About the service: Bloomfield is a nursing home. It provides accommodation, nursing and personal care for up to 102 older people, some who are living with dementia. At the time of the inspection there were 79 people living at the service.

People’s experience of using this service: People were supported by staff who were kind, caring and passionate. Improvements had been made around the consistency of staff. Agency staff had reduced. Staff worked well as a team. There was a friendly and inviting atmosphere at the service and a positive staff culture. Staff knew people well and had good relationships with people.

Meaningful activities were provided for people on a group and individual basis. The service was developing its engagement with the local community and had made links with local organisations to extend social and recreational opportunities. Such as gardening and a lunch club.

The environment and facilities had been considered in order to support people’s independence, experience and social opportunities. The service was bright, clean, tidy and well maintained. There was safe access to pleasant outdoor space. Visitors were welcomed.

People, staff and relatives said the service was well-led and managed. The registered manager and senior staff team had ensured improvements at the service had continued and been sustained.

Care plans were person centred and included how people preferred their care and support to be delivered. People’s individual choices and wishes were encouraged and respected. People were treated with dignity.

People enjoyed the food provided by the service. Mealtimes were relaxed and sociable. Feedback was sought from people, relatives and staff through meetings. People felt comfortable in raising any concerns or issues.

For more details, please see the full report which is on CQC website at www.cqc.org.uk

Rating at last inspection: Requires Improvement (June 2018).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

We undertook an unannounced inspection of Bloomfield on 26 and 27 February 2018. At the last comprehensive inspection of the service in September 2017 five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations were identified and the service was rated as Inadequate and placed in special measures. Since 2013 the service had been inspected six times and had failed to meet the regulations on all occasions.

During this inspection we checked that the provider was meeting the legal requirements of the regulations they had breached. You can read the report from our last comprehensive inspections, by selecting the 'All reports' link for Bloomfield, on our website at www.cqc.org.uk

Bloomfield is a ‘care home’. 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. Bloomfield can provide care and support for up to 102 older people, some whom are living with dementia. At the time of our inspection there were 56 people living at the service.

The service provides accommodation in purpose built premises. The service is over two floors and has four separate areas. Ash Way and Salisbury Rise provide general nursing care and Beech Walk and Mendip View which provides care and support to people living with dementia.

There was a registered manager 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 service had set out an action plan in order to make improvements and meet the regulations that had been identified as being in breach at the past and previous inspections. The action plan had been regularly updated and improvements made. The provider had taken action and no breaches of regulations were identified at this inspection. People, staff and relatives told us about the improvements made at the service and the positive impact the registered manager had made.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Documentation and processes for people’s consent to care in line with the Mental Capacity Act 2005 had been reviewed. However, we did identify some people’s records which had not been fully completed. Audits monitored these areas and the provider’s action plan identified that this area was still being improved.

Improvements had been made in staffing levels. Staffing numbers were above the level deemed safe by the provider. We received positive feedback and conducted observations where we evidenced that people’s care and support needs were met in a timely manner. Occupancy levels at the service were currently low. The provider acknowledged that as numbers living at the service rose staffing would need to be carefully monitored and reviewed to ensure it continued to meet people’s needs. Recruitment of new staff followed the provider’s procedure and all relevant checks had been undertaken and monitored.

Systems to monitor and review the quality of care and support were effective. A range of audits were conducted to monitor different areas of the service, people’s care and experiences. For example, care records, medicines, dining experience, infection control and daily records were checked.

We undertook an inspection on 27 and 28 September 2017. The previous comprehensive inspection was undertaken on 21 March 2017. At this inspection the provider had breached three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations. These breaches related to: Person-centred Care and Good Governance. The service was rated as ‘Requires Improvement’. At this inspection we checked whether improvements had been made and the service was no longer in breach of the regulations.

