We inspected Blair House on 9 and 10 July 2018. The first day of the inspection was unannounced. We previously carried out inspections at Blair House. At our inspection in September 2015 we found the provider was in breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the premises had not been well maintained and the provider had not ensured systems and processes were in place to assess, monitor and improve the quality and safety of the service provided. The service was rated requires improvement. We inspected again in November 2016 where we found further breaches of regulations in relation to risks to people’s safety, people did not receive care that reflected their needs and choices. Staff had not received the training and support they needed to look after people and systems and processes were not in place to assess, monitor and improve the quality and safety of the service provided. The service was rated inadequate and placed into special measures.

We further inspected in July 2017 where we found significant improvements had been made and the provider was meeting the regulations. The service was removed from special measures. However, we found improvements were needed to ensure people’s meal choices were always supported and food was well presented. We also found that improvements that had been made in relation to management oversight of Blair House needed time to be maintained and managed to ensure it was fully embedded into everyday practice. The home was rated requires improvement to reflect this.

Before the inspection we had been made aware of concerns related to the management of the home. We undertook this unannounced comprehensive inspection to look at these concerns and all aspects of the service. We found some improvements had been made in relation to people’s food choices, however we identified further areas where improvement was required.

Blair House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Blair House provides accommodation and personal care for up to 29 people in one adapted building. At the time of the inspection there were 11 people living there. People living at the home were older people some of whom were living with a dementia type illness or mental ill health. People had a range of needs associated with old age and their health.

There was a registered manager at 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There was a quality assurance system in place, and this was well organised. However, this had not identified all the shortfalls we found. People’s records did not fully reflect the care they required and received. Although there were a range of activities, improvements were needed to ensure people were able to access a variety of meaningful activities throughout the day.

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. However, mental capacity assessments and best interest decisions were not in place for everyone who needed them.

Staff had the training however competency assessments had not been completed to demonstrate staff had the knowledge and skills they needed.

Staff knew people well. They demonstrated a good understanding of their needs and choices. People were treated with kindness, respect and understanding. They were supported to make decisions and choices throughout the da

Blair House provides residential care for up to 29 older people. People required a range of help and support in relation to living with memory loss, dementia and personal care needs. Most people were independently mobile, some with the use of mobility equipment and required support and prompting from staff. There were nine people living at the home at the time of the inspection. The provider had made a decision after the inspection in November 2016 not to admit people to the service until improvements had been made. This was no longer in place and people had moved in for periods of respite. However, the provider and registered manager told us people had been reluctant to move into Blair House due to further improvements needed to the environment and the enforcement action taken by CQC.

Blair House was inspected in November 2016. A number of breaches were identified and it was rated as inadequate. The Care Quality Commission (CQC) took enforcement action and the service was placed into special measures. Special Measures means a service will be kept under review and if needed could be escalated to urgent enforcement action. CQC issued three Warning Notices after the inspection in respect of safe care and treatment, premises and equipment and good governance. We also found two further breaches in relation to a lack of person centred care and failing to ensure sufficient numbers of appropriately trained and competent staff were in place at all times.

This inspection took place on 24 July 2017 and was a full comprehensive inspection to check the provider had made suitable improvements to ensure they had met regulatory requirements. We found that appropriate actions had been taken and issues had been addressed. The provider was now meeting the regulations and the service no longer required to be in special measures.

Blair House had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was in day to day charge of the home, supported by the nominated individual working on behalf of the provider.

People told us they enjoyed the meals and people’s weights were monitored. People did not have their choice supported at supper time. Pureed meals were not presented in an appetising way.

Systems to assess and monitor the service provided had been significantly improved. These had been implemented and continued over recent months which demonstrated that improvements had become part of the day to day systems within the home, these now needed to be maintained. This included auditing, provider oversight and an open transparent culture within the home. People spoke positively of the improvements which had taken place. Staff felt supported and people’s views had been sought and responded to.

We found significant improvements to the care documentation and records. Staff had access to relevant information about people; this meant they knew people and their care needs well. People received care which was assessed, planned and reviewed regularly to ensure their needs were met and to reflect their preferences. Individual and environmental risk assessments were in place when risks to people’s safety had been identified. When accidents, incidents or falls occurred clear systems were in place to record and respond appropriately. Referrals were made to other health professionals if needed.

Staff had an understanding of recognising and reporting abuse. Staff had received training and information was available to ensure they understood their responsibility. The registered manager was aware of what was required to be reported and kept a record of when this had taken place. Improvements had been made to ensure people’s digni

Blair House is a large Georgian building registered with CQC to provide residential care for up to 29 older people. At the time of the inspection there were 20 people living at the home including four people staying at Blair House for a period of respite care. There was a lift at the home and due to the layout of the home a chair lift was available to some of the upper floor rooms which could not be accessed by the lift.

This was an unannounced inspection which took place on 14 and 16 November 2016.

