Blenheim House Specialist Care Centre is a care home and can accommodate up to 85 people across four separate units, each with separate shared space. One of the units specialises in providing care to people living with dementia. 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.

This inspection took place on the 11 and 12 September 2018 and was unannounced on the 11 September 2018.

A registered manager was not in post. 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 current manager will be applying to register as manager with CQC.

There were a range of quality audits undertaken and the manager told us there was an action plan on driving improvements. We found that audits were not in place for all areas of service delivery. For example, care planning. A comprehensive action plan was not in place from outcomes of all the audits. While patterns of accidents were analysed, action plans were not in place to prevent the same type of accident from reoccurring. This meant the monitoring of service delivery was made more difficult because action plans were not in place for all shortfalls identified or on how they were to be met.

There was an online care planning system which relatives and staff told us they preferred from the old paper system. Relatives said the previous system took time from their relative for report writing. However, there were inconsistencies within the system. This meant information about an area of need was not consistently recorded in the same section of the online care plan. The manager told us some icons were unlinked to reduce the sections where information could be repeated.

Care plans were not always person centred or reviewed monthly when people’s needs changed. Where there was input from health care professional their guidance was not used to develop care plans. For people that at times became anxious and frustrated care plans were not in place on how situations were to be managed by staff.

Risk management systems were used to assess people’s individual level of risk. Action plans were devised were risks were identified. While risk assessments gave staff guidance on how to minimise the risk, for some people the information was not up to date. Monitoring charts were used to ensure the risk level was minimised. For example, repositioning, food and fluid intake. However, monitoring checks were not consistently completed. This meant staff could not be certain the level of risk was minimised and if people’s health was deteriorating.

The training matrix showed that staff had completed multiple courses on the same day which may not be effective to embed good practice. Staff gave positive feedback about the training offered.. One to one meetings known as mentorship meetings took place with a line manager to discuss shortfalls in training. For example, moving and handling.

The home was clean well decorated and free from unpleasant smells. We saw housekeeping staff on duty within the home. While there were some areas of the environment that were adapted for people living with dementia, signage was needed to improve people’s orientation. For example names on doors and signs for toilets. For some people personal items were not included in the memory boxes on their bedroom doors. Without names on doors and memory boxes people living with dementia were not helped to find their bedrooms independently.

Medicine systems were managed safely. There was an electronic system for medicine administration and audits of medicine systems showed outcomes

Blenheim House provides personal and nursing care for up to 53 people.

At the time of our inspection, 47 people were living at Blenheim House. The home was last inspected in June 2015 and was found to be requiring improvement in the effective and responsive domains. Subsequently the provider submitted an action plan to address these shortfalls and during this inspection we check to see that these improvements had been made and sustained.

This inspection took place on 22 June 2016 and was unannounced. We returned on 23 June 2016 to complete the inspection.

At the time of the inspection, a registered manager was not in post, however following the inspection we were notified by the nominated individual that a successive candidate had been offered and accepted the post. The new manager had since started the process with CQC to become the registered manager. 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 provider had made the necessary improvements since the inspection in June 2015 in ensuring that the Mental Capacity Act 2004 was being adhered to and all staff had a good grasp of verbal and written English.

People who use the service and their relatives were positive about the care they received and praised the staff and management. People told us they felt safe living in Blenheim House and were involved in planning and reviewing their care.

Systems were in place to protect people from abuse and harm and staff knew how to use them.

People received their medicines on time. A new electronic medicine recording system was in place. At this time, not all of the required information was on the system and the provider continued to monitor and make improvements to the system. A pharmacy audit had identified improvements around medicines management and the provider was working to address this.

During our inspection we found there were times when staff were not visible or available to people.

Staff understood the needs of the people they were providing care for. People's needs were set out in care plans they had been involved in developing. Staff followed these plans, which helped to ensure people received care in the way they preferred.

Staff were appropriately trained and had the right skills to provide the care people needed. Staff had a good understanding of their role and responsibilities. Staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The service was responsive to people's needs and wishes. People's views about their care and support was listened to and acted upon. There was an effective complaints procedure in place.

The provider regularly assessed and monitored the quality of care provided at Blenheim House.

We considered our inspection findings to answer 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 inspection was carried out to assess what the provider had done in response to the action we had told them to take following our last inspection. This was in relation to the safe management of medicines.

This is a summary of what we found-

Is the service safe?

