Blackwater Mill Residential Home

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We assessed 3 quality statements within this key question. We found 1 breach of the legal regulations in relation to person-centred care. People's preferences in relation to their personal and intimate care needs were not being met. We observed people looking unkempt. People did not always receive timely support from staff and this compromised their dignity. Information about people and their individual interests and needs was often absent or out of date. People who were unable to join in the planned activities, were not supported to engage in meaningful activities and appeared to have limited interaction. Staff shared they would like to have more time to spend socially with people. People did not have choice and control over their care, treatment and wellbeing. People did not appear to be involved in reviews of their care. Feedback from relatives reflected a lack of involvement and communication from the service. However, people gave positive feedback about the staff team. One person said, “They [staff] are very good, lovely, I have no concerns.”

This service scored 45 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People's preferences in relation to their personal and intimate care needs were not being met. One person told us they were not offered the opportunity to shower regularly. Another said, “I have a bed bath but would like a shower.” People did not always receive timely support from staff and this compromised their dignity. One person was sitting in wet clothing. We informed staff of this. After 20 minutes we checked to find the person had a clean ‘Kylie’ sheet over their lap while their clothes underneath remained wet.

Some staff raised concerns over supporting people to maintain their comfort and appearance. One staff member said, “I think people are clean in the morning, but staff don’t keep up with things like changing a top if someone spills their dinner down them.” With reference to washing, a staff member told us, “I don’t think enough showers are done.” Another staff member shared that many people favoured a wash over a bath or shower. A representative of the provider confirmed there were no records to demonstrate people had been offered the opportunity to bath or shower and had refused.

Visiting professionals made reference to people appearing unkempt. One professional told us they had concerns people were, “Unshaven, unclean.” Some professionals raised concerns over staff understanding of Dementia and how it can impact on people. One professional told us, “I talked about Dementia and how this can change someone’s character and perception of situations, but [Staff member] was not open to this perception and reported that [Name] is just a rude, angry [person].” Visiting professionals reported witnessing unprofessional and hurtful behaviour from staff. A senior member of the team was reported to say, “I just want him out of here, get rid of him” in front of the person. Another professional said, “I find that the staff are generally not person centred and there is a lack of compassion or general care when interacting with staff and management within the home.”

We observed people looking unkempt. When we raised specific concerns with staff these were not adequately addressed, for example a person was given a clean ‘Kylie’ sheet but their clothing underneath remained wet. People’s bedrooms were dirty and required maintenance. Some bedrooms smelt of urine. We noted a lack of attention to detail, for example several clocks were set to at the wrong time and we observed clothes piled up on top of wardrobes even though there was ample space inside. We observed incontinence aids in full view on surfaces in people’s bedrooms.

People who were unable to join in the planned activities, were not supported to engage in meaningful activities and appeared to have limited interaction. One relative said, “I would really like Mum more involved in activities and able to watch TV sometimes, to improve her quality of life. Mum always sits in the dining room where there is no TV.” Feedback from people who were able to join group activities included, “I like the music activities” and, “activities are good.” People gave positive feedback about the staff team. One person said, “They [staff] are very good, lovely, I have no concerns.” Another told us, “I have no worries, the staff are nice, and they talk to me nicely. I get help when I need it, I don’t need to wait.”

Staff shared they would like to have more time to spend socially with people. They told us an increase in staffing would support them to meet people’s emotional needs and to deliver, “proper, care, comfortable care.” One staff member said, “We cannot relax. All the positions and pad changing is going smoothly, but if somebody is asking me to sit with them for 5-10 minutes, I didn’t have the time.” Staff told us information in the care plans entitled ‘All about me’ was often absent or out of date. The purpose of ‘All about me’ is the help staff understand the person, their life history and what is important to them.

We observed people sitting for long periods without meaningful activity or engagement. We observed three people sat at individual tables in the dining room on arrival one day. When we left the service in the afternoon they remained in the same position. People were often in their bedrooms with no entertainment, for example radios and televisions were not on. We noted one person had a lake view but was unable to see it as their chair was positioned too far back and they were unable to move it independently. We observed a group activity in the lounge on 25 March. A Harpist was playing and there were 8 people present. There was a relaxed atmosphere and people appeared engaged and happy.

People's care plans did not always contain information about their personal, cultural, social and religious beliefs. Those we reviewed contained limited and basic information about the person, their interests and what was important to them. Some care plans contained errors such as not referring to a person by their preferred name. Other care plans had not been updated to reflect a change, for example when a person was no longer able to go outside or downstairs due to a deterioration in their health. Audits of care plans had not generated sufficient improvement. For example, a representative of the provider had identified the issue of the person not being referred to by their preferred name in January 2024, yet this had not been updated. Records of activity provision indicated mixed experiences. For those able to join in planned activities there was variety on offer. However, for those cared for in their rooms, there was minimal evidence of meaningful activity being offered. Activities recorded were task based, for example brushing or washing hair. Over a 20-day period 4 people had no social activity recorded, another 4 had less than 1 hour of social activity documented. The failure to deliver person centred care was a breach of Regulation 9 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People did not appear to be involved in reviews of their care. Feedback from relatives reflected a lack of involvement and communication from the service. One relative told us they had not been informed about a change in their loved one’s medication. People told us they were not always able to access drinks or snacks, particularly in the evenings. Relatives reported people waiting more than an hour for a cup of tea when requested. One person described feeling hungry during their stay. They said, “I was always so hungry while I was there. You know it’s extraordinary, I mean I haven’t felt hungry since I came home.” They also told us the vegetarian option was often the same dish, just without the meat. A relative said, “Hot meals are often served lukewarm or cold.” However, another person said, “I get enough to eat and the food is very nice.”

Staff told us they struggled on occasion to provide people with appropriate snacks, especially during the evenings. They also reported vegetarian options were limited. Staff told us they supported people to be as independent as they were able. One staff member said, “I think most staff encourage people [to be independent], some I think just want to help. I don’t think it is because it is quicker to do it for them.”

People were not always supported to make choices. Menus did not appear to be made available in alternative formats. One person told us their meal had been chosen for them as they could not read the menu. We observed people waited over an hour once seated in the dining room to receive their meals.

Records did not demonstrate people and/or their representatives had been involved in reviews of their care. Care plans did not always contain sufficient guidance for staff to manage specific conditions and enable them to provide consistent support to people. For example, a person living with dementia had no detailed information in their care plan to support staff to understand how their dementia impacted them as a person and how they were to be assisted. Care plans for people had conflicting information, some were generic, lacked detail and were not always person centred. Parts of some people’s care plans referred to them by different names or ‘she’ when the person was ‘he’ and vice versa. We were not assured people received food in line with their preferences. We noted people recorded as disliking fish or pork had been given these meals. One person, stated to be vegetarian, was recorded as being served a meat dish. Records indicated a long gap between the evening meal and breakfast, with no snacks recorded as being offered. The menu included a ‘night owl menu’ available on request, but staff indicated there was a lack of options to offer people once the kitchen had closed.

We did not look at Responding to people’s immediate needs during this assessment. The score for this quality statement is based on the previous rating for Caring.

We did not look at Workforce wellbeing and enablement during this assessment. The score for this quality statement is based on the previous rating for Caring.