This unannounced comprehensive inspection took place on 9 January 2019. The purpose of the inspection was to check whether the provider had made the necessary improvements since the last inspection in August 2018 when the service was rated as inadequate. This was because we found failings in numerous areas; these were in relation to care planning, risk assessments and a series of other safety issues including poor moving and handling practices and poor medicine's control. We also found the service to be in breach of five other regulations These breaches were in respect of a lack of person centred care, failure to obtain consent, inappropriate supervision and support of staff, the employment of fit and proper persons and failures to demonstrate oversight and compliance with the regulations by the registered provider. We took enforcement action against the provider which meant they were unable to admit people to the home without prior written agreement from the Care Quality Commission (CQC).

Feng Shui House (Blackburn) 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. Feng Shui House (Blackburn) is registered to provide accommodation for up to 16 people who require support with personal care. On the day of our inspection there were nine people living in the home.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, we therefore reviewed what actions the provider had taken to improve the service.

Since the last inspection, a registered manager had been appointed. 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 2008 and associated Regulations about how the service is run. The registered manager demonstrated a commitment to continuous improvement in the service.

Since the last inspection, the provider had received considerable support under the local authority's Quality Improvement strategy. They had been required to complete an action plan which had been closely monitored through this quality improvement process. As a result of this input, we found significant work had taken place since our last inspection to improve the safety, effectiveness and quality of the service; this meant the provider was no longer in breach of any of the regulations we reviewed. However, the provider needed to continue to embed the learning from the advice they have received from professionals and demonstrate the improvements made could be sustained over time.

Improvements were still required in respect of how the learning from accidents and incidents was shared across the staff team. The provider also needed to further develop their system for monitoring and recording the service’s compliance against all required regulations. Since the service is no longer rated as inadequate overall, or in any of the key questions, it is therefore out of Special Measures. The service has an overall rating of requires improvement.

The provider had improved their systems to monitor the quality and safety of the service through regular audits and spot checks. However, we were told there were no formal reports completed by the provider to assure themselves of the service's compliance against all the regulations.

Although accidents and incidents had been recorded. There was no evidence that any learning from these had been shared within the staff team. The registered manager assured us a system would be put in place to analyse themes and trends from accidents or incidents and ensure any lesso

This comprehensive inspection took place on 1, 2 and 3 August 2018. The first day of the inspection was unannounced. At the last comprehensive inspection on 19 February 2018, we found the provider was meeting all the regulations we reviewed.

Following the inspection in February 2018 we received concerns regarding the management of risks. The team therefore inspected the service on 14 May 2018 against two of the five questions we ask about services: is the service safe and is the service well–led? The inspection revealed that improvements needed to be made to the processes in place when people were unable to consent to taking their prescribed medicines and in pre-recruitment checks the provider made for care staff.

At the May 2018 inspection the rating for the key question - is the service safe? had deteriorated to ‘Requires improvement’ but the overall rating for the service remained ‘Good’.

This inspection on 1 August 2018 was undertaken to check on concerns we had received about the service in relation to people’s safety and moving and handling practices and inappropriate care planning. We conducted a comprehensive inspection so that we could ensure that people were safe and to re-inspect the service and provide a new rating.

Feng Shui House (Blackburn) 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. Feng Shui House accommodates up to 16 people. On the day of our inspection there were 12 people using the service.

The registered provider was an individual who also managed the home on a day-to-day basis. Registered providers 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. As the registered provider was also responsible for managing another care home, they were supported in the day-to-day running of the home by a deputy manager.

During this inspection we found that the service was in breach of regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to care planning and risk assessing and a series of other safety issues; including poor moving and handling practices and poor medicine’s control. This meant that people were at risk from injury. We also found that the service to be in breach of five other regulations These breaches were in respect of a lack of person centred care, failure to obtain consent, inappropriate supervision and support of staff, the employment of fit and proper persons and failures to demonstrate oversight and compliance with the regulations by the registered provider. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals are concluded.

