Bluebell Nursing and Residential Home 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. Bluebell Nursing and Residential Home provides accommodation and personal care for up to 80 older people, some people living with dementia and people who require nursing support.

This inspection was completed on the 5 and 6 September 2018 and was unannounced. At the time of the inspection, there were 71 people living at Bluebell Nursing and Residential Home.

At the last inspection on 26 and 27 April 2017, the service was rated ‘Requires Improvement’. One breach of regulation was highlighted and this referred to Regulation 12 [Safe care and treatment]. The breach of regulation specifically related to poor medication practices and procedures. At this inspection we found that medication practices and procedures had improved and compliance achieved.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines. This meant people received their prescribed medicines as they should and in a safe way. The registered provider had made the required improvements since our last inspection to the service in April 2017.

Current national guidance and standards in relation to infection control required improvement. Improvements were also required to the physical environment of the service as some areas relating to the environment required redecoration and improvement. The Memory Unit had not been adapted to meet people’s needs, particularly for people living with dementia. Not all people’s care and support needs were sufficiently detailed or accurate, however we recognised this was a records-based issue and there was no impact to demonstrate people’s care and support needs were not being met.

The service had 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 2008 and associated Regulations about how the service is run.

People told us the service was a safe place to live and there were sufficient staff available to meet their care and support needs. Appropriate arrangements were in place to recruit staff safely. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed to ensure their safety.

Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs to ensure theirs’ and others’ safety.

Staff received opportunities for training and this ensured staff employed at the service had the right skills and competencies to meet people’s needs. Newly employed staff received a robust induction based on their level of experience in a care setting. Staff felt supported and received appropriate supervision at regular intervals and an appraisal of their overall performance. Staff demonstrated a good understanding and awareness of how to treat people with respect, dignity and to maintain their independence.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The registered manager was working with the Local Authority to make sure people’s legal rights were being protected. People who used the service and their relatives were involved in making decisions about their care and support.

Where people were at risk of poor nutrition or hydration, this was monitored, and appropriate healthcare professionals sought for advice and interventions. People had their nutritiona

Bluebell Nursing and Residential Home provides accommodation and personal care for up to 80 people who require nursing care and people living with dementia. The service is situated over three floors and includes a residential unit on the ground floor, a nursing unit on the middle floor and a dementia unit on the top floor.

The inspection was completed on the 26 and 27 April 2017 and was unannounced. At the time of the inspection there were 73 people using the service.

The service had a registered manager in post at the time of our 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.

The arrangements for the effective management of medicines required improvement as not all people who used the service received their prescribed medication and staff’s practice relating to the administration and recording of medication was not safe.

Although quality assurance systems were in place to assess and monitor the quality of the service provided, improvements were required to ensure that where issues were highlighted and required addressing, action plans were devised and completed to show that these were acted upon in a timely manner. Whilst people were positive about the management arrangements at the service, suitable arrangements were required to ensure that ‘on call’ systems and the day-to-day management of the service when the registered manager is on annual leave or has an extended period of leave is clear and roles and responsibilities of people in charge defined and not ambiguous.

People told us the service was safe and relatives told us they had no concerns about their member of family’s safety. Staff were able to demonstrate a good understanding and knowledge of a person’s specific support needs, so as to ensure their and others’ safety. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow.

People told us there were sufficient staff available to meet their needs. Suitable arrangements were in place to ensure that the numbers and skills of the staff team were effective in meeting the needs of the people they supported. Appropriate arrangements were in place to recruit staff safely so as to ensure they were suitable to work with and support people in their care.

People benefitted from a staff team that were trained to meet the needs of people using the service. We saw from their interactions, facial expressions and mannerisms that people were content, comfortable and relaxed in staffs company. Staff were seen to be warm and caring towards the people they supported and were treated with compassion. People confirmed they were also treated with respect and had their privacy and dignity upheld at all times.

Care plans were sufficiently detailed and provided an accurate description of people’s care and support needs. Risks to people’s health and wellbeing were assessed, managed and revised where appropriate. Suitable assessments had been carried out where people living at the service were not able to make decisions for themselves and to help ensure their rights were protected.

People were supported to be able to eat and drink sufficient amounts to meet their needs. The dining experience was positive. People’s healthcare needs were supported and people had access to a range of healthcare services and professionals as required.

There was an effective system in place to respond to comments and complaints.

We carried out an unannounced comprehensive inspection of this service on 29 and 30 April 2015. Following our inspection we were notified of incidents in which we reviewed and judged to be of concern. One person had sustained a bone fracture following a fall. Additionally, we received information of concern from an external agency. The external agency advised that unexplained bruising had been found for one person. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those areas. You can read the report rom our last comprehensive inspection, by selecting the ‘all reports’ link for Bluebell Nursing and Residential Home on our website at www.cqc.org.uk

Bluebell Nursing and Residential Home provides accommodation and personal care for up to 80 people who require nursing care and people living with dementia. The service is situated over three floors and includes a residential unit on the ground floor, a nursing unit on the middle floor and a dementia unit on the top floor.

A registered manager was 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.

Although suitable arrangements were in place to manage the majority of identified risks, improvements were required in relation to the pressure mattress settings so as to ensure that these were aligned to people’s weight.

Improvements were required to show that the provider’s own quality assurance systems effectively analysed and evaluated information so as to identify where quality or safety for people using the service was compromised and to drive improvement. The management team were not aware that several members of staff had not received up-to-date manual handling training or training relating to the management and prevention of falls.

The service managed incidents and accidents well in an open, transparent and objective way. There was no evidence to suggest that where incidents and/or accidents had occurred, all appropriate steps had not been taken to try and safeguard people for their health and wellbeing. Although there were some occasions whereby staffing levels were not maintained, there was no evidence to show that this impacted on the safety of people using the service nor did reduced staffing levels correlate with any significant incidents or accidents.

Where people could become anxious or distressed staff supported them to manage their behaviour and care plans provided appropriate guidance for staff to follow to ensure theirs and other’s safety and wellbeing.

The inspection was completed on 29 and 30 April 2015 and there were 72 people living at the service when we inspected.

Bluebell Nursing and Residential Home provides accommodation and personal care for up to 80 older people, people who require nursing care and people living with dementia. The service is situated over three floors and includes a residential unit on the ground floor, a nursing unit on the middle floor and a memory unit on the top floor.

A registered manager was 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 service was newly registered with the Care Quality Commission in October 2014.

Care plans did not accurately reflect people’s care and support needs and improvements were required to ensure that all people who used the service received the opportunities to participate in social activities.

Improvements had been made to ensure that the management of medicines within the service was safe. This meant that people received their prescribed medicines as they should and in a safe way.

People and their relatives told us the service was a safe place to live. There were sufficient staff available to meet their needs. Appropriate arrangements were in place to recruit staff safely. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure their and others’ safety.

Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed and improvements had been made to ensure that risk assessments were accurately completed.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills to meet people’s needs. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity.

The dining experience for people was positive and people were complimentary about the quality of meals provided. People who used the service and their relatives were involved in making decisions about their care and support. People told us that their healthcare needs were well managed.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The manager was up-to-date with recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) and at the time of the inspection they were working with the local authority to make sure people’s legal rights were being protected.

People and their relatives told us that if they had any concerns they would discuss these with the management team or staff on duty. People were confident that their complaints or concerns were listened to, taken seriously and acted upon.

There was a failure to have an effective system in place to monitor people's care records and people's activities. The manager was able to demonstrate how they measured and analysed the care provided to people, and how this ensured that the service was operating safely and was continually improving to meet people’s needs.