The inspection took place on 07 November 2017 and was unannounced. At the last inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to two instances regarding good governance and one in person-centred care. At this inspection we found the required improvements had been made.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the key questions safe, responsive and well-led from requires improvement to good.

Blackrod House 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. Blackrod House accommodates up to 30 people across two separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. The home is situated on the corner of the main road through the centre of Blackrod, near Bolton. Local shops and amenities are close by.

There was 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.

People we spoke with said that they or their relative felt safe. There were sufficient numbers of staff on duty during our inspection and staff answered call bells promptly.

Staff recruitment practices were robust and helped protect people from receiving care from unsuitable staff. Clear safeguarding policies and procedures were in place, staff had received training and were confident to report any concerns.

Health and safety checks were in place and equipment was regularly serviced and maintained. Appropriate general and individual risk assessments were in place. There were robust systems for managing medicines within the home.

Staff induction was thorough and included a range of mandatory training. Further training was on-going for all staff. Staff supervisions were undertaken on a regular basis.

Care plans included a good range of information around health and well-being and evidenced people’s nutritional and hydration requirements. Appropriate referrals were made to other agencies when required.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People we spoke with told us staff were kind and caring. We observed staff engaging in conversation with people throughout the day. People’s privacy and dignity was respected.

People were encouraged to be as independent as possible. Care plans evidenced that people were involved with care planning and reviews. There was a service user guide given to new users of the service and their families.

The care plans we looked at included documentation that was person-centred and outlined people’s choices and preferences. Reviews of care were undertaken on a regular basis.

There were a range of activities at the home, as well as trips out. We observed a number of individual and group activities taking place on the day of the inspection.

The service had an appropriate and up to date complaints policy, which was outlined within the service user guide and displayed within the home. Formal complaints were responded to in line with the policy. The service had received a number of compliments.

People’s wishes for when they were nearing the end of their life were recorded clearly within the care plans and a number of staff had received training in this area.

People who used the service and relatives stated they thought the service was well managed and the management approachable. Staff we

The inspection took place on 17 January 2017 and was unannounced. The last inspection was undertaken on 26 August 2015 when the home was rated as Requires Improvement. At that inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities)

Regulations 2014. These breaches related to the provision of safe care and treatment.

Blackrod House is registered to provide accommodation for up to 30 people. A unit for people with varying stages of dementia is located on the first and second floors, while residential care is provided by the unit on the ground floor. The home is situated on the corner of the main road through the centre of Blackrod, near Bolton. Local shops and amenities are close by.

There was a registered manager at the 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.

At this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to good governance, person-centred care and requirement to display ratings. You can see what action we told the provider to take at the back of the full version of the report.

Record keeping was poor and risk assessments were not always included within the care plans. Although there was no evidence to say that anyone had suffered harm, the lack of appropriate guidance for staff around how to mitigate risks could potentially place people at risk of significant harm.

Care records were inconsistent and did not include all appropriate care plans. Where people’s choices with regard to care were documented, these choices were not always respected. This meant that, although the care we observed was delivered kindly, people were not always receiving care according to their preferences and wishes.

The current CQC ratings were displayed near the front door of the premises. However, the ratings were not displayed on the website.

Audits were undertaken but the quality of some of the audits was poor. Care plan audits had failed to identify gaps in the records, so improvements to these records were not being made.

People told us they felt safe at the home and there was an appropriate safeguarding vulnerable adults policy in place. Staff we spoke with had a good working knowledge of the safeguarding procedures.

The service had emergency plans in place and emergency equipment was maintained and serviced appropriately.

Recruitment of staff was robust and staffing levels were sufficient to meet people’s needs. The service had a robust induction programme and training for staff was on-going.

Infection control procedures were followed and there were appropriate medicines systems in place to help ensure medicines were given safely.

The environment included signage to assist with orientation and there were tactile objects, a sensory room and a reminiscence lounge for people to use.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA).

People told us the staff were caring and we observed friendly and patient interactions between staff and people who used the service throughout the day.

We saw that people were encouraged by staff to do what they could for themselves. This helped promote independence.

Appropriate information was given to people who used the service and their relatives. We saw that people were encouraged to be involved in their care planning and reviews of care and regular customer satisfaction questionnaires were sent out.

There were a number of activities within the home as well as regular trips out. There was a well-equipped sensory room and a reminiscence lounge for people to use.

The complaints procedure was displayed within the home a

The unannounced inspection took place on 26 August 2015. This was in order to provide a rating

for the service under the Care Act 2014. We were also responding to whistle blowing concerns made to the Care Quality Commission (CQC) about the care provision at the service.

Blackrod House is registered to provide accommodation for up to 30 people. A unit for people with varying stages of dementia is located on the first and second floors, while residential care is provided by the unit on the ground floor. The home is situated on the corner of the main road through the centre of Blackrod, near Bolton. Local shops and amenities are close by.

There was a registered manager at the 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.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities)Regulations 2014. This breach related to the provision of safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe living at the home. There was an appropriate safeguarding vulnerable adults policy and procedure in place and staff demonstrated a good working knowledge of this.

The service had emergency plans in place and emergency equipment was well maintained. However there were some environmental risks identified, such as doors propped open, a non-functioning light bulb in an area with no natural light near the top of some stairs and rooms which were situated near the top of some stairs. Although there was a fire door and the lift was adjacent to these rooms the absence of light could have presented a risk to people who used the service who had a level of confusion.

Recruitment of staff was robust, involving appropriate procedures and checks to ensure staff were suitable to work with vulnerable people.

Medicines policies and procedures were in place but medicines were not always given safely.

The home specialised in dementia care, but staff were not able to say what dementia model they were working to. The environment lacked signage and other touches conducive to good dementia care.

Care plans included appropriate information, but were difficult to follow. They had been regularly reviewed to ensure information about care needs was up to date.

The service had a robust induction programme and training for staff was on-going. However, staff would benefit from more in-depth dementia training to ensure people living with dementia had their needs met appropriately.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

People said the staff were caring, but we observed little natural interaction going on throughout the day. Staff concentrated on tasks to be completed rather than chatting with people who used the service.

Regular satisfaction surveys were undertaken to ascertain people’s views of the service and we saw the most recent of these. Most people had made positive comments. Relatives’ meetings provided a forum for people to raise any concerns, put forward suggestions and air their views.

The service had champions amongst the staff for dignity and end of life care. They ensured they kept up to date with information and disseminated it to the other staff members. People’s wishes for the care they wanted when they were nearing the end of life, if they had expressed these, were noted within the care plans.

Personal information within the care plans was inconsistent, so that not all of them were person centred and individualised.

The home worked well with other agencies and there was appropriate documentation and correspondence with regard to other services kept within the care files.

There were a number of activities on offer at the home and the service had a dedicated member of staff to lead activities and trips out. There was a well-equipped sensory/relaxation room and a reminiscence lounge for people to use.

The service had an appropriate complaints policy in place and there was a complaints log which evidenced that complaints were dealt with appropriately.

There was a registered manager in place.The registered manager had little knowledge of what constitutes good dementia care and did not follow the service’s own protocol with regard to infection prevention and control.

Staff supervisions and appraisals were undertaken regularly and staff were encouraged to access training and attend meetings.

Audits were undertaken but there was little evidence of any analysis of the results to facilitate continual improvement to care delivery.

Relatives’ surveys were undertaken regularly to ascertain their views of the service provision.