This inspection took place on 17 and 20 August 2018 and was unannounced. We last inspected the service on 26 September 2017 when we carried out a focussed inspection to follow up on concerns in relation to medicines management which had resulted in a warning notice being issued to the provider. At that inspection we found improvements had been made, and the provider had followed their plan and met the legal requirements in that area.

Bloomfield Court 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 Court accommodates 47 people in one adapted building, across three floors.

There was a registered manager but they were not present during the inspection. 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.

Systems were in place to ensure concerns of a safeguarding nature were reported, recorded and acted upon. Staff were aware of the risks to people and how to manage those risks. Management were responding to concerns raised regarding staffing levels, the deployment of staff across and this had not been resolved at this time. Systems were in placed to ensure people were supported by staff who had been safely recruited.

Improvements had been made in respect of medicines management and staff had received training and their competencies checked in this area. People were protected from the spread of infection and where incidents and accidents took place, lessons were learnt and action was taken.

People were involved in the pre-assessment of their care which provided staff with the information they needed to meet people’s needs. Staff felt well trained but concerns had been identified by management in respect of staff induction and action was being taken to rectify this.

People were supported to receive a balanced diet and access healthcare services in order to meet their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were described as caring and compassionate and people had warm, positive relationships with many of the staff who supported them. People’s choices about how they spent their day were routinely respected and people were encouraged where possible, to retain a level of independence. People were treated with dignity and respect.

Care records reflected people’s personal preferences and they were supported by staff who were aware of what was important to them. Management acknowledged that activities available required development and plans were being made to improve this part of the service.

People were confident that if they raised complaints they would be acted on and listened to. Where complaints had been received they had been investigated and acted upon.

A lack of oversight of the service had resulted in a number of concerns being raised. The management team had responded to the concerns and a number of measures were in place to improve care delivery. Staff were on board with the vision for the service and work was underway to drive improvement.

Bloomfield Court provides care and support for up to 47 people who may live with dementia and conditions related to old age. At the time of our inspection 47 people lived at the home.

We carried out a focussed inspection on 27 June 2017 to follow up on concerns in relation to medicines management. We found that improvements had not been made and there was a continued breach in relation to Regulation12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 due to unsafe medicine management. We issued a warning notice and the provider wrote to us to say what they would do to meet the legal requirements.

We carried out an unannounced focussed inspection of this service on 26 September 2017.

We undertook this focused inspection to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bloomfield Court on our website at www.cqc.org.uk

The home had a registered manager who was not present at our inspection. 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 overall medicines were managed safely and people received their medicines as prescribed.

Bloomfield Court provides care and support for up to 47 people who may live with dementia and conditions related to old age. At the time of our inspection 44 people lived at the home.

We carried out an announced comprehensive inspection of this service on 21 November 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 due to unsafe medicine management.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bloomfield Court on our website at www.cqc.org.uk”

Our focused inspection took place on 27 June 2017 and was unannounced.

We found continued failures similar to our previous inspection findings and could therefore not be ensured that medicines were handled safely.

The home had a registered manager who was present at our inspection. 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.

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

This inspection took place on 21 and 22 November 2016 and was unannounced. Bloomfield Court provides accommodation for 47 people who require personal care. People who live there have a range of conditions related to old age including living with Dementia. At the time of our inspection 44 people were using the service.

At our last inspection in August 2015 the provider was not meeting regulations associated with the Health and Social Care Act 2008 which related to safe management of medicines. Evidence that we gathered during this inspection showed that improvements were still required.

There was a registered manager in post and she was present during our inspection. 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.

Medicine management needed to be improved to ensure people received their medicines as prescribed by their doctor. You can see what action we have asked the provider to take at the back of the report.

People told us they felt safe at the home, and staff had received training to ensure they knew how to recognise and report any concerns. We found risks to people were assessed and action was taken to minimise the risk of harm. People and relatives told us the staffing levels were satisfactory and we received mixed feedback from staff. We did not see that there was any impact on people due to the current staffing levels. Improvements had been made since our last visit to the cleanliness of the home, and systems were in place to monitor this.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Although staff sought people’s consent before providing support they were not fully aware of which people were subject to deprivation of liberty authorisations. Staff received training to enable them to have the skills and knowledge for their role. Some staff told us they would benefit from further training in relation to supporting people with behaviours that can be challenging and we saw action was being taken to provide this.

