Archived: Blackwell Vale Care Home

Blackwell Vale is a nursing care home registered to provide personal and nursing care to up to 60 people. There were 45 people living at the home at the time of this inspection.

The home is set out over two floors in an older, purpose-built building. The first floor accommodated people who were living with dementia. The ground floor accommodated people who have general nursing and personal care needs.

People’s experience of using this service and what we found

At the time of this inspection there was no demonstration of competency checks and clinical support of nurses. Some nurses had not had any supervision or training over the past year. There were plans for improvement in this area.

People and relatives said the staff were very kind and caring. They felt the staff knew them very well and understood their preferences. People said they were treated with dignity and respect by all staff. They said staff were careful and sensitive when supporting them. People enjoyed the company of the friendly, welcoming staff.

People and relatives said this was a safe place to live. There were enough staff to meet people’s needs. Staff knew how to report any concerns and said these would be acted upon.

The home was clean and warm. Some areas needed redecoration and improved lighting. The home was not fully adapted to support people who were living with dementia. We have made a recommendation about this.

People’s needs were assessed to make sure their care could be provided. Staff worked well with other care professionals to support people’s health needs.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service upheld this practice.

People received personalised support that matched their individual preferences. There had been a period where there had been few activities but there were plans to improve this.

People and relatives commented positively on the open culture in the home and the approachability of the manager and staff.

There had been a gap in the management of the home for a period last year. The new manager was clear about the areas that needed attention and had plans to address them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 February 2019). The service remains rated requires improvement. This service has been rated requires improvement for three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to training and support for nurses at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Blackwell Vale 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. Blackwell Vale provides nursing and personal care to 60 older people. The home has two floors, the upper floor accommodates people who have a dementia related condition and the ground floor accommodates people who have general nursing and personal care needs. There were 44 people living at the home at the time of the inspection.

At our previous inspection in January 2018, we found two breaches of the Health and Social Care Act 2008. These related to good governance and staff competencies. We rated the service as requires improvement.

Following the inspection, the provider formulated an action plan to address the breaches. At this inspection, we found that sufficient action had been taken to address those breaches. Continued improvements were still required in some areas of the service.

Since the last inspection the acting manager had registered as the 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.

During this inspection we identified some practices that required attention, for example keeping the kitchen door locked, and gaps in daily temperature records and fire drills. Action was taken to address these issues.

People said they felt safe and comfortable at the home. Risk assessments were in place about people’s needs and about the premises. The home was comfortable, clean and maintained. Medicines were managed in a safe way but there were some shortfalls in relation to recording.

People who could express a view told us they received a “good service”. Staff had opportunities for relevant training. Staff supervisions had not always been carried out because of the previous gap in the management arrangements, but staff said they felt supported.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005 and best interest meetings had been held to make sure people were not restricted unnecessarily. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service to support this practice required further development. We made a recommendation about this.

People received the right support with their nutrition and hydration needs. Risks to people’s nutritional well-being were assessed and managed. People said they enjoyed the meals and the quality of food was good.

Before people moved to the home their needs were assessed to check if the home could provide the right care for them. The home worked with other health services to make sure people were supported with their health needs.

People and relatives told us staff were kind and caring. Staff were considerate, respectful and helpful when assisting people. There were friendly relationships between staff and the people who lived there.

There was a welcoming atmosphere in the home. Staff supported people to make their own individual choices and used different ways to help them do this.

Staff were knowledgeable about people’s individual care needs and how they wanted to be assisted. People had opportunities to join in activities and go out into the local community.

People had information about how to make a complaint. They were asked for their views and these were acted on. The registered manager had an open-door policy and made themselves available to speak with people, relatives and care professionals.

Staff made positive comments about the registered manager and said they felt supported by the management team. Staff told us that the atmosphere in the home was very good. They enjoyed working at the home.

The provider had a quality assurance system that included the views of people, staff and visitors. Regular audits and checks were carried out and action was taken if issues were identified, although some issues seen during this inspection had not been identified. The management team was aware this was an area for continued and sustained improvement.

This is the second consecutive time we have rated the service as requires improvement.

Blackwell Vale Care Home 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. Blackwell Vale Care Home provides nursing and personal care to 60 older people. The home has two floors, the upper floor accommodates people who have a dementia related condition and people who have general nursing and personal care needs lived on the ground floor. There were 44 people living at the home at the time of the inspection.