We found the service was safe because people were protected against the risks associated with medicines. We found that there have been improvements made to the way medicines were handled and managed in the service since our previous inspection.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One staff member said “I try and explain and offer choices, people can change their mind”. One relative said “they follow wishes”.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One relative said “the care is very good”. Another relative said “they are very patient and spend lots of time”.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Staff received appropriate support to enable them to provide care and support to people living at the home. One staff member said “all staff attend training”.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

During our visit we found a home that had a lively and kind caring atmosphere, where staff engaged respectfully with people who used the service. We saw evidence that the dignity of people who used the service was being maintained. People who used the service and their relatives were able to contribute to personalised care plans.

The home had several measures in place to ensure that a hygienic environment was maintained and infections prevented where possible.

Attention was paid by staff to ensure that meals were prepared that met the nutritional needs of people who used the service. Where people had difficulties eating assistance was given and people were encouraged to eat to maintain their health and wellbeing.

Staff in the home had completed safeguarding adults training and know how to identify abuse and make an appropriated alert. People who live in the home said that they felt safe and knew who to complain to if they were concerned about bad practice.

There are sufficient numbers of suitably qualified staff in the home, who demonstrated through their practice that they understood the needs of people using the service and how to meet them.

A quality assurance system was in place within the home. Clinical audits and a range of safety checks were carried out. A recent quality survey of all stakeholders confirmed a high level of satisfaction with the home.

In October 2011, we carried out a planned review of Sampford care home. At this inspection we found there were outcomes which did not meet meet compliance and asked the provider to make improvements.

We visited the home on 16 February 2012 to see what improvements had been made.

People made very positive comments about the staff saying they were polite and respectful. People commented they were very happy with the personal care and support given and felt staff had more time to spend with them.

There was now a range of activities and outings which people said they were encouraged to join in with. People who preferred to stay in their rooms said they were more involved in activities and had daily social interaction.

Families said they felt involved in the care planning process. They were also confident that if they had a complaint it would be dealt with promptly.

People told us they thought the home smelt nice and was very clean throughout. One visitor remarked that although they thought the home had been mostly clean before, a ‘spring clean had made such a big difference’.

We spoke to six people who lived at the home, although some had limited capacity to provide meaningful feedback about the service. We spoke to four relatives who were mainly positive in their comments about the staff, telling us: “They work very hard”, “Everybody (the staff) is really nice, although sometimes there are not enough of them. Sometimes they are so rushed and they do not take the care they should.” Some people did not feel involved in their care planning and relatives were not sure what the plan of care was. Several people expressed concerns about the standard of cleanliness in the home, saying “ It could be cleaner” and “ the vacuum cleaning is a bit hit and miss”. Three people made comments about the lack of things to do in the daytime. Others said that they did not know all of the people living in the home. We were told by a member of staff that the provider of the home carries out a yearly survey asking residents and relatives for their opinion about the service.

This inspection took place on 29 and 30 June 2015 and was unannounced. At the time of the inspection the service did not have a registered manager. However, the new manager in post had applied to the Care Quality Commission to become the registered manager. 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 and associated Regulations about how the service is run. Blenheim House Specialist Care Centre is a residential care home which provides nursing and personal care for up to 53 adults, some of whom are living with dementia. At the time of our visit there were 50 people living in the home.

Blenheim House is a purpose built care centre located in Melksham on the edge of the Wiltshire countryside. The accommodation is set over three floors, residential, the Clover Meadow floor offering dementia care and the nursing floor. Each bedroom has en-suite facilities. There is a bar, café and cinema and lounges. There are two lifts to access the first and second floors. The gardens are landscaped with a pond and several seating and sensory areas.

Assessments of capacity and best interest decisions were not always recorded when people lacked capacity to decide on their care or treatment. The care records demonstrated that people’s care needs had been assessed and considered their emotional, health and social care needs. However, there was a lack of recording and communication to evidence that people received safe care and treatment.

There were systems in place to ensure that staff received appropriate support, guidance and training through supervision and an annual appraisal. Staff received training which was considered mandatory by the provider and in addition, more specific training based upon people’s needs. There was a focus on staff developing skills and knowledge; however we found that not all staff had the necessary level of language skills to be able to effectively communicate with people.

Not all care plans had been adequately developed to meet people's needs. On the nursing unit, the quality of recording was inconsistent or had not been completed.

People and their families praised the staff at Blenheim House for their kindness and the care they gave. We could see that people had developed caring relationships with staff and were treated with dignity and respect. People told us they enjoyed the surroundings of the home.

Staff had received training in how to recognise and report abuse. People told us they felt safe living in Blenheim House. There was an open and transparent culture in the home and all staff were clear about how to report any concerns they had. Staff were confident that the manager would respond appropriately. People we spoke with knew how to make a complaint if they were not satisfied with the service they received.

People took part in a range of one to one or group activities and the home were continuing to develop this part of the service.

The manager and provider carried out audits on the quality of the care delivered, the safety of the environment and all aspects of health and safety.

We found 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 this report.