Care plans did not always accurately reflect people’s current needs and had not been sufficiently reviewed. Assessments of people’s needs did not direct staff on how to manage potential risk or how best to support people. Advice and input from external healthcare professionals had not been included in care plans or passed on to staff and had not been followed. Risks or hazards within the environment had also not been considered.

A bedroom shared by two people was dirty and required immediate attention and a thorough clean to prevent the risk of infection.

Medicines were not always stored safely and there was concern over the absence of policies around the use of covert medicines and medicines that were provided on an ‘as required’ basis (PRN).

Inspectors had to intervene with one person who was being helped to eat unsafely and not consistent with the direction from health care professionals.

People had access to harmful substances in an open room

This unannounced focused inspection took place on 14 May 2018. We had previously carried out an unannounced comprehensive inspection of this service on 19 February 2018 when we found the provider was meeting all the regulations we reviewed.

Following the inspection in February 2018, we received concerns regarding the management of risks, particularly those relating to people’s nutritional needs. The team therefore inspected the service against two of the five questions we ask about services: is the service safe and is the service well –led?

No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection. Although the rating for the Key Question: is the service safe? had deteriorated to Requires improvement, the overall rating for the service remains Good.

Feng Shui House (Blackburn) 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 care home is a detached building on the outskirts of Blackburn and accommodates up to 16 people in one adapted building. On the day of our inspection visit there were 12 people living at the home.

The registered provider was an individual who also managed the home on a day to day basis. Registered providers 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. As the registered provider was also responsible for managing another care home, they were supported in the day to day running of the home by a deputy manager.

People told us they felt safe in the home. They told us the staff that supported them were kind and caring. Sufficient numbers of staff were on duty to be able to meet people’s needs in a timely way.

Staff had completed training in safeguarding adults and knew the correct action to take if they witnessed or suspected abuse. They told us they were confident the managers in the service would take action if they reported any concerns to them.

Most people’s medicines were handled safely. However, we noted improvements needed to be made to the processes in place when people were unable to consent to taking their prescribed medicines. These processes help to ensure people’s rights are upheld and decisions are taken, where necessary, in their best interests.

Each person’s care records contained an assessment of the risks relevant to them. We saw that, with one minor exception, care records had been reviewed and updated when people’s needs and risks changed to help ensure they received safe care and treatment.

We noted that people’s nutritional needs were clearly documented. Staff sought and followed advice from relevant health professionals in relation to any identified nutritional risks. We observed that people received appropriate individual assistance to help them safely eat their meals.

Staff recruitment files contained all the required information. However, we noted references for one staff member had not been sought by the home or verified as genuine by the registered provider. One reference for another staff member had not been received until after they had commenced employment at the home. Such pre-employment checks are important to help ensure that people living in the home are protected from the risk of unsuitable staff. We were told no concerns had been raised about the conduct of any new staff employed to work in the home since the last inspection.

People were cared for in a safe and clean environment. Systems were in place to protect people from the risk of cross infecti

This inspection was carried out on the 19 February 2018 and was unannounced. At the last inspection in February 2017 we identified two breaches of regulation. We found the registered provider did not have effective systems to protect the rights of people who were unable to consent to their care and recruitment processes were not sufficiently robust to protect people from the risk of unsuitable staff.

After the inspection in February 2017, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of regulation. They provided us with an action plan which indicated legal requirements would be met by June 2017.

During this inspection carried out on the 19 February 2018 we found improvements had been made and the registered provider was meeting the requirements of the regulations. We saw applications were made to ensure that where people’s rights were restricted, this was done so lawfully. We saw evidence people’s mental capacity was assessed and people were asked to consent to their care whenever possible. We looked at two recruitment files. We found appropriate recruitment checks were carried out and there was a full employment history on both files. This helped ensure suitable people were employed to work at the home.

