About the service: Blackwell Care Centre is a care home that provides personal care for up to 49 people, some of whom are living with dementia. At the time of the inspection 47 people lived at the service. Most people lived there permanently, and some people spent short periods there to provide respite for their main carers. The accommodation was established over two floors. On the ground floor there were bedrooms and an activities room, which could also be used as a café space. On the second floor there were bedrooms and several communal spaces. These included a large dining area, a conservatory and smaller lounge spaces.

People’s experience of using this service:

• There was a warm, welcoming and very friendly atmosphere. The provider was very person-centred and staff had an exceptional understanding of people's individual needs.

• Staff were extremely responsive towards people’s lives and care requirements.

• People and relatives told us they were fully involved in the creation and review of their care plans.

• Staff showed exceptional care and compassion when caring for people at the end of their lives. The service was totally committed to assisting people to pursue their interests which created a sense of belonging and purpose. A range of activities were on offer to ensure a variety of opportunities which reflected people’s wishes and interests.

• The registered manager was passionate about providing person centred care and this was reflected in every aspect of the service. People and relatives were empowered to help run and improve the service, in a survey to visitors the feedback was exceptionally positive. People’s views were considered and had been used to make changes to the menu, the environment and activities.

• Partnerships had been developed with the community and health and social care professionals.

• A range of regular checks had been completed to review the quality of the care and any areas were improvements were required. When identified improvements were implemented to continuously work in the interests of the people living at Blackwell Care Centre.

• People’s safety had been considered and risks had been reduced by the introduction of equipment or guidance. Staff had received training in relation to safeguarding and knew how to protect people from harm.

• Medicine was managed safely. The risk to any infection was reduced by the maintenance of high standards of hygiene. People enjoyed the food and their nutritional needs were met.

• People enjoyed living at the home and told us staff were kind and respectful of their choices. There were sufficient staff to meet their needs and staff were recruited in accordance with best practice.

• People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Health care had a focus to ensure people’s ongoing wellbeing.

• Information was provided in a range of formats to support understanding. People were able to access spiritual support to meet their religious beliefs.

• There was a registered manager at the home and the rating was displayed at the home and on their website. When required notifications had been completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

Rating at last inspection: Good (Published December 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found the service continued to be Good, and in some areas improved to Outstanding.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 31 October and 3 November 2016. The first visit was unannounced.

Blackwell Care Centre is a care home which provides accommodation, nursing and personal care for up to 49 people. On the day of our inspection 46 people were living there.

The service had a registered manager who was also one of the providers of the service. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected on 22 July 2014 when we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2010. The registered person had not established and acted in full accordance with the best interests of people receiving care where they were unable to provide their own consent. At this inspection we found the required improvements had been made. Also, the provider had not protected people against the risks associated with the unsafe use and management of medicines because they had not ensured appropriate arrangements for their administration, recording, handling and storage were in place. At this inspection we identified several areas where improvements were still required.

People were protected from bullying and harassment by staff who were aware of what to do if they had any concerns regarding this. Appropriate risk assessments were included in care plans and people's freedom was respected. Where it was appropriate people were involved in making decisions about taking risks. There were sufficient numbers of staff on duty to keep people safe, though these were not always deployed effectively enough to ensure people's safety. People's medicines were not always managed safely and we found some medicines had been opened and the date of opening not recorded.

People received care from skilled and trained staff who were aware of their responsibilities. Consent to care and treatment was sought in line with the Mental Capacity Act and Deprivation of Liberty Safeguards.

People were supported to have enough to eat and drink and fresh food was available. Where people required a specialist diet this was provided. Access to health and social care was readily available when necessary.

Positive caring relationships were seen between people and the staff who supported them and we saw kindness and compassion demonstrated in the home. People were supported to express their views and privacy and dignity was promoted and respected.

People's needs were responded to in a way that showed respect for their preferences and people were involved in activities in the home. Activities were undertaken five days a week and, where people were unable to leave their rooms due to their medical condition, they were supported by the activities co-ordinator in social activities in their own rooms twice a week. Concerns and complaints were investigated and people told us they felt able to approach the registered manager with any concerns they had.

There was an open culture in the home and links with the local community enhanced the quality of life of people living in the home. The registered manager was a visible and respected leader who was aware of their responsibilities. This helped to ensure high quality care was delivered. This was monitored by a series of processes and robust records were kept.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to safe care and treatment of people using the service. You can see what action we told the provider to take at the back of the full version of the report.

As part of our inspection we spoke with the registered manager, nurses and staff and people receiving care at the home . We also examined records and observed people receiving care. 48 people were living at the home at the time of our inspection.

