Archived: Blossom Care Home

During this inspection, we checked to see whether improvements had been made. We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, premises and equipment, staffing, governance, consent and person centred care. We also identified a breach of the regulation relating to dignity and respect.

Blossom Care Home is a residential home, registered to provide care for up to a maximum of 20 people. There were 12 people living at the home at the time of our inspection. On the first day of our inspection, there was no management presence at the home. At 9am we were told the interim manager was due to arrive. However, at 10.15am we were told the interim manager was absent from work due to sickness and the deputy manager was on leave. On the second day of our inspection, the interim manager had returned to work.

The service had a registered manager at the time of our inspection. However, the registered manager had been absent from work due to maternity leave since March 2016. The interim manager told us the registered manager was not returning to Blossom Care Home.

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 registered provider was not present at the home on a day to day basis and had engaged an agent, who had employed an interim manager. The interim manager had been in post since November 2016.

The staff we spoke with understood the signs to look for which may indicate potential abuse and staff were clear about who they would report concerns to.

We found some risks to people had not been assessed and care plans were not sufficient to ensure everyone’s needs could be met safely. Some care records did not contain information which would enable staff to safely assist people to move. A person who was at risk of choking did not have an associated risk assessment in order to provide staff with the information they would require to safely assist the person. These concerns were highlighted at the last inspection.

The premises were not safe and an enforcement notice had been issued by the West Yorkshire Fire and Rescue Authority. Some work, which was required to meet the requirements of the enforcement notice, had not been completed. Some windows on the first floor were open wide, well beyond the recommended limit, and this presented a risk to people. Other building safety works were outstanding such as gas safety and lift maintenance works.

Staff had been safely recruited but we found the deployment of staff was not always effective.

Recording of the administration of medicines was inconsistent and not always in line with the registered provider’s own policy.

There was a lack of staff support, supervision and training. There was no training matrix in place to provide an overall view of training. Some staff had not received training in areas such as safeguarding, the Mental Capacity Act 2005, fire safety and basic first aid. Evidence of staff supervision was lacking and staff told us they had not received regular one to one supervision in order to monitor their performance and development needs.

People were not supported to have maximum choice and control of their lives and staff did not support people in the least restrictive way possible. The registered provider was not acting in accordance with the Mental Capacity Act 2005 (MCA). Some people had decisions made on their behalf without the principles of the MCA being followed. Some people were being deprived of their liberty without authorisation or the necessary safeguards in place.

People received support to access additional healthcare such as GPs and district nurses.

Although people told us they felt staff were caring, our observations were that staff did not always treat people with dignity and respect. We observed some staff providing care and support without communicating with people.

People’s human rights were not always upheld. We had identified this as a concern at the last inspection in November 2016 and had discussions with the registered provider and their agent, and they had failed to make improvements.

Some care plans contained personalised information to enable staff to provide effective care. However, some people’s care plans required updating and were lacking essential information, such as risk assessments and specific plans of care. This had been highlighted as a concern at the last inspection.

We found there to be a lack of meaningful activities and two people told us told us they were bored.

People were able to make their own choices, such as what to eat, what to wear, where to sit and what time to get up and go to bed.

We found continued inadequate management of Blossom Care Home. There was a lack of management oversight. For example, regular safety checks had not been completed, some audits had not been completed, there was a lack of staff support, the premises were unsafe, risks were not assessed, appropriate records were not kept and emergency plans were not in place.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. Services in special measures are kept under review and further enforcement action may be taken as appropriate.

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.

Blossom Care Home is a residential home, registered to provide care for up to a maximum of 20 people. There were 12 people living at the home at the time of our inspection.

The service had a registered manager in post at the time of our inspection. However, the registered manager had been absent from work due to maternity leave since March 2016. We had been advised by the registered provider that Blossom Care Home would, ‘Run as normal in the absence of the registered manager.’ The registered provider told us this was because they would be present and were familiar with the home, residents and staff and they would continue to manage the home alongside a senior care assistant.