Blair House was inspected in September 2015. Two breaches of Regulation were identified in Regulation 15 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured all premises and equipment was properly maintained. The provider did not have systems in place to assess, monitor or improve the quality of service provided.

The provider sent us an action plan stating they would have addressed all of these concerns by October 2016. However, at this inspection we found although some improvements had been made in relation to the premises, new areas of concern were identified. This was a continued breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found that the provider had failed to make adequate improvements to ensure an effective system was in place to regularly assess and monitor the quality of service that people received. This was a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Some further breeches of regulation were also found during this inspection.

People’s level of care and support needs varied. Whilst some people could take care of themselves and were mobile, others used walking frames or required assistance from staff for all personal care and mobility needs. Those who remained predominantly independent required prompting and support at times to ensure they remained safe. Some people had mental health concerns, dementia or memory loss. A couple of people went out alone or with friends and family, whilst others required more assistance with all care needs and remained in bed or in the communal areas of the home as they chose.

Blair House had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was in day to day charge of the home.

Pre admission assessments did not identify people’s health needs. People with specific health and care needs did not have care plans and documentation in place to inform staff. People with dementia did not have any assessments to identify how this impacted on their daily lives or how their dementia presented in day to day life. People who used continence aids did not have this information included in their continence care plan. Care plans did not routinely include information regarding peoples mental health needs. People who were assessed as requiring pressure care equipment did not have daily checks in place to ensure pressure areas were assessed and monitored to identify concerns. People’s safety was not being fully assessed and maintained. One person who was unsafe to go out alone had the door opened by staff who were unaware they were not safe to leave unaccompanied and they went out.

Some health and safety checks had not been completed since the maintenance employee left in May 2016. This included water temperature, descaling, cleaning and flushing of water systems, fire alarm checks and some day to day maintenance around the home. Infection control measures had not been maintained. We found areas of the home that needed cleaning. There was no designated laund

Due to their dementia type illnesses not all of the people we spoke with were able to tell us about their experiences of living at the home.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Blair House is registered to provide permanent and respite care for up to 29 older people. There were 10 people living at the home at the time of the inspection. Including one person living at the home for a period of respite care. People required a range of help and support in relation to living with dementia, mobility and personal care needs.

Blair House is owned by Regal Care Trading Ltd. Regal Care Trading Ltd had been in administration since 2012 and was taken over by a new provider in April 2015.

The home is a four storey Georgian building. There was a passenger lift at the home, due to the layout of the building, which included some split levels; a chair lift was in place to rooms which could not be accessed by the passenger lift.

This was an unannounced inspection which took place on 8, 9 and 11 September 2015.

Blair House did not have a registered manager. However, the acting manager was in the process of applying to register as manager with CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 acting manager was in day to day charge of the home supported by the registered manager of a nearby sister home. People and staff spoke highly of the acting manager and told us that they felt supported by them and knew that there was always someone available to support them when needed.

The provider had not ensured the home had been properly maintained. The provider had not visited the service to review concerns identified in audits completed by the acting and supporting manager.

There were systems in place to assess the quality of the service. However, when quality and safety issues were identified for example the décor of the home and issues with flooring, the provider had not responded in a timely manner.

The lift was out of order during the inspection, staff and people living at Blair House told us that this had been an on-going issue over many months. There were areas of the building that were in need of repair. This included the flooring in the dining room which could present a trip hazard and areas of redecoration. Due to the fact the lift was currently out of order the dining room was not accessible although people were not currently at risk. The acting manager had implemented safety measures which included moving people to bedrooms accessible without using the lift to minimise the impact on people. People told us they were happy with the measures put in place.

Some areas of documentation needed to be improved this included identifying people’s choice and involvement in decisions, for example bathing and showering. We also found documentation for medicines needed to be improved.

The acting manager carried out a programme of supervision and appraisals for staff. However, the managers had not received any formal supervision or support from the provider.

Staff received training which they felt was effective and supported them in providing safe care for people. Robust recruitment checks were completed before staff began work.

Care plans and risk assessments had been completed to ensure people received appropriate care. Care plans identified all health care needs and had been reviewed regularly to ensure information was up to date and relevant.

Staff demonstrated a clear understanding on how to recognise and report abuse. Staff treated people with respect and dignity and involved people in decisions about how they spent their time.

People were encouraged to remain as independent as possible and supported to participate in daily activities.

People were asked for their consent before care was provided and had their privacy and dignity respected.

People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes.

Referrals were made appropriately to outside agencies when required. For example GP appointments, dental appointments and hospital visits.

Fire evacuation procedures needed to be improved to incorporate different staffing levels at night. Personal evacuation procedure information was in place in event of an emergency evacuation. This information had been updated to ensure that people who had moved rooms due to the lift breakdown remained safe in the event of an emergency evacuation.

Feedback was gained from people this included questionnaires and regular meetings with minutes available for people to access.

Notifications had been completed to inform CQC and other outside organisations when events occurred.

We found breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.