Below is a summary of what we found.

Was it safe?

We saw some staff assisting and supporting people safely and in a way that met with their needs and known preferences. We found that people’s care was planned and delivered in a way that was intended to ensure their safety and welfare. The provider was not ensuring arrangements for managing medicines were adequate to protect people from risk.

Was it effective?

People’s care plans mostly described the care they required. Care plans did not, however, fully account for people's needs, for example their individual type of dementia or provide information to help staff understand how each person’s condition affected them. We saw that people had various health conditions that could present a risk but information was not provided to alert staff about any possible problems or how to assist people with specific health needs. We found that appropriate consent was mostly being obtained for people's care but where people were unable to make decisions for themselves, for example due to dementia, the Mental Capacity Act 2005 was not always being correctly used.

Was it caring?

We observed staff providing peoples' support and saw they were caring and helpful. People told us they were happy with their care, and one person said; ”I feel fine here. It's as good as it can be, I think.” We saw that staff interacted with people in a manner that acknowledged their own reality and experience, which is important for people living with dementia. People we living at the home looked smart and well groomed.

Was it responsive?

People told us they were confident that any concerns or complaints they had would be dealt with by the registered manager and staff. We saw people's care plans were updated in response to changes in their needs or the advice of specialists other professionals.

Was it well led?

We saw the registered manager completed a range of checks of the quality and safety of service provided. They were also introducing a new system to ensure information about incidents and accidents was analysed and any risks identified and managed. Procedures were in place in case of emergencies occurring to help ensure people could continue to safely receive care at the home. Care planning for people approaching the end of their lives was consistent with professional guidance.

At our visit there were 47 people living in the home and personal care was also provided to one person who lived in their own home. People we spoke with were positive about the service. One person said, “It’s fabulous.” Another person said, “It’s beautiful living here you couldn’t wish for a better place.”

People’s care records were personalised and showed that their written consent was properly obtained before they received any care at the home. Where people’s assessed needs identified any risks to their health and welfare, we found their written care plans showed what action staff needed to take to reduce these.

We found that people received care from staff, who were properly recruited, trained and supported and saw that staff spoke to them with consideration and respect.

People told us that the home was kept clean and we found they were protected from risks of infection.

There were 41 people using the service at the time of our visit. We spoke with eight people using the service, three relatives, six members of staff and one visiting professional during the visit. We spoke with four visiting professionals and one relative by telephone following the visit.

People told us that they liked using the service. One person said “Staff are very good” and another said “There couldn’t be better staff” and another described the service as marvellous. They told us that privacy and dignity was observed when personal care tasks were undertaken. Relatives we spoke with also confirmed that staff were kind and treated people properly.

All the people we spoke with stated the food was good and told us they enjoyed their meals. One person told us “The food is lovely” and confirmed that alternatives were offered to what was on the main menu.

At our visit people spoken with told us they received the care and support they needed and said that staff treated them with respect and maintained their dignity and privacy.

All the people that we spoke with expressed satisfaction with their care, treatment and support and two people told us about some of the ways the home consulted with them. Examples provided included, via their care reviews, regular meetings held with them and their representatives, newsletters, a suggestions box, a displayed ongoing calendar of events and activities and satisfaction questionnaires.

Recent satisfaction survey returns that we saw, conducted with people by the home, provided mainly positive feedback. We found where comments from these had informed areas of service improvement relating to risk based and person centred care approaches.

One person told us about a recent meeting held with people who use the service and their representatives, where information was provided about end of life care and advanced care planning. People also confirmed they were properly consulted about the extensive building repairs in progress, including at their planning stage. Four people asked, said the home was always kept fresh and clean.

One person told us, ‘It’s a marvellous home’. ‘Nothing is too much trouble.’

Another said, ‘My wife is happy, the care and food is excellent.’ Adding ‘I visit every day and have lunch with her’. ‘Staff go out of their way to make things the best they can for both of us.’

Six people spoken with about meals provided, said they usually enjoyed the food and were asked about their likes and dislikes. One person said they personally found the food did not meet with their preferences in terms of the meat quality. All said they were regularly offered a choice of drinks and snacks and three people said that although the lunchtime menu was set, that if they didn’t wish to have the set meal, the cook would arrange an alternative with them.

Of the four people whose care we looked at more closely, we found that their personal and health care needs were suitably accounted for, including for their medicines and they were provided with the necessary equipment to assist them.

We also held discussions with the nurse in charge and three of the six care staff on duty along with the newly appointed activities coordinator. All said they were provided with the training, support and equipment they needed to enable them to perform their role.