People were encouraged to be independent and their privacy and dignity was respected. People were supported to maintain good health; we saw that staff alerted health care professionals if they had any concerns about their health. Relatives knew how to make a complaint and were confident their complaint would be fully investigated and action taken if necessary. Systems were in place to involve people and their relatives in their care and their feedback was sought.

People and relatives described the registered manager as approachable and they said she was visible in the home. Systems were in place to support staff and to enable them to share their views about working in the home. Arrangements were in place to assess and monitor the quality of the service; however these were not always effective as they had not identified some of the shortfalls we found on our visit.

Our inspection was unannounced. On the day of our inspection 40 people lived at Bloomfield Court.

We had received some anonymous concerns which we referred to the local authority. The local authority has not yet given us feedback on their investigation into these.

During our inspection we spoke with seven people who lived there, four relatives, eight staff and the registered manager. All people and their relatives we spoke with told us that the overall service provided was good. One person said, “I could not find a better place”. A relative said, “It is wonderful here. I cannot say a bad word. They are very well looked after. It is so much better than the home they were in before”.

The summary is based on our observations during the inspection, discussions with people who used the service, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full 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?

The registered manager knew of Deprivation of Liberty Safeguard (DoLS) processes. DoLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury. This showed that the registered manager could follow processes if required to ensure that people were not unlawfully deprived of their liberty.

We found that where staff had identified concerns regarding risks associated with people’s health and welfare they had been referred to appropriate agencies.

We identified that the premises were safe and that equipment used was serviced regularly to ensure that it was safe.

Is the service effective?

All people, relatives and staff we spoke with told us that the people who lived there were safe and well cared for which gave assurance that an effective service was being provided.

People had their needs assessed and staff knew how to support people in a caring and sensitive manner. The care records showed how they wanted to be supported and people told us they could choose how this support was provided.

Staff received support from senior staff to ensure they carried out their role effectively.

People told us they could make choices about their food and drink. We saw people were provided with a choice of food and refreshments and given support to eat and drink where this was needed.

Arrangements were in place to request heath, social and medical support to help keep people well.

Staff received on-going support from senior staff to ensure they carried out their role effectively. All staff we spoke with told us that they felt supported.

Is the service caring?

We found that care and support was provided with kindness and compassion. People told us that they could make some choices about how they wanted to be supported.

One person told us, “The staff are wonderful. They are so kind”. An agency care worker told us, “Compared to other care homes I have worked in this one is very good. People are well cared for and look happy”.

The staff knew of people's care and support needs which ensured that individual personal care was provided in a way that people preferred.

One person said, “For family reasons I moved out of here. I was so depressed when I was away. They let me come back and I am so pleased and relieved. They welcomed me back. This is my home and I am so happy and content here”.

Is the service responsive?

We found that meetings were held to enable people and relatives to raise any issues they wanted to. This showed that the provider was willing to listen to the views of the people who lived there to improve the overall service provision.

When people became unwell the staff noticed this and secured appropriate medical input.

We found that staffing due to sickness and other factors was problematic. However, the registered manager ensured that staffing numbers were adequate by using agency and bank staff to cover. Recruitment of permanent new staff was on-going.

We found that the registered manager had taken note of our previous concerns and had learnt from past experiences. For example, care plans had improved. The registered manager had implemented a more robust pre- admission assessment process and did not accept people who they felt would challenge the service or be a risk to the people who lived there. This made the home a safer place for people to live in.

Is the service well led?

A registered manager was in post which meant that consistency and familiarity was provided.

The staff were confident they could raise any concern about poor practice at the home and it would be addressed to ensure people were protected from harm.

Staffing was generally organised to ensure people’s needs were met and support was available for activities.

Overall, we found that training was available for staff and most of the required training had been received.

We identified that staff followed instructions and their attitude was positive. This had a positive impact on the running of, and the atmosphere of, the home.

No-one knew we would be visiting that day as our inspection was unannounced. Our inspection team included two compliance inspectors and an expert by experience.

At the time of our inspection 33 people lived at the home. The majority of people had a diagnosis of dementia. The home environment comprised of three floors where people lived and were cared for.

During our inspection we spoke with eight people who lived there, six relatives, ten staff, the newly registered manager and the area manager. As with our previous inspections of August and December 2013 the people who lived there and their relatives made positive comments about the care the service provided. One person said, “It’s good here. The staff are nice to me they really do take care of me”. Another person commented, “The staff are lovely they look after me. They give me nice food and are kind to me”. A third person said, “I am content here”. A family member said, “They are well looked after. I have not got any concerns”. Another relative said, “Overall, I think that things have improved here in the last few months”.