You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Bloomfield, on our website at www.cqc.org.uk

Since July 2013 we have conducted a comprehensive inspection at the service six times. The provider has failed to fully meet all the regulations on all six occasions. Since the previous inspection in March 2017 there have also been repeated breaches of the same regulations. These relate to staffing and failing to submit statutory notifications. We have also identified additional concerns relating to recruitment checks, safeguarding adults, good governance and consent.

“The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Bloomfield provides accommodation for people who require nursing or personal care to a maximum of 102 people. The accommodation is set over two floors with four separate areas. These are 'Ash Way' and 'Salisbury Rise', which provides general nursing care and treatment to people, and 'Beech Walk' and 'Mendip View' which provides care and support to people living with dementia. At the time of our inspection 69 people were living at the service.

The registered manager had recently left 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. On the day of our inspection the interim manager was on leave. During their leave the service was being run by the deputy manager with support from the senior management team.

At our previous inspection we found the service was not sufficiently staffed to meet people’s needs. Since our inspection in inspection in March 2017 we found insufficient improvements had been made.

Recru

We undertook an unannounced inspection of Bloomfield on 21 March 2017. When the service was last inspected in August 2016 we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

As a result of the findings of the inspection in August 2016, we served two Warning Notices in relation to the management of medicines and governance. We returned to Bloomfield in November 2016 to ensure action had been taken in relation to the Warning Notice served around the management of medicines. The service had achieved compliance with that part of the regulation during that inspection.

In addition to the Warning Notices, we set requirement actions in relation to the other breaches of regulations. The provider wrote to us in September 2016 to tell us how they would achieve compliance with these requirements which we reviewed during this inspection. In addition to this, we also followed up compliance against the Warning Notice served in relation to governance.

Bloomfield provides accommodation for people who require nursing or personal care to a maximum of 102 people. The accommodation is set over two floors with four separate areas. These were ‘Ash Way’ and ‘Salisbury Rise’ which provided general nursing care and treatment to people. The ‘Beech Walk’ and ‘Mendip View’ accommodation provided care and support to people living with dementia. At the time of our inspection, 67 people were living at the service.

A registered manager was in post at the time of inspection. They had registered with the Commission in July 2016. 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.

Although we found some improvements during this inspection, the service was unable to demonstrate they had fully complied with the requirements of the Warning Notice in relation to governance. Although we found a reduction in recording errors and omissions by staff, we still found recording errors in relation to the planning of the care and treatment people required. We also found errors in the daily records that showed if people had received care in accordance with their assessed needs. This demonstrated that governance systems were not effective in identifying the recording errors.

We found evidence that people had not received care in line with their assessed needs and the provider had failed to consistently ensure enough staff were deployed to meet people’s needs. We received information from people and their relatives on how this had resulted in a negative impact on care delivery and we made observations to support this during the inspection. The service had not ensured that all legal notifications had been sent to the Care Quality Commission.

The current identified shortfalls are of particular concern as there are continued breaches of some regulations and the service is currently running at limited occupancy level. A further increase of people being accommodated may result in further negative outcomes for people receiving care and treatment at Bloomfield.

People at the service commented they felt safe. People received their medicines when they needed them and there was a system to review reported incidents and accidents. There were safe recruitment processes in operation and staff understood their obligations to safeguard people. People’s risks were assessed and the service was clean. Checks on the environment and equipment within it were completed.

The service had met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity t

We carried out a comprehensive inspection of Bloomfield on 16 August 2016. Following this inspection we served two Warning Notices for breaches under two separate regulations of the Health and Social Care Act 2008. In addition to this, we also found three further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulations 2009 was also identified. We have set requirement actions relating to these breaches.

We undertook a focused inspection on 1 November 2016 to check the provider was meeting the legal requirements for one of the regulations they had breached that resulted in them being served a Warning Notice. This focused inspection was to ensure the provider had taken sufficient action that ensured people were protected against the risks associated with medicines. This report only covers our findings in relation to this areas. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for ‘Bloomfield’ on our website at www.cqc.org.uk

Bloomfield provides accommodation for people who require nursing or personal care to a maximum of 102 people.