At our previous inspection in September 2017, we found six breaches of the Health and Social Care Act 2008. These related to safe care and treatment, safeguarding people from abuse and improper treatment, meeting nutritional and hydration needs, receiving and acting on complaints, staffing and good governance. We took urgent enforcement action and imposed conditions upon the provider’s registration to minimise the risk of people being exposed to harm. This included the suspension of new admissions to the home. We also asked the provider to assess the competency of the registered manager. We rated the service as inadequate and placed the service in 'special measures.' This meant the service was kept under continuous review.

Following the inspection, the provider formulated an action plan and sent us regular updates in response to the breaches and concerns we had identified.

We carried out this inspection to check whether the provider had complied with the imposed conditions and had met the breaches which were identified at our last inspection. We also brought our inspection forward, following the receipt of a notification of an incident which had occurred at the service. This incident is being examined outside of this inspection process; however, we wanted to ensure that people were receiving a safe and suitable diet.

At this inspection, we found that the provider was taking action to address the previous concerns we had raised. Further improvements were still required. We considered however, that sufficient action had been taken to ensure people's safety. We agreed that the conditions imposed upon the provider's registration could be removed. The service was also taken out of special measures.

There was a registered manager in post. They were not present at the time of the inspection. The deputy manager who we refer to as the acting manager throughout the report was managing the service in the registered manager’s absence. 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 and associated Regulations about how the service is run.

At this inspection, we found that some improvements had been made with regards to the premises, infection control and medicines management. However, we identified several new and ongoing shortfalls and omissions. Following our visits to the home, the regional manager sent us an update to inform us that these issues had been addressed. Whilst we were satisfied that action had been taken to address the concerns we raised; we considered that an effective system was not fully in place to monitor the safety of the service.

People and relatives told us that people were safe. Staff informed us they were now more confident that any safeguarding issues they reported would be dealt with appropriately. The local authority informed us that safeguarding reporting had improved.

We found there were sufficient staff deployed. Two nurses were normally on duty through the day. Agency staff were still used at the service and the provider tried to ensure the same agency staff were requested for consistency. Staff were always present in the lounges, dining rooms or in the corridors. We saw that they carried out their duties in a calm unhurried manner.

Staff told us that there was sufficient training available. However, we identified shortfalls in diabetes and medicines management. We also identified concerns relating to people who required nutritional support via a Percutaneous Endoscopic Gastrostomy (PEG) tube. A PEG is the procedure whereby a tube is placed directly into the stomach and by which people receive nutrition, fluids and medicines. Evidence of the clinical skills and competencies of staff including agency staff were not always available.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. There was a lack of evidence to demonstrate that staff were following the MCA.

The provider used a contract caterer to provide meals at the home. We saw that some people’s dining experience was more positive than others. Several people’s meals did not correspond with the guidelines issued by their speech and language therapist. Following our inspection, the regional manager wrote to us and stated that action had been taken to address all the issues which we had raised. Whilst we were satisfied that action had been taken to address the concerns we raised; we considered that an effective system was not fully in place at the time of the inspection to ensure people’s nutritional needs were met.

Action was being taken to ensure the design and décor of the service met the needs of people. Work was being carried out to secure the garden to ensure its safety for people who were living with dementia. We identified some shortfalls with regards to ensuring people’s privacy, dignity and independence in relation to the environment. Following our inspection, the regional manager told us that these issues were being addressed.

We observed positive interactions between staff and people. Staff displayed warmth when interacting with people. They were very tactile in a well-controlled and non-threatening manner.

Care plans were in place which aimed to inform staff how people’s physical, emotional, social and spiritual needs should be met. We found however, that records relating to PEG care lacked important information to ensure that this procedure was carried out safely.

We received mixed feedback about activities from people and relatives. We noticed that there was a lack of meaningful activities for people who spent most of their time in bed or in their bedrooms. We have made a recommendation about this.

Since 2011, the provider has breached one or more regulations at six of our 12 inspections. We have rated the service inadequate twice since 2015. At this inspection, we found that some improvements had been made at the time of our inspection and further improvements were made following our visits. However, we identified two breaches of the regulations, including a continuing breach of the regulation relating to good governance. This meant that systems were not fully in place or operated effectively to ensure compliance with the regulations and achieve good outcomes for people.

