This inspection was unannounced and took place over three separate dates, 13 November 2018, 18 November 2018 and 12 December 2018.

Blair House is a residential ‘care home’ which provides accommodation and personal care for up to 41 people, including people living with complex mental health conditions. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement.

The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home is a large detached property set in a residential setting fairly close to Southport Town Centre. A the time of the inspection there were 40 people living at the home.

A registered manager was in post.

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 home was last inspected in December 2016. The home was rated as good overall. We found during this inspection a breach of legal requirement, and the home is now rated as ‘requires improvement’ overall.

Risk assessments were in place for people who lived at the home and the majority of risks were well assessed and reviewed regularly. However, we did see that one person’s risk assessment did not contain enough information for staff to follow to keep the person safe. There is an ongoing police investigation in relation to this incident which will not be reported upon.

There were quality assurance procedures in place which checked service provision however, they were not always effective. We saw that quality assurance systems were mostly robust. We did see however, that some of the processes with regards to service provision, such as the risk assessments required further improvements.

Everyone we spoke with told us that they felt safe living at Blair House.

A medicines inspector looked at how medicines were managed in the home. We looked at storage, records and administration and found that medicines were managed safely.

Medicine audits demonstrated that changes and learning took place to improve procedures and staff confirmed this. There was a good culture for reporting errors and we saw evidence of analysis and changes made to improve the service.

Staff were able to describe how they ensured people were kept safe from harm or abuse. Staff discussed the actions they would take to report actual or potential abuse, which included reporting to the registered provider or registered manager, the local authority or the police.

Staff were recruited safely to enable them to work with vulnerable people. We saw that each staff member had been subject to a Disclosure and Barring service (DBS) check.

Staff rotas and our conversations with staff evidenced that there was mostly enough staff employed to work at the service and on shift to support people appropriately. Some staff had worked at the home for a number of years. There was however, some use of agency staff in the home, which some people said they did not like. We saw that the registered manager was trying to decrease their usage of agency staff, which had been successful in the last months.

The home was clean and tidy. There were hand washing facilities and hand sanitizers found throughout the home. Personal protective equipment (PPE) was available and we staff using these when they served people’s food.

The training matrix and examination of staff training certificates showed that all mandatory training was in date, and had been completed by staff. We saw that specialised training was taking place to support people living with complex mental health conditions. The registered manager informed us during our inspection, that more training had been arranged for the staf

This inspection took place on 9 December 2016 and was unannounced.

Blair House provides nursing and personal care for people who have mental health needs. It is registered to provide 41 places. The home is a large detached property set in a residential setting fairly close to Southport Town Centre.

A registered manager was in post.

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 home was last inspected in September 2015. The home was rated as ‘requires improvement’ and we found a breach of regulation relating to staffing as staff were not always trained and supervised appropriately. We told the provider to take action. The provider wrote to us following this inspection and told us what action they were going to take to ensure they met this breach.

We saw during this inspection, the provider developed and implemented a new system of training and induction which all staff had undertaken. We saw that staff had been trained to support people with mental health conditions, and all staff had been regularly supervised and had had an appraisal. The provider was no longer in breach of this regulation.

We found during the last inspection that the registered manager had not always informed CQC when reportable incidents had occurred, however they had agreed to do this at the last inspection in September 2015. We saw during this inspection CQC had been advised of all reportable incidents

Everyone told us they felt safe living at the home. People told us the staff made them feel safe as they knew the staff team well.

Medication was managed safely within the home.

Risk assessments were detailed and informative. Risks to people and any triggers were described along with the course of action the staff were required to take to help keep the person safe.

Staff we spoke with were able to describe the course of action they would take if they felt someone was being harmed or abused in anyway.

Recruitment procedures were robust to ensure staff were suitable to work with vulnerable people. Systems were in place to maintain the safety of the home. This included health and safety checks of the equipment and building

People had a plan of care in place which was personalised and contained information such as their likes, dislikes and backgrounds. This was as well as other information relevant to their needs ensuring they received care which met their needs.

The registered manager and the staff had knowledge of the Mental Capacity Act (2005) and their roles and responsibilities linked to this. We saw that capacity assessments had been completed for people which were decision specific and showed how the least restrictive option was chosen.

The home had aids and equipment to meet people’s needs and staff would encourage people to do things for themselves when it was appropriate to promote their independence.

We found the home to be clean, spacious and well decorated.

Food was fresh and home cooked. Everyone we spoke with told us that they enjoyed the food and got enough to eat and drink.

Staff referred to outside professionals promptly for advice and support.

A process was in place for managing complaints and the provider’s complaints procedure was available so people had access to this information.

People and relatives were complimentary about the registered manager, the directors, and the culture of the home in general.

Staff were aware of the provider’s whistleblowing policy and told us they would not hesitate to report any concerns or bad practice.

Systems were in place to monitor the standard of the service and drive forward improvements. This included a number of audits for different areas of practice

There were a new group of d

This unannounced inspection of Blair House Care Home took place on 21 September 2015.

Blair House provides nursing and personal care for people who have mental health needs. It is registered to provide 41 places. The home is a large detached property set in a residential setting fairly close to Southport Town Centre.

A registered manager was not in post. A manager had been appointed and commenced in post and they had applied to the Care Quality Commission (CQC) as the registered manager and this application was in process. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered person’s 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 living at Blair House told us they felt the home was a safe place to live.