There was a registered manager 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.

During this focused inspection on 1 November 2016, we found that sufficient action to achieve compliance with the safe and proper management of medicines had been achieved. The management at the service had introduced daily governance systems since our last inspection. This ensured that records relating to medicines were checked a minimum of twice daily for any recording errors or omissions. At shift handovers, additional documentation had been introduced between nursing staff that confirmed stock levels had been checked. All of the people who required pain relieving transdermal patches and skin creams had been individually reviewed and new documentation detailing their needs had been produced for staff.

We undertook an unannounced inspection of Bloomfield on 16 August 2016. When the service was last inspected in March 2015 there was one breach of the legal requirements identified. We found that people were not fully protected against the risk of unsafe or inappropriate care and treatment as records were not accurately maintained. In addition to this we found that although the provider had governance systems, these were not consistently effective.

The provider wrote to us in May 2015 to tell us how they would meet the requirements of this regulation. During this inspection we found the provider had again failed to achieve full compliance with this regulation. In addition, we found an additional three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

Bloomfield provides accommodation for people who require nursing or personal care to a maximum of 102 people. At the time of our inspection 84 people were living at the service.

A registered manager was in post at the time of inspection. They had registered with the Commission in July 2016. 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 not ensured people’s medicines were managed safely. In addition to this, we found that where people had an incident or accident, insufficient action or management level reviews had been completed to minimise future risks to people. There were insufficient systems to ensure people were being lawfully deprived of their liberty. We found that Deprivation of Liberty Safeguard (DoLS) authorisations were out of date. DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. In addition to this, the provider was not always providing care in line with people’s consent and with mental capacity legislation.

The provider had not introduced robust systems since our last inspection to ensure that staff maintained accurate records of people’s care, placing people at risk of unsafe or inappropriate care and treatment. The service did not consistently deliver appropriate care that met people’s needs. There was no system that ensured people living in isolated areas of the building were regularly checked and some air mattresses were incorrectly set which may have had an adverse effect on people’s health and well-being. We found that pain management was not always effectively monitored. There were insufficient robust governance systems to ensure people’s clinical and non-clinical needs were met safely. The provider had failed to send a legal notification as required.

We received mixed feedback from people in relation to staffing levels at the service. Most staff commented that staffing numbers were sufficient, however they commented they did not feel the provider’s staffing tool was accurate. People we spoke with told us that generally there were enough staff but we did receive some negative feedback. The service was clean and checks of the environment and equipment were completed. Staff understood their obligations in relation to safeguarding adults and recruitment procedures were safe.

Staff were supported through training and the provider had an induction aligned to the Care Certificate. The service management were currently implementing regular supervision and appraisal. People were supported by staff that understood the principles of the Mental Capacity Act 2005 in relation to offering people choices. Where required, people were supported to eat and drink and the feedback we received about the food was positive. People could acce

The purpose of this inspection was to follow up two areas of non-compliance from our inspection in July 2013. This was because the provider had failed to maintain effective infection control procedures and practices. In addition to this the provider had not ensured that staff were appropriately supported by having regular supervision and appraisals to aid them in their role.

The provider sent us an action plan that detailed how they would achieve compliance with outcome 8 and 14 of the Essential Standards of Quality and Safety. During this inspection the actions the provider told us they were planning to take, had been implemented within the service.

Robust infection control procedures were in place and staff received supervision and appraisals on a regular basis.

We did not speak with people that lived in the home directly about the outcomes that we were inspecting. However we observed staff positively interacting with people that lived in the home and visiting relatives, throughout our inspection.

One member of staff we spoke with told us they were the home's infection control champion. This meant they had responsibility to ensure staff complied with the infection control procedures that were put in place. The member of staff told us they were clear about their role and enjoyed the extra responsibility. Another member of staff confirmed the recent improvements that were made were positive.