Staff told us that the atmosphere and team work had improved. They informed us they enjoyed working at the home. We observed that this positivity was reflected in the care and support which staff provided throughout the inspection. Staff responded positively to any requests for assistance and always sought to be complimentary when speaking with people.

We found two breaches of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. These related to good governance and staffing [training]. You can see what action we told the provider to take at the back of the full version of the report.

Blackwell Vale Care Home is a 51-bed home providing residential, nursing and dementia care. There were 49 people living at the home at the time of the inspection.

A registered manager was in post and our records showed she had been registered with the Care Quality Commission [CQC] since 2010. 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 and associated Regulations about how the service is run.

We found concerns with the safety and security of the premises. We accessed the top floor of the building via an open fire door early in the morning. We also found a number of hazardous items and equipment that were accessible to people throughout the home, including those living with dementia.

Infection control was poor and we found dirty bedding and equipment which was so heavily contaminated it had to be cleaned or discarded during our inspection. Bathrooms and toilets were not fit for purpose. A number were used as storage, or were damaged and unable to be used. Toilets were positioned on raised plinths which were damaged, unsightly and were not impermeable to urine meaning they could not be effectively cleaned. Some posed a risk to people due to sharp edges.

Personal Emergency Evacuation Plans (PEEPS) were in place for people who had died, and a number were missing for people that had moved into the home. These were updated during our inspection. Individual risks to people were assessed, but care plans developed to mitigate risks were not always followed; in relation to choking for example.

We found medicines were not safely managed. Records were not accurately maintained and we found a medicine error following a review of stock levels. Guidance was not fully in place to describe how medicines given as and when required should be administered. Prescribed medicines were not always made available to people in a timely manner. The registered manager carried out a full audit of all medicines following the concerns we raised and found some further discrepancies which they put plans in place to correct.

Records did not support that staff had received the training they required to carry out their role safely. Nursing competency and clinical training records were not up to date and could not evidence that nursing skills were being maintained and monitored. It was difficult to ascertain from training records, the percentages of staff that had received up to date training. Staff told us they received regular supervision and that they felt well supported.

Sufficient numbers of suitably qualified staff were not always deployed effectively in the home. The provider was having difficulty in covering shifts due to staff absence at short notice particularly at the weekends.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes.

People were not always supported to have choice and control of their lives. Records did not demonstrate that staff supported them in the least restrictive way possible and contained conflicting information. The policies and systems in the service did not always support this practice.

There were complaints about the quality and variety of food provided and meetings were taking place to address this at the time of the inspection. We found kitchen staff had not been trained in the preparation of special meals including pureed diets, and meals were provided which contained lumps and posed a choking risk to people. Training was provided soon after we raised this concern.

We observed care that was kind and considerate and most people and relatives we spoke with told us they were happy with the care provided. We were told, and observed documentation that demonstrated, there had been a prolonged period of staff unrest on the upstairs Nightingale and Chadwick dementia care units. This had resulted in staff refusing to work with others and even sickness and stress. We were advised that this did not impact upon people who used the service but we judged that although this behaviour was caused by a small number of staff, the impact was widespread and affected the smooth operation of the service.

A complaints procedure was in place and we found a number of complaints had been made including relating to the manner and attitude of staff. These had not all been thoroughly investigated and we referred some of these complaints to the local authority safeguarding adults team. Following our inspection the senior management team reviewed all complaints and in some cases took action to look into individual concerns in more detail.

Care plans were in place for each person but the information in plans varied in quality and detail. Some care plans were detailed and person centred, others contained inaccurate information and did not reflect care as it was being delivered at the time of the inspection. Others contained contradictory information so it was difficult to ascertain which was the correct version.

A range of activities were available and we observed group and individual activities. There were mixed views about the range available to ensure people had opportunities to engage in meaningful activities of their choice and to go outside. We were told by some people however, that activities had improved of late. Staff had worked hard to create areas of interest in the home such as a garden room. A sensory room was also available.

An effective system was not in place to monitor the quality and safety of the service and records for not all up to date and accurately maintained. The registered manager and provider had not picked up all of the concerns we identified during this inspection.

Following the inspection, we wrote to the provider to request a detailed improvement plan which stated what action they had taken or planned to take to address the concerns and shortfalls identified during the inspection.