Feng Shui House (Blackburn) 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 care home is a detached building on the outskirts of Blackburn and accommodates up to 16 people in one adapted building. On the day of our inspection visit there were 11 people living at the home.

The registered provider was an individual who also managed the home on a day to day basis. Registered providers 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. As the registered provider was also responsible for managing another care home, they were supported in the day to day running of the home by a deputy manager. On the day we inspected the registered provider was unavailable however, the deputy manager was present.

At this inspection people told us staff were caring towards them. We observed positive interactions between staff and people who lived at Feng Shui House (Blackburn). There was a culture of promoting dignity and respect towards people. Staff we spoke with understood the importance of high standards of care to give people meaningful lives. One person told us, “I feel quite relaxed and comfortable here, so I am happy where I am.”

We found there were sufficient staff during our inspection visit. They were trained and able to deliver care in a compassionate and patient manner. One person commented, “I don’t use the call bells as there is always a staff member about.”

We checked staff records and noted employees received training appropriate to their roles. One staff member told us, “I had an induction. It was good, I enjoyed it.”

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded.

The registered provider had processes and practices to safeguard people from abuse. Staff had received suitable training and when we spoke with them were able to identify types of abuse and how to react to abusive actions should they occur. Systems were in place to ensure people who lived at the home and required restrictive practices were lawfully deprived of their liberty.

We looked around the home and found it had been maintained and was a clean, safe place for people to live. For example, we found equipment had been serviced and maintained as required.

Medication care plans and medicine risk assess

This was an unannounced inspection which took place on 23 January 2017. This was the first inspection since the service registered with the Care Quality Commission (CQC) in August 2016.

Feng Shui House (Blackburn) is a large detached house which provides accommodation for up to 16 older people in a mixture of single and double en-suite bedrooms. At the time of this inspection there were 10 people living in the home.

The registered provider was an individual who also managed the home on a day to day basis. Registered providers 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. As the registered provider was also responsible for managing the ‘sister’ service in Blackpool, they were supported in the day to day running of the home by a deputy manager.

During this inspection we identified two breaches of Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because recruitment processes were not sufficiently robust to protect people from the risk of unsuitable staff. Required checks had not been carried out when applicants had worked previously with vulnerable adults or children and a complete record had not always been maintained of people’s employment history. In addition the rights of people who were unable to consent to their care in Feng Shui House (Blackburn) were not always properly protected. This was because the required Deprivation of Liberty Safeguards (DoLS) applications had not always been made to authorise any restrictions in place.

Staff had received training in safeguarding adults from abuse. They were able to demonstrate their understanding of the correct action to take if an allegation of abuse was made to them or if they suspected that abuse had occurred. Staff told us they would be confident to use the whistleblowing policy that was in place should they witness poor practice in the service.

We found people were cared for by sufficient numbers of suitably skilled and experienced staff. We saw that staff received the essential training and support necessary to enable them to carry out their role effectively and care for people safely.

People who used the service told us they felt the staff had the skills and experience to meet their needs. People were happy with the care and support they received and spoke positively of the kindness and caring attitude of the staff.

We found the system for managing medicines was safe. Records we reviewed showed staff worked in cooperation with health professionals to help ensure that people received appropriate care and treatment.

The standard of fixtures and fittings in the service was high. Feng Shui principles had been used in the décor of the property to help promote the well-being of people living in the service. All areas of the home were clean and well maintained. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply.

People’s care records contained enough information to guide staff on the care and support required. The care records showed that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate the risk. Care records had been regularly reviewed to ensure they were an accurate reflection of people’s needs.

Systems were in place to help ensure people’s health and nutritional needs were met. People who used the service told us the quality of the food was good. We observed that, where necessary, staff offered people gentle support and encouragement to eat.

Staff told us they enjoyed working in Feng Shui House (Blackburn). They told us the principles on which care was delivered meant people were treated as individuals and staff had the time to promote well-being through dis