We visited to see how the home had improved provision for meeting people’s privacy and dignity needs. We also looked at the numbers of staff and how they were monitored and supported. We found there had been a focus on training staff, especially about understanding and working with people who have dementia.

We observed examples of patient and kind care. Staff gave people choices and explained what they were doing. We spoke with six people living in the home, and a visitor. They told us staff were very respectful. People were not rushed when receiving care. They were helped with choosing appropriate clothes and deciding where they wanted to go in the home. A person told us: “They understand as much as they need to about me as a person.”

Nursing and care staff told us they and their colleagues had received dementia training by way of e-learning. Most said they could see a difference in the quality of their work as a result.

We found there were enough staff to meet people’s needs. Recruitment of staff matched losses. Shortfalls in staffing were covered from a relief bank and by existing staff offering additional hours. All but one of the staff we spoke with said there were enough staff. People who lived in the home told us call bells were answered quickly. They said staff maintained checks on people’s wellbeing throughout the day.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector and joined by an Expert by Experience (People who have experience of using services and who can provide that perspective).

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.

We found that people who used the service were mostly treated in a way that showed staff respected their privacy and independence. But we observed some care practices where some staff were not always maintaining people’s dignity in the way they looked after them.

People who used the service felt satisfied with the meal options they were offered at the home. People who could not make choices were well supported to eat the food that they liked.

People felt able to talk to staff if they had any concerns about their care and welfare.

The relatives and/or friends of people who could not make their views known were able to talk to staff on their behalf if they had concerns about their safety and welfare.

People felt they were generally cared for by enough staff to meet their needs. However some people said staff sometimes seemed rushed and they seemed to be “very short staffed”.

We carried out this inspection over two days on 9 and 10 March 2015. The inspection was unannounced. During our last inspection on 17 April 2014 we identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The provider wrote to us with an action plan of improvements that would be made. During this inspection we found the provider had taken steps to make most of the necessary improvements.

Bloomfield is run by Barchester Healthcare Homes LTD who are a large organisation delivering care and support to older people across England, Scotland and Wales. Bloomfield provides accommodation which includes nursing and personal care for up to 102 people. They provide services to older people some of whom are living with dementia. It is spread over two floors and divided into five units. On the day of our inspection there were 73 people living there. One of the units had been closed for refurbishment.

At the time of our inspection the home did not have a registered manager. The management of the service was being overseen by an operations manager, regional support nurse and regional operations manager until a new registered manager could be recruited. Recruitment for a new manager was being undertaken. 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.

We found that records relating to the planning of people’s care still required improvement in some areas. People’s care plans did not always reflect what care, support or treatment they required for staff to be responsive to their needs.

Whilst the provider had a system to regularly assess and monitor the quality of service that people received but this was not consistently effective.

All of the people we spoke with said they felt safe living at Bloomfield. Staff we spoke with had the knowledge to identify safeguarding concerns and felt confident to act on them to protect people. Staff confirmed they had received training to support them to identify abuse and respond appropriately should it occur.

People’s nursing and health care needs were met. Staff treated people using the service with respect and in a dignified way. Staff spoke kindly to people and we heard staff regularly offering people reassurance and explaining what they were doing. We saw staff offering people choices in a variety of ways to ensure they could make meaningful choices. Staff were knowledgeable about people’s individual needs and preferences.

People and their relatives spoke positively about the care and support they received from members of staff. People were supported with their personal care in ways which promoted their privacy and dignity and encouraged independence.

Effective recruitment procedures where in place to ensure people were supported by staff with the appropriate experience and character. Staff we spoke with said that they felt supported and received regular supervision meetings with their line manager. These meetings were used to discuss progress in the work of staff members and identify areas of development and training.

We found the service to be clean and tidy. The staff could explain the procedures they would follow to minimise the spread of infection. Housekeeping staff followed a daily cleaning schedule to ensure that all areas of the home were cleaned.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.