We referred all of our concerns about the service to Cumbria County Council and following our inspection, the local authority had placed the home into 'organisational safeguarding'. This meant that the local authority was monitoring the home closely.

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 so that 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.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. 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 it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found six breaches of the Health and Social Care Act 2008. These related to safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, receiving and acting on complaints, good governance and staffing.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Blackwell Vale Care Home provides nursing and personal care to 60 older people. The home has two floors, the upper floor accommodates people with dementia type illnesses and the ground floor is designated to people who require general nursing and residential care. Both floors have separate dining and communal areas and all of the bedrooms in the home are for single occupancy.

The home was last inspected in December 2014. At this inspection we rated the service as inadequate. The home was in breach of the following regulations of the Health and Social Care Act (HAS) 2008 (Regulated Activities) Regulations 2010:

Regulation 22 HSCA 2008 (Regulated Activities) Regulations 2010 Staffing.

Regulation 13 HSCA 2008 (Regulated Activities) Regulations 2010 Management of medicines.

Regulation 14 HSCA 2008 (Regulated Activities) Regulations 2010 Meeting nutritional needs.

Regulation 23 HSCA 2008 (Regulated Activities) Regulations 2010 Supporting staff.

Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 Care and welfare of people who use services.

Regulation 10 HSCA 2008 (Regulated Activities) Regulations2010 Assessing and monitoring the quality of service provision.

The above regulations have now been replaced with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the home was no longer in breach of any of the above regulations and met all of the 2014 Regulations.

At the last inspection in December 2014, we asked the provider to take action to make improvements in the areas outlined above. This action has now been completed.

The service had 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.

The service had sufficient staff on duty to meet people’s needs at the time of our inspection.

The staff knew how to identify abuse and protect people from it.

The home was clean and odour free.

The service had carried out risk assessments to ensure that they protected people from harm and minimised any risks identified.

Medicines were ordered, stored, administered and disposed of correctly.

Staff had been trained to an appropriate standard.

The service co-operated with other providers of health and social care.

There were systems in place to make sure people had a good diet and were adequately hydrated.

Staff had developed caring relationships with people who used the service.

Support plans were written using a person centred approach, relatives and staff had noticed an improvement in person centred care since our last inspection.

There was a complaints process in place.

There was a robust quality assurance system in place which meant that the registered manager, her deputy and area manager were aware of areas that required improvement in the service. This included management of the team and helping staff to maintain good standards of personal care for people who used the service.

We saw that new systems had been put in place since our last visit in July 2013 for the monitoring of records within people's care plans. This meant that the quality monitoring of the records would identify that if actions were required to improve the records these could be implemented quickly. This meant that records kept about people living at Blackwell Vale may protect them from the risks of unsafe or inappropriate care and treatment because records were appropriately maintained.

Overall, we found that medicines were handled safely and people received their medicines when they needed them.

The home had a range of equipment to support people who lived there. People benefitted from having the equipment they needed to ensure they received the support they required in a safe way.

We spoke to a number of staff on duty during our inspection. All the staff we spoke with told us they felt there had been recent changes which meant there was sufficient staff available to provide the care people in the home needed.

People were asked their views about the service provided and these were taken into account of. They were asked about their care and treatment in an annual survey.

The records we looked at in people's rooms were not up to date nor did they reflect what was occurring in the practical care being delivered.

Review of care plans showed that risk assessments were in place to safeguard people's safety in the home. There were procedures in place to monitor the quality of the care and service being provided. Regular audits were being completed by the manager monitoring the homes environment, care plan records, medication procedures, maintenance of the building, staff training, infection control and handling of complaints. Where issues had been identified the manager had produced an action plan with timescales set for improvements to be made.

On the day we inspected the home we found there were enough qualified, skilled and experienced staff to meet people's needs.

People who used this service told us there is always plenty of staff on duty and they are available when they need them. We were told: "There seems to be plenty of staff around." Another person told us: "Staff are a decent lot, I am well fed and well provided for. It's great living here".

We found staffing levels were sufficient for the number of people living in the home. We looked at the staff rosters for the previous two months and found that the home was appropriately staffed and rosters demonstrated that this was always the case.

There was a staffing matrix which was used to identify the minimum number of staff on duty. On review of this matrix and in discussion with the manager we found that the home was staffed according to people's need which was above the minimum required numbers.