This inspection took place on 27 July 2017 and was unannounced. The inspection took place at night and was prompted by concerns which had been raised with us about the night care arrangements. The previous inspection of 06 October 2016, found the service was good. At this inspection we concluded that the service continues to be rated as Good as we found the service was operated in a safe way at night.

Blackthorns is a residential service providing accommodation and personal care for up to 62 older people. On the night of our visit there were 52 people living at the service.

A registered manager was in post and attended the service on the night of the inspection. 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.

Risks to individuals were identified and there were plans in place which set out how the risks should be managed. We looked specifically at the risks associated with falls and found that where necessary, equipment was put in place to reduce the likelihood of injury.

The manager had oversight of accidents and we saw that these were analysed to identify any contributing factors.

Staff were clear about the steps that they needed to take in the event of an emergency but it was agreed that the documentation would be strengthened to further safeguard people.

Staffing levels were adequate and there were sufficient staff available to meet people’s needs at night. The service was however dependent on agency staff and continues to recruit a permanent staff team. We saw that there were plans to reduce staffing in the early morning and it was agreed that this would be reviewed.

The inspection took place on 06 October 2016 and was unannounced. The previous inspection of 14 December 2015, found the service required improvement. There were breaches in regulation that related to staffing levels, the management of medicines and the delivery of person centred care. We followed up these areas at this inspection and found that improvements had been made.

Blackthorns is a residential service providing accommodation and personal care for up to 62 older people. On the day of our visit there were 56 people living at the service.

A registered manager was in post and present on the day of the inspection. 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.

Staffing levels had improved since the last inspection and there were sufficient staff available to meet people’s needs. The service was however dependent on agency staff and continues to recruit a permanent staff team. There were systems in place to ensure that the newly recruited staff were vetted to ensure their suitability.

Medicines were well organised, appropriately stored and administered as prescribed.

Risks were identified and where necessary equipment was put in place to reduce the likelihood of injury. Health and safety audits were undertaken and checks made on equipment to check that they were working effectively.

Staff were trained and inducted into their role but did not always put their training into practice. People had good access to health care professionals when they needed support or treatment.

The registered manager and staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. People's best interests had been considered when decisions that affected them were made. Applications for DoLS authorisations had been submitted where restrictions were in place.

People enjoyed the meals and they looked nutritious and nicely presented. Greater oversight of people eating in their rooms would ensure that those at risk were identified promptly.

Relationships between people living in the service and staff were positive. Staff were caring and kind. There were activities in place which people enjoyed. Regular meetings were held with people who lived in the service and their relatives to ascertain their views and identify areas where the service could develop.

People were positive about the management of the service. The manager was assessable and encouraged a culture of openness. Audits were undertaken to identify shortfalls and action plans developed setting out how they intended to improve.

This inspection took place on the 14 December 2015 and was unannounced. Blackthorns is a residential service providing accommodation and personal care for up to 62 older people. On the day of our visit there were 57 people living at the service.

A new manager had recently been appointed and was present during the inspection but was not registered. 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.

There were not always sufficient numbers of staff available to meet people’s needs which meant that people did not always receive good care. Further work was needed to ensure people needs and preferences were met. Care plans were not always up to date and did not provide staff with sufficient guidance. This combined with a new staff team meant that individuals whose needs were more complex were at increased risk of poor care. Staff were generally caring but care delivery focused on the completion of tasks.

The new manager was working to raise morale and develop staff skills but this was at an early stage of development.

Staff received training, but there was a new staff team and the training did not always provide them with the knowledge and skills they needed to meet the needs of people living at the service. Medication administration practice did not always follow the recommended professional guidance.

There were effective procedures in place to ensure that references and other checks were undertaken and to reduce the risk of employing unsuitable staff.

The provider had systems in place to reduce the risk of people experiencing abuse and staff had been provided with guidance in reporting issues of concern.

Audits were undertaken by the manager and area manager but these were not always effective as they did not identify some of the key issues which we found at the inspection.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

When we inspected the service it had 52 people living there who required personal care. We observed people moving freely around the home, taking part in activities and making choices about how and where they wanted to spend their time.

We spoke with the registered manager and three staff. We spoke with nine people who used the service. We looked at records at the home. Below is a summary of what we found.

During our inspection we looked to see whether we could answer five key questions: is the service safe, effective, caring, responsive and well led?

Is the service safe?

The staff we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe how they effectively protected people from the risks of cross infection and maintained good clinical hygiene in the service.

Recruitment procedures were rigorous and thorough. Staff received the training they needed to ensure that people were cared for safely for example, moving and handling and safeguarding of vulnerable adults from abuse. Staff also received training on the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant that staff had been provided with the information they needed to recognise signs of abuse, risks to people's safety and how to report these concerns so that actions were taken to safeguard people.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to improve.

