Blackburn (Florence House)

Blackburn (Florence House) is a residential care home providing personal care to 11 people at the time of the inspection. The service can support up to 13 people.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

People's independence was promoted, and staff encouraged people to participate in their care decisions. People's care plans were person centred and reviewed regularly. Risks associated with people's care were assessed to identify how their care could be provided safely and were reflective of the individual’s needs. Staff supported people to take part in meaningful activities and supported people to go on holidays and outings. The service had sufficient staffing to meet peoples’ needs and the same agency workers were used to maintain consistency. The service was clean and rooms were personalised to individual needs. We observed wardrobes needed securing to keep people safe and this was done following the inspection. The environment was being maintained in line with health and safety expectations and some updates to the décor was being planned by registered manager.

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

Right care

People received supportive care. Staff respected people's privacy and dignity. They understood and responded to people’s individual needs. People had access to health care professionals when they needed them. Medicines were not always recorded accurately; records contained gaps and medication records were not being checked to ensure the information was accurate. Following our inspection, the provider shared additional evidence to demonstrate medication recording practice had been improved and addressed.

Right culture

People received good quality care, support and treatment because staff were trained in areas related to their needs and staff received regular supervision from support leaders. Recent audits for medication were not effective, we made a recommendation about this. Systems were in place to monitor and learn from trends and themes in the service. Staff provided positive feedback on the management team, although some staff felt communication around changes in the service could be improved. Families were happy with the support being provided and described the positive outcomes people had achieved. Positive feedback on partnership working was provided by professionals.

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

Rating at last inspection

The last rating for this service was good (published 14 September 2018).

Why we inspected

The inspection was prompted in part due to concerns received about medicines, activities, infection control, staff engagement and management. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Blackburn (Florence House) on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have made a recommendation in relation to systems and oversight of the service at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Heathcotes (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 values of the service reflected those that underpin the Registering the Right Support and other best practice guidance. These included choice, independence and inclusion. People with learning disabilities using the service could live as ordinary a life as any citizen.

Heathcotes (Blackburn) is registered to provide accommodation and personal care for 13 people. On the day of our inspection there were 12 people residing in the service who were living with a learning disability and/or mental health diagnosis and complex needs.

The service had a registered manager in place. A registered manager is a person who has registered with the 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.

We undertook a comprehensive inspection of Heathcotes (Blackburn) on the 6 and 7 June 2017. The overall rating from this inspection was ‘Requires Improvement’, with ‘Good’ in responsive. There were three breaches of the Regulations in relation to unsafe management of medicines, lack of induction, training and supervisions for staff and the provider had not notified the Commission of incidents which affected the safety of people using the service. We also made recommendations about infection control and quality assurance audits.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s), is the service safe, is the service effective and is the service well led? During this inspection we found the necessary improvements had been made and the overall rating has therefore improved to Good.

Risk assessments were in place to keep people safe. We saw individual risk assessments were in place in relation to people’s health care needs. We also saw risks in the environment had been considered to ensure the safety of people who used the service, staff and visitors.

Medicines were managed safely. Staff had received training in administering medicines and their competencies were checked regularly. We found medicines were stored safely, the medicine administration records were completed without any gaps and controlled drugs were safely stored.

Recruitment systems and processes in place were robust. We saw references, identity checks and Disclosure and Barring Service checks were completed before staff were employed. People who used the service told us and records we looked at showed adequate numbers of staff were on duty.

We have made a recommendation in relation to the cleanliness of the service.

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 supported this practice.

All new staff members were expected to complete an induction when they commenced employment. Training courses were available to staff which were relevant to their roles. Staff members told us and records confirmed that staff members received supervisions and appraisals on a regular basis. All staff members told us they were able to discuss any training requirements they had.

During our inspection we noted an incident which we felt required bringing to the attention of the registered manager. This was around the lack of communication between one staff member and a person who was visually impaired when mobilising around the service. However, we also observed lots of positive interactions where staff displayed a caring attitude and kindness.

Staff members knew people very well, including their preferences, background and history. People’s care records contained information relating to their sexuality, cultural/spiritual needs and relationships.

Support plans that were in place were person centred and evidenced the person had been involved in the development and review of these. These were detailed and contained information about people’s likes and dislikes.

Throughout our inspection and from records we looked at, we saw people were encouraged to be independent. This included people being supported to make their own drinks or food in the kitchen.

The registered manager had acted on our recommendation and robust auditing tools were in place within the service. The provider’s quality assurance managers also audited the service on a regular basis.

We saw regular staff meetings were held. Staff told us these were regular and they were able to bring up topics for discussion.

Heathcotes (Blackburn) is registered to provide accommodation and personal care for 13 people. On the day of our inspection there were 13 people residing in the service who were living with a learning disability and/or mental health diagnosis and complex needs.

At the time of our inspection the service did not have 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. The previous registered manager had been promoted within the company and a new manager had been put in place on 30 March 2017. The new manager had submitted their application to register with us and their fit person’s interview was planned for 22 June 2017.

During this inspection three breaches of the regulations were found. These were in relation to the unsafe management of medicines, lack of adequate staff training and supervisions and failure to submit relevant notifications. You can see what action we told the provider to take at the back of this report. We also made recommendations about infection control and quality assurance audits.

We reviewed medicines management within the service and found this was not always safe. Records we looked at showed staff members had been signing for medicines prior to administering them to the person. We also found that a prescribed ‘thickener’ was out of stock and had been out of stock the previous month. On the morning of our inspection a staff member had signed to confirm the thickener had been administered despite this being out of stock. Prior to our inspection we received information of concern in relation to the over use of as required medicines. We checked this during our inspection and found no cause for concern.