Staff we spoke with had a good understanding of safeguarding and how to report concerns and policies were in place to guide staff.

There were processes in place to maintain the safety of the building and equipment within it, such as risks assessments and servicing of equipment.

Care files we viewed showed that people had had risks assessed in relation to their mental and physical health to ensure their safety and wellbeing.

Our observations showed us that there were adequate numbers of staff on duty to meet people’s needs.

Records we viewed showed that appropriate checks had been completed to ensure prospective staff were suitable to work with vulnerable people.

A medicine policy was in place to ensure staff followed principles of safe administration of medicines. Regular audits were completed to ensure risks regarding the management of medicines were minimised.

People living at Blair House were supported by the staff and external health care professionals to maintain their health and wellbeing. Our observations showed us that staff responded timely and appropriately to changes in people’s physical health.

Staff felt well supported in their role and had completed an induction on commencement of their post. Staff felt this induction was sufficient to ensure they could meet people’s needs.

Records showed that supervision was irregular and not all staff had completed mandatory training to ensure they had the knowledge and skills to meet the needs of people living in the home. We made a recommendation in the main body of the report about this.

Staff we spoke with had a good understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, though not all staff were aware of the individual agreements in place to protect people’s safety and wellbeing.

People were involved in the development of their plans of care and people we spoke with told us their needs were being met.

We observed that staff sought consent from people prior to providing support. Capacity assessments had been completed for those people who may not have been able to consent to their care.

People told us the meals in Blair House were very good and there was always a choice. Records showed that people’s preferences were recorded and their nutritional needs had been assessed.

People we spoke with told us staff were kind and caring and treated them with respect. Our observations showed us staff protected people’s privacy and dignity.

Processes were in place to seek feedback from people living in the home, for instance through regular meetings and quality assurance surveys.

Care plans we viewed were detailed, individual to the person and reflected people’s needs and preferences.

People told us there were a variety of activities available, both within the home and within the community. An activities coordinator was employed to support people to maintain their social interests.

A complaints policy was in place and available to people to view. People told us they had not had reason to make a complaint, but were aware of how to raise concerns should they need to. People told us they felt able to raise concerns with staff and were confident that they would be listened to.

We received positive feedback regarding the management of the home. People told us communication was good, that the manager was “Approachable” and staff felt supported by the management team.

Processes were in place to ensure the quality and safety of the service. This included audits covering areas such as medicines, health and safety and accidents.

We found some incidents had occurred which should have been reported to CQC as legally required, but had not been.

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

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

People living at Blair House Care Home were treated with dignity and had their privacy respected. We observed safeguarding procedures at the home and staff had received relevant training as part of their initial induction process. Recruitment procedures were robust which ensured only those people with the required skills and knowledge were employed which kept people safe. Although no applications had been submitted for Deprivation of Liberty Safeguards, (DoLS) procedures were in place if such an application was necessary when a person was judged to be unable to make informed decisions because they lacked capacity to do so.

Is the service effective?

Before any person was admitted into Blair House, they received a thorough pre-admission assessment which ensured the provider was able to meet their required needs. People and/or their representatives had been involved in the care planning process which meant their needs and wishes were listened to and acted upon. The environment at the care home enabled people to move around freely and safely.

Is the service caring?

Throughout our inspection, we observed people living at the care home being cared for and supported by attentive and dedicated staff members. One person said, "It was the best move I ever made coming here". People living at the care home attended, if they wished, regular meetings and completed surveys and we were told if any concerns were raised they were addressed immediately. People`s wishes were listened to and recorded in their care plans and staff members responded to their wishes to help meet those identified needs.

Is the service responsive?

People at the care home had the opportunity, if they wished, to take part in a range of activities. We observed the pre-arranged activities programme displayed on the wall. People also visited places of interest which had been chosen by them and kept them involved within their local community. A rigorous complaints procedure was in place at the care home and so people were assured that in the event of any complaints being made, they would be investigated and if necessary, action would be taken.

Is the service well-led?

We saw evidence of a multi-agency approach to providing care for people at Blair House which maintained the safety and welfare of all people living there. The provider had several internal and external audit systems in place. This ensured the quality of service being provided to people living at the home was monitored, so it continued to improve. Staff members were clear about their roles and responsibilities which ensured a good quality of care and support was received by all people at the care home.

People living in the home told us they were free to come and go as they wished and were encouraged to be as independent as possible.The home had in place processes for seeking people’s views about how the home was run. This included holding regular residents’ meetings and the use of a ‘comments’ box. The home had carried out regular surveys and we saw that the home had acted upon the views people gave in the surveys.

Care plans were personalised and based on the person’s individual assessments and their preferences, providing staff with clear guidance about how to support the person concerned.The atmosphere in the home was calm and relaxed. We observed care and support being delivered and there was good communication between people and staff.

Several people managed some or all of their medication themselves and the home had systems in place to support them to do this safely. We saw that risk assessments were completed and a care plan was signed by the person concerned.

People we spoke with told us that there were always staff available when they needed them. Staff told us that staffing levels and skill mix were appropriate and supported them to carry out their job.

Regular audits were carried out to identify any areas of concern and take appropriate action to improve the quality of the care and support provided. These included audits of the running of the kitchen, the administration of medication and the completeness of care records.