Bluewater Care Home

Updated 13 October 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by three inspectors and a medicines inspector.

Service and service type

Bluewater Nursing Home is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement dependent on their registration with us. Bluewater Nursing Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post. The provider informed us they had recruited a manager who had not yet commenced working at the service. The deputy manager had been acting up to manage the service and will be referred to in this report as “the acting manager”.

Notice of inspection

The date of this inspection was unannounced. We requested a range of documentation prior to the site visit to support our inspection process.

Inspection activity started on 25 May 2022 and ended on 5 July 2022. We visited the location on 7 June 2022 and provided feedback remotely on 5 July 2022.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We also reviewed information received from the provider and third parties since the last inspection, and other information received from the provider.

During the inspection

We spoke with the acting manager, the director and the head of care on the site visit. We spoke with six residents, two people’s relatives on site and two people’s relatives by telephone. We observed staff interactions with people through lunch time and through the afternoon.

We reviewed a range of records, including five people’s care records, staff training records, medication records and other records related to the management of the service, including audits, policies and procedures.

Updated 13 October 2023

About the service

Bluewater Nursing Home is a residential care home providing personal care to 15 people aged 65 and over at the time of the inspection. Some people were living with dementia. The service can support up to 60 people. Although it is called Bluewater Nursing Home, the home does not provide nursing care.

The home is based over four floors accessed by an interconnecting passenger lift. The ground floor provides communal areas for people and the first, second and third floors provide bedrooms, communal bathrooms and a small communal area. Only the lower two floors were in use at the time of the inspection.

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

The provider continued to fail to ensure risks to people’s health, safety and wellbeing were assessed and managed, which put people at increased risk of avoidable harm. Care provided was not always safe, in line with national guidance and risks were not always managed in the least restrictive way. There had been improvements in the management of health and safety, fire safety and other environmental risks identified at the last inspection.

There was evidence the provider had continued not to consistently and appropriately report and investigate incidents. The safeguarding authority had not always been informed of relevant incidents. There were not always enough suitably skilled and competent staff deployed to meet people’s needs and manage risks to people’s safety.

There had been some improvements in medicines management, however some issues remained. Staff had received a range of training. The provider was not able to demonstrate staff had been trained in specialist administration of one person’s medicine which was to be given in the event of them choking.

The home was visibly clean. There were appropriate arrangements for visitors. The environment was spacious, we identified a need for further signs, in line with dementia friendly guidance, to support people to know where the toilets were.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People’s capacity to consent to decisions about their care was not always assessed, and it was not clear they had been provided with enough information to make an informed choice.

There had been improvements in managing people’s nutrition and hydration needs. One person had gained weight, which was positive for them. Another person was being supported to lose weight, which was their goal. People were usually offered enough to drink but were not always given choices about what they wanted to drink.

Some people told us there was not enough to do, we observed some people were isolated and anxious and did not have enough occupation or emotional support. There were a range of activities available, however these were not always tailored to meet people’s individual needs.

Although more audits had been completed, these were not sufficiently robust to assess and improve the quality and safety of the service. There were a number of continued breaches of regulations. Although some actions had been completed to address issues identified at the last inspection, not all issues identified had been addressed and people were still not receiving safe care. The required actions had also not been incorporated into a service improvement plan. New issues were identified at this inspection, demonstrating the provider was not pro-actively assessing their compliance with the regulations and working to improve in these areas.

Although the provider regularly engaged with other healthcare professionals, we were not assured their advice was consistently followed or clearly written into care plans. The local authority told us the provider had failed to attend large scale safeguarding enquiry meetings to review incidents which had taken place within the home, and had failed to provide an improvement plan when this was requested.

The provider was found to be defensive and not receptive to CQC ‘s feedback

Relatives gave mixed feedback, they felt they could raise concerns with the provider and these were usually resolved. One relative described the home as “OK, not the best”, another said the staff “looked after [their relative] well”. Other feedback included that “the environment is very unique” and “overall, I am happy with the care and support”.

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 inadequate (published 1 February 2022) and there were breaches of regulation. At this inspection we found the provider continued to be in breach of regulations.

This service has been in special measures since 19 May 2021.

Why we inspected

We carried out an unannounced inspection of this service between 25 March and 15 April 2021 and identified breaches of legal requirements. We undertook a follow-up, focussed inspection from 4 to 16 November 2021 to review if actions had been completed and if the breaches were met. We identified continued breaches of regulations in relation to consent; safe care and treatment; nutrition and hydration; good governance and fit and proper persons employed.

We carried out this inspection to follow up on these breaches of regulation and to understand if these were now met.

Enforcement and Recommendations

One breach has been resolved on this inspection, however we identified two new breaches of regulation and four ongoing breaches of regulation. We have identified breaches in relation to person-centred care, consent, safe care and treatment, good governance, staffing and fit and proper persons employed at this inspection.

Following this inspection we cancelled the provider's registration.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.