Archived: Blackdown Nursing Home

Updated 29 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 31 October and the 8 November 2018. The first day was unannounced and was carried out by an adult social care inspector, a specialist advisor and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses services for older people. The second day of the inspection was announced and was carried out by the adult social care inspector.

Prior to the inspection we reviewed information we held about the service, and notifications we had received. A notification is information about important events, which the service is required by law to send us. We sought feedback from the local authority Quality Assurance Improvement Team (QAIT) to obtain their views as they had been working with the provider to implement new processes.

We met most of the people using the service and spoke with seven people to ask their views. We spoke with five visiting relatives. Our observations around the home enabled us to see how staff interacted with people and how care was provided. A number of people using the service were unable to provide detailed feedback about their experience of life at the home. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with the registered manager, clinical lead, two nurses, activity person, eight staff which included senior care assistants, care staff, housekeepers and the cook. We also spoke with the two directors. We looked at three staff records, which included staff recruitment and supervision records. We reviewed eight people's care records on the new computerised care system and five people’s medicine administration records. We looked at the provider’s quality monitoring systems such as audits of medicines, policies, accident records, training records and at health and safety.

We sought feedback from twelve health and social care professionals who regularly visited the home. We received a response from two of them.

Updated 29 November 2018

This comprehensive inspection of the Blackdown Nursing Home took place on 31 October and the 8 November 2018. The first day of the inspection was unannounced. This meant that the provider and staff did not know we were coming. The second day of the inspection was announced.

Blackdown Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and both were looked at during this inspection. The service provides care and accommodation for up to 33 people who may require nursing care or who are living with dementia. On the first day of the inspection there were 31 people staying at the service.

The home is a detached property located in the small town of Mary Tavy, near Tavistock. There are two lounges and a large dining room for people to use. There is a large garden with views of surrounding countryside.

At the last inspection in August and September 2017 we found the provider in breach of four Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not ensured people’s care and treatment were appropriate and their needs and preferences met. People had limited opportunities to take part in activities suitable to stimulate and engage them. The provider had not ensured the premises were safe for use and did not have effective systems in place to assess, monitor and improve the quality and safety of the service provided.

The service was rated as requiring improvement overall and in the safe, responsive and well-led domains. The effective and caring domains were rated as good.

Following the inspection, the provider developed an action plan to ensure improvements were made. The service had also worked in partnership with the local authority quality assurance and improvement team (QAIT) to improve their systems and processes and put in place a service improvement plan (SIP). At this inspection we found the provider had completed the actions and were no longer in breach of the regulations. They were continuing to use their SIP and had prioritised actions needed.

There was a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 had been registered with CQC in July 2017.

The registered manager had put in place comprehensive quality assurance systems which identified when improvements were needed. The providers regularly visited the service and undertook quality checks and were kept informed about the running of the service.

The provider had made improvements which ensured people were protected from the risks of unsafe and unsuitable premises. Fire safety precautions were in place and followed. There were plans and procedures in place to safely deal with emergencies. Checks and audits were undertaken to ensure the environment was safe. Learning from incidents and accidents took place and appropriate changes were implemented.

There were appropriate infection control processes in place. The home was clean and homely. People received their prescribed medicines on time and in a safe way. Staff ensured people were referred promptly to health professionals when required.

The activity provision at the home had improved. A full-time activity person had been recruited. They had developed a programme of activities which people said they enjoyed doing. The programme included activities which were assessed and meaningful to people.

People felt safe living at the home and with the staff who supported them. There were sufficient staff on duty to meet people’s needs and keep them safe. Staff were knowledgeable about how to recognise signs of potential abuse and were confident any concerns raised would be acted upon. They had completed training to ensure they had the right competencies, knowledge and skills to support people at the home.

People were supported to eat and drink enough and maintain a balanced diet. Positive improvements had been made to the dining experience at the home. Individual risk assessments were completed. Staff had put in place preventative measures where people were identified at an increased risk of skin damage or weight loss.

Staff treated people with respect and were kind and compassionate and maintained their dignity when helping them with daily living tasks. They addressed people by their name and personal care was delivered in private in people’s rooms. They knew the people they cared for well and when supporting people at the end of their life they were cared for in an individualised and dignified way.

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. Capacity assessments were undertaken and best interest decisions were being recorded. This helped to protect people’s rights. Staff gained people’s consent and involved the person before they provided care. They listened to people’s opinions and acted upon them. Visitors were made welcome and could visit without time restrictions.

Care and support was planned and delivered in a way the person wished. Care plans identified people’s care and support needs and how they wanted staff to support them.

People were supported to maintain their personal appearance. This included support with shaving and hairdressing appointments. The registered manager had improved staff recording of personal care on the computerised system. Senior staff undertook spot checks each day to ensure people’s personal needs had been completed.

People knew how to share their experiences and raise a concern or complaint. They were confident the registered manager would take action as required.

Everyone said they had confidence in the registered manager. They had implemented a lot of improvements since the last inspection. They had worked with staff to improve the team work at the home in line with the provider’s website.