meet their social and emotional needs.

The provider's systems for monitoring and improving the quality of the service were not always effective.

There were not enough permanent, regular staff deployed to provide consistent and effective care which met people's individual needs.

We found six breaches of Regulations during the inspection. These were in respect of person centred care, dignity and respect, safe care and treatment, nutrition and hydration, good governance and staffing.

We are taking action against the provider for failing to meet Regulations. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The inspection took place on 27 September 2017 and was unannounced. This was the first inspection of the service since it was registered with the provider, MMCG (2) Limited on 4 August 2017. Previous to this the service was registered with and managed by another organisation.

Blenheim Care Centre provides accommodation for a maximum of 64 people. The service has three floors and accommodates people in single rooms each with en suite facilities. to the ground floor was designed to accommodate up to 12 older people and 8 people with physical disabilities. The first floor was designed to accommodate up to 22 older people with dementia care needs and the second floor for up to 22 older people with dementia care needs. Each floor has communal dining, sitting rooms and bathing facilities. Nursing staff were employed to provide care on the ground and second floors. At the time of the inspection 51 people were living at the service.

MMCG (2) is part of the Maria Mallaband Care Group, a privately owned organisation providing care homes, day care and domiciliary care across the UK, Northern Ireland and Channel Islands.

The registered manager left the organisation in August 2017. There was a temporary manager in post. The provider was in the process of recruiting a permanent 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 and associated Regulations about how the service is run.

The staff did not always care for people in a respectful way and sometimes focussed on the tasks they were providing rather than the needs and wishes of the people who they were supporting.

There was not enough information about how to meet some people's care needs within their care plans and this meant there was a risk they would receive care which was inappropriate or unsafe.

People's social and leisure needs were not always being met.

Care records were not always clearly maintained.

The provider had systems for monitoring the quality of the service and making improvements. However, these improvements were not always sufficient to address any identified shortfalls.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to person centred care, dignity and respect, good governance and staffing. You can see what action we told the provider to take at the back of the full version of the report.

The environment had not been suitably designed and equipped to meet the needs of people living with the experience of dementia. We have made a recommendation in respect of this.

The staff took part in training in relation to their role but did not always demonstrate the skills and knowledge from this training. The staff were not always supported and supervised to make sure they met people's needs and understood their roles and responsibilities. However, the provider had started to address this and provide better training, support, supervision and information.

Some people felt there were not enough staff to meet people's needs and keep them safe. The provider had assessed staffing levels and felt that these were sufficient. We observed that the staff did not spend time engaging with people or supporting them for longer than physical care tasks. It was unclear whether this was due to staffing levels, the deployment of staff or custom and practice of the staff team. There were times of the day when there were not enough staff to support everyone at the same time, for example, during mealtimes. There were some instances where staff worked consecutive days without sufficient time off and this practice could put people at risk.

People were safely cared for at the service. Risks to their wellbeing were assessed and managed. People received their medicines in a safe way and as pre