The registered provider was not present at the home on a day to day basis and had engaged an agent to be involved in the day to day running of the home. The agent had appointed an interim manager, who had been in post for two weeks prior to our inspection.

The staff we spoke with understood the signs to look for which may indicate potential abuse and staff were clear about who they would report concerns to. However, the registered provider had failed to notify the Care Quality Commission about some allegations of financial abuse in line with legislation.

We found multiple risks to people had not been assessed and care plans were not sufficient to ensure everyone’s needs could be met safely. Some care records did not contain information which would enable staff to safely assist people to move. A person who was at risk of choking did not have an associated risk assessment in order to provide staff with the information they would require to safely assist the person.

The premises were not safe and an enforcement notice had been issued by the West Yorkshire Fire and Rescue Authority. Some work which was required, in order to meet the requirements of the enforcement notice, had not yet begun. Some people did not have personal emergency evacuation plans in place which meant they could be at risk of harm in the case of an emergency evacuation.

Staff had been safely recruited and we found staffing levels had improved since the last inspection.

Medicines were managed and administered in a safe way.

There was a lack of staff support, supervision and training. We could not find evidence, and the interim manager was unable to confirm, what staff training had taken place. There was no training matrix in place and some staff told us they had undertaken training but had not been issued with certificates. Evidence of staff supervision was lacking and staff told us they had not received regular one to one supervision in order to monitor their performance and development needs.

The registered provider was not acting in accordance with the Mental Capacity Act 2005 (MCA). Some people had decisions made on their behalf without the principles of the MCA being followed.

The cook did not have the necessary skills and knowledge to ensure people’s nutritional needs were met. This meant meals were not fortified when necessary and a person’s diabetes was not managed effectively.

Some recent improvements to the environment were evident such as new flooring and freshly painted walls in some areas. Some people’s bedrooms were not personalised.

People received support to access additional healthcare such as GPs and district nurses.

We observed staff to be kind and caring. Everyone we spoke with told us staff were caring. We observed people appeared comfortable and relaxed in the company of staff.

Two people did not have care plans in place and some other people’s care plans were lacking in information. Care plans were not regularly reviewed and people were not involved in developing or reviewing their care plans.

One person told us they were bored and we found there was a lack of meaningful activities.

People were able to make their own choices, such as what to eat, what to wear, where to sit and what time to rise.

A new interim manager had been appointed and had been in post for two weeks. However, we found a continued history of inadequate management at Blossom Care Home. There was a lack of management oversight. For example, regular safety checks had not been completed, audits had not been completed, there was a lack of staff support, people’s views were not sought and acted upon, the premises were unsafe, risks were not assessed, records were not kept and emergency plans were not in place.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

This inspection found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to providing person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and good governance.

The home provides accommodation for up to 20 people who require personal care. There were 12 people living at the home at the time of the inspection.

The service had a registered manager in place. 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.

Staff had received safeguarding training and understood the signs to look for, which may indicate potential abuse. However, safeguarding reporting procedures were not robust and had not been followed.

Risk assessments and care plans were not sufficient to ensure that everyone’s needs could be met safely.

Staff had been safely recruited but sufficient numbers of staff were not deployed to ensure that people’s needs could be met.

The home was clean and fresh and good practice was followed in order to reduce the risk of the infection.

Staff did not receive appropriate support and supervision to enable them to perform their roles effectively.

People were given menu choices and their diet and nutritional needs were met. People had access to additional health care when required.

Staff were caring at times. However, there were also some negative interactions and periods of missed opportunities to engage with people. End of life wishes were considered.

Different ways of communicating with people had been explored and good use was made of communication cards.

People told us they were bored and there was a lack of meaningful activities.

People were able to make their own choices, in terms of meals and when to rise in a morning.

The registered provider had demonstrated they could be flexible and responsive, by the way that some people residing at the home were accommodated, to ensure their needs were met.

Management oversight at the home was weak. There was a lack of auditing and lack of staff supervision. In some areas the registered manager had not made improvements following the last inspection.

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.

You can see what action we told the provider to take at the back of the full version of the report.