The inspection was carried out on 22 and 23 January 2019. The first day of our inspection was unannounced while the second day was announced.

Blossoms Care Home Limited 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. Blossoms Care Home is a service that provides accommodation and personal care for up to 22 older people with dementia. At the time of the inspection, the service was fully occupied with 22 people who were living with a range of health and support needs. These included; diabetes, epilepsy and dementia. The service had a large communal lounge, dining room available on the ground floor; with armchairs and TVs for people.

At the last Care Quality Commission (CQC) inspection on 08 August 2016, the service was rated as Good. At this inspection, we found the service Requires Improvement.

The service has a registered manager. 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 2008 and associated Regulations about how the service is run.

Risks to people’s care needs had not been appropriately managed. We identified issues with a lack of risk assessments for people living with diabetes and epilepsy. We will check this when we return.

People were not always supported to eat and drink enough to meet their needs. Choices were not always provided regarding food. People told us they were not always given a choice of food.

People told us they were not always involved in their care. There were limited activities located around the service for people to be engaged with. Not everyone was engaged in activities during our inspection. We made a recommendation about this.

Staff did not receive regular training and supervision to help them meet people's needs effectively.

The registered manager ensured the complaints procedure was made available if people wished to make a complaint. One person told us that they complained to the registered manager but nothing was done about it. This is an area for improvement.

Although systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service, these had not been rigorously followed. Records were not always accurate, complete and consistent.

People were not given the opportunity to provide feedback about how the service could be improved. Feedback provided by professionals were not acted upon.

Staff treated people with dignity and ensured people's privacy was maintained particularly when being supported with their personal care needs.

People received the support they needed to stay healthy and to access healthcare services.

The provider followed safe recruitment practice. There were appropriate numbers of trained staff to meet people’s needs and keep people safe.

Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for. There were systems in place to support staff and people to stay safe.

Medicines were managed safely and people received them as prescribed.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

We found three breaches 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.

This unannounced inspection took place on 8 August 2016. Blossoms Care Home Limited provides personal care and nursing care for up to 22 older people. 21 people were using the service at the time of the inspection.

There was a registered manager in post at the time of this inspection. 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.

This is the first comprehensive inspection of the service by the Care Quality Commission (CQC) since registration in February 2014.

People were happy with the care they received at the service. People were treated with respect and their dignity upheld. Staff asked people for their consent before providing them with care and support. People received the support they required in line with their preferences and wishes.

People received safe care and support. Staff understood the types of abuse and neglect which could happen to people and their responsibility to report any concerns to keep them safe. People had received their medicines safely as prescribed and staff supported them to keep their money safe. Staff assessed risks to people and had support plans in place to manage the risks to keep them as safe as possible. There were sufficient staff on duty to meet people’s needs.

Staff assessed people’s needs and their support plans showed the care and support they required. Staff met with people and their relatives regularly to discuss their support plan and identify any changes in people’s needs. The service also received input from healthcare professionals involved in people’s care. People received support in line with principles of the Mental Capacity Act 2005 (MCA) and the requirements of the Deprivation of Liberty Safeguards (DoLS).

People accessed the health and care services they needed. People received the support they required in the final years of life and told us staff kept them as comfortable as possible. People had a choice of fresh and nutritious food which they liked.

Staff felt comfortable speaking with the registered manager and felt able to suggest ways for improving the service. People, their relatives and staff found the registered manager approachable and open to ideas and feedback. The registered manager held meetings with people to get their views about the service and their feedback was used to develop the service. People understood the complaints procedure. The registered manager responded appropriately to complaints, in line with the service’s procedures.

The registered manager made regular checks on the quality of the service and made improvements when necessary. Staff felt supported in their role to provide care to people and received regular supervision. Staff attended regular training courses, and had the knowledge and skills to support people with their health needs. Health professionals told us the service communicated well with them to ensure people received the support that reflected their needs.