Risk assessments were in place to keep people safe. We saw risk assessments in place in relation to medicines, moving and handling, travelling in a car and accessing the kitchen. We found one risk assessment had not been put in place in relation to a person choking; however the manager sent this to us the day after our inspection.

Prior to our inspection we received information of concern in relation to the low staffing levels at the service. We checked this during our inspection and found some gaps in the rota where staffing had not been arranged. However, we spoke with the manager who informed us that new staff members were awaiting a start date and themselves and the deputy manager made up the numbers if they were required to do so. We were reassured by this.

There were systems and processes in place to keep people safe in the event of an emergency such as fire. Regular fire drills were held, people had personal emergency evacuation plans (PEEP’s) in place, firefighting equipment was serviced regularly and gas and electrical items were checked.

Prior to our inspection we received information of concern in relation to the heating and hot water in the service. We were informed that the service had been without heating and hot water for two weeks. We checked this during our inspection and found there had been some minor issues with the new boiler which had been addressed. The service had not been without heating or water for any significant length of time.

On the first day of our inspection we noted some bathrooms did not have paper towels or hand wash in them. We mentioned this to the manager who informed us they had requested a staff member went out to purchase some. On the second day of our inspection we still found one bathroom without hand wash. We have made a recommendation that the service considers current legislation and best practice in regards to infection control.

Prior to our inspection we had received concerns in relation to the lack of training for new members of staff. We checked this during our inspection and found staff members new to the service had not always undertaken the provider’s required week long induction course. New staff members were providing support on a one to one basis without having had the necessary training to do so. Supervisions and appraisals were not always in line with the services’ own policies and procedures.

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found capacity assessments and best interest meetings had been held. The manager had applied to the relevant supervisory authorities for a DoLS for ten people.

Prior to our inspection we received information of concern in relation to the lack of food in stock in the service. We checked on this during our inspection and found plenty of food available in stock to meet people's dietary requirements. People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met.

Prior to our inspection we received information of concern in relation to the abrupt nature of some staff members. We observed both negative and positive interactions from staff members. We have made a recommendation in relation to privacy and dignity.

We observed that all personal and confidential information was appropriately stored and only those people who were permitted to access it could.

Records we looked at showed that prior to moving into Heathcotes (Blackburn), a pre-admission assessment was undertaken. This provided the manager and staff with the information required to assess if Heathcotes (Blackburn) could meet the needs of people being referred to the service prior to them moving in.

Complaints were dealt with within the service. We saw a policy and procedure was in place which directed the manager on their responsibility to ensure any complaints were learned from and dealt with.

Those people who could not communicate verbally had a communication book in place. This directed staff members on the most effective way to communicate with the person as well as information on the person’s hearing and sight.

The manager was not aware of her responsibilities to submit certain notifications and had failed to notify us of a serious injury and the approval of three DoLS.

We have made a recommendation in relation to quality audits that are conducted within the service. This is to ensure they are sufficiently robust to identify issues or concerns as we found during our inspection.

Was the service safe?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications were currently required. Relevant staff had been trained to understand when an application should be made, and how to submit one. Staff told us they would react to any safeguarding incidents and the people who used the service said they did not feel threatened by staff. This meant that people were safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. A visitor said, "They look after the building very well and have improved the home in many ways. He was able to have his room decorated the way he wanted it".

The registered manager sets the staff rotas, they take people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helps to ensure that people's needs are always met. Staff members told us, "In general there are enough staff and we meet people's needs to the best of our ability", "As a rule there are enough staff to meet the needs of people here. We have one to one care for all service users and sometimes there are two to one if we go away" and "I do not think there are enough staff here sometimes because of staff sickness. There would be plenty if they all turned in".

Was the service effective?

People's health and care needs were assessed with them if possible, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs. People who used the service told us, "I get good care here. Staff are very nice. We have a new staff member and she is very nice. I am not afraid of anyone, they are all kind" and "Staff look after me very well but let me do lots for myself. Staff do not bully me. It is my home and I am very happy with it".

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Was the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. All three people we spoke with said staff were kind. A relative said, "He gets one to one care but they do not follow him around so he feels independent. I have always found that their behaviour is appropriate and have not seen any abuse. They know him very well and can help prevent any potential mental health problems. His health is good because they prevent any problems in the way they care for him. Staff have a positive mental attitude". People using the service were able to voice their opinion in the way the service was run at meetings and their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People who used the service were encouraged to fill in parts of the plans of care to give staff sufficient information to treat them as individuals.

Was the service responsive?

People completed a range of activities in and outside the service regularly. Some people had access to their own transport or were escorted in staff cars. Activities included holidays as well as going to venues such as places of interest, shopping, eating out and social clubs. On the day of the inspection several people were out. Two people had gone to the sea life centre, one for a meal with his relative and one person shopping.

All three people said they were happy living at the home and had no concerns. A family member told us she was in daily contact with her son but staff could be contacted at any time.

Was the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a good quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly and as a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times. Three staff members told us, "I like working here. Management are supportive", "I am happy working here. It's a good place to work" and "I love my job. We have understanding management who listen and we can communicate with them. The manager is always easy to approach".

People who used the service said, "I make a lot of my own food. I can choose what I want to eat and I am going to eat out tonight" and "I can cook and I help in the kitchen. We get very good food here. We can choose what we want". People who used the service were supported to be involved in their diets and therefore enjoyed what they ate.

Plans of care contained the wishes of people in many aspects of their lives to enable staff to deliver person centred care.

People were asked their views about how they wished the care home to progress. People told us, "I like it here. It is special" and "I am happy here. You can choose what you want to do so I am happy".