The service was clean and safe throughout.

Is the service effective?

During our previous inspection on 3 January 2014 we noted some shortfalls in the way people were supported with their mobility needs. We looked to see if improvements had been made. The service had updated all moving and handling plans in people's records to reflect their mobility needs including details of the aids they required and how many staff needed to support them to be safe.

People's health and care needs were assessed before they came to the home to determine their needs and make sure the service could meet them effectively. People's needs relating to their skin care, continence, daily living choices, mobility and risk of falls had been identified in care plans where required. We did discuss with the manager that the care plans were repetitive and inconsistent in some areas. They assured us that they would address this with staff immediately.

People’s health and care needs had been assessed and care plans were in place. People were involved in their care plan reviews and signed their care plans where they were able to. Where people needed to make bigger decisions and they lacked the capacity to do so, mental capacity assessments and best interest decision meetings had taken place to. This meant that people’s capacity to consent to their care had been assessed before people made decisions on their behalf and they were involved in the decisions about their care.

We saw arrangements were in place for care plans to be reviewed regularly to make sure information about people's care and support needs remained appropriate and accurate. We discussed with the manager that, because of the repetition of some records and updates in different areas of others, we were concerned that staff did not have the most up to date information they required to care for people safely. We followed our concerns up by speaking to staff, they were all aware of people's changing needs. The manager assured us that the inconsistency in the records would be addressed.

People had access to a range of health care professionals some of which visited the home.

Is the service caring?

We saw staff were attentive to people's needs throughout our inspection, they interacted positively with people and gave people time to respond. We found staff showed patience when communicating with people who lived in the home.

People we spoke with were positive about the care provided by staff. We asked one person if the staff were caring and they told us, "Very much." Another person told us about the staff, "They're fine." Someone else said staff were, "Very good."

Is the service responsive?

We saw people were able to access help and support from other health and social care professionals when necessary.

People were able to participate in a range of activities. During our inspection people were taking part in bingo in one of the dining rooms. People were engaged and interacted well with staff. We sat with people while they played bingo, they enjoyed the activity. There were colourful notices of upcoming activities and photos of activities people had participated in. People accessed a reminiscence area of the service and enjoyed this.

The service responded to people's needs. Throughout our inspection call bells were answered promptly and people walking around the service were often joined by a staff member to ensure they were happy and walked with them if they needed some guidance. One person who preferred to stay in their bedroom told us, "They check on me regularly."

Is the service well-led?

The service had a quality assurance system in place to identify areas of improvement. There were regular audits on medication, health and safety and infection control.

Records seen by us identified that the service was well maintained and all required servicing of equipment and other supplies was done regularly. As a result the quality of the service was continuously improving.

We found staff employed to work at the service had all the necessary skills to support the people who lived in the home. Staff told us that they felt well supported and received regular training.

One person told us that the manager was, "One of the best.” Another person told us about the manager, "She is a nice manager." The service held team meetings and residents meetings to include people in the running of the service. The manager told us that a satisfaction survey was planned for later this year to gain people's views in more detail.

People that used this service told us that they were pleased with the service and had their needs met. We found an effective service in operation. We observed a staff group that were caring and compassionate to people who were older and living with dementia. We found that enough staff were employed and rostered on shift to make the service a safe place to live. People were treated with dignity and respect. The environment was comfortable and had been appropriately furnished to meet the needs of older people and their associated conditions.

We found a manager that was responsive to our questions and matters raised with them. The service needed to develop further their safe systems relating to moving and handling to ensure the safety of everyone. We examined the complaints systems in place and found that the manager responded in a timely way and learnt from matters brought to their attention.

During this inspection we spoke with eight people who used the service. One person said, “I couldn’t do any better. My room is kept neat and clean.” Another told us, “Staff care for me very well. I like the company and the food.”

A relative told us, “I looked at many homes before choosing this one and I cannot find fault with it. The cleanliness is amazing.” They also told us, “If I had any complaints I would be happy to speak with the manager. I think the manager would try to solve any problems I raised.”

We observed that staff were genuinely caring and respectful towards the people they were supporting. It was clear from our discussions with staff that they enjoyed their work and wanted to do their best for people.

The people with whom we spoke were happy with the care they received at Blackthorns. They did not raise any concerns and provided positive comments about the staff and the care they received. They confirmed that they are involved in decisions on how their care was to be provided and felt they could approach staff if they had any concerns.

People with whom we spoke were complimentary about the food served at the home. They added that the food was nice and they enjoyed their meals. The portions seen during a lunchtime meal were plentiful and seconds were offered. Tea, coffee and juice was offered to people throughout the day.

People were happy with the cleanliness of the home and decoration and it showed that some thought had been put into the surroundings. They provided a homely environment with furniture and fittings that many of the people living at Blackthorns may have had in their own homes. This was a talking point for many of the people living there.