During our inspections of August and December 2013 we found non- compliance with four of the essential standards for quality and safety, care and welfare of people who use services, safeguarding people who use services from abuse, staffing and assessing and monitoring the quality of service provision. In December 2013 our concern was significant regarding the care and welfare of the people that lived there. At that time we issued a warning notice. We carried out this inspection to find out if improvements had been made. We found that overall improvements had been made, but further improvements were needed regarding care and welfare and staffing levels.

We found that people's needs had been assessed by a range of health care professionals including dieticians and specialist doctors. We identified that there had been significant improvement concerning dementia care and support. However, although we found that risk assessments, care planning and care actions had improved we found that further improvement was needed to ensure that people’s needs were fully met.

We identified that systems were in place to report abuse. We also found that care and supervision that had been provided since our previous inspection had improved. This had prevented a continuation of the high number of incidents of physical aggression and physical attacks between the people who lived there.

We found that action had been taken to improve staffing levels. On two of the three floors we determined that staffing levels were adequate, however we found that a further review was needed regarding staffing levels on the top floor.

Since our previous inspection we found that the registered provider placed additional managerial support into the home to engender improvement and the manager has recently been formally registered with us. Our observations and the evidence that we gathered gave better assurance that the home was being operated in the best interests of the people who used it.

No-one knew we would be visiting that day as our inspection was unannounced. Our inspection team included two compliance inspectors, a specialist advisor in dementia care and an expert by experience.

At the time of our inspection 40 people lived at the home. The majority of people had a diagnosis of dementia. The home environment comprised of three floors where people lived and were cared for.

During our inspection we spoke with ten people who lived there, five relatives, eight staff and the manager. As with our previous inspection in August 2013 the people who lived there and their relatives made positive comments about some aspects of their care and the service provided. One person said, “I have a nice home here, there is nothing else I need”. Another person commented, “It is real nice in here, very comfortable”. A third person told us, “It is a nice place to live”. A family member said, “It is really nice here. My relative has been in other homes before for a short stay. This one is much better”.

During our inspections of August 2013 we found non- compliance with four of the essential standards for quality and safety: care and welfare of people who use services, safeguarding people who use services from abuse, staffing and assessing and monitoring the quality of service provision.

The non-compliance that we identified had an impact on the care, welfare and safety of the people who lived there. Since that inspection the registered provider agreed with the local authority to voluntarily cease any new admissions to the home. An additional night staff member was also provided. We carried out this repeat inspection to find out if improvements had been made.

We found that some people's needs had been assessed by a range of health care professionals including dieticians and specialist doctors. However, as with our previous inspection we found that risk assessments, care planning and care actions did not always ensure that people’s needs were met or that they were safe. We also found that care relating to people’s dementia support needs was inadequate.

We identified that systems were in place to report abuse. However, the care and supervision that had been provided had not prevented incidents of physical aggression and physical attacks between the people who lived at the home. Some of those incidents had resulted in injury.

We found that some action had been taken to improve staffing levels. We were told by the manager that some new staff had been appointed and were due to start work soon which it was hoped would improve the situation further. However, people we spoke with told us that current staffing levels did not meet their needs. One person said, “The staff are so busy they do not have time to talk to us old folk”.

Overall we found that the management of the home was inadequate. Our observations and the evidence that we gathered did not give assurance that the service was being operated in the best interests of the people who used it, or that they would be well cared for and would be safe.

There were 42 people living at the home on the day of our inspection. No one knew we would be inspecting that day. Some people were unable to verbally share with us their views about their care, we used different ways to evidence their experiences such as observing care, speaking with relatives and looking at their care records.

During our inspection we spoke with 11 people who lived at the home, three relatives, nine staff, and two visiting health professionals. The majority of people we spoke with were complimentary about the home in general. One person said, “I like it here”. Another person said, “The staff are all lovely”. One relative said, “They are well cared for. I never worry about them”. Another relative said, “The staff look after them well”. However, all staff, people and visitors we spoke with told us that there were not enough staff provided.

We found that people were treated politely and that their privacy and dignity was maintained.

We saw that people's needs had been assessed by a range of health professionals including dieticians and specialist nurses. However, we identified that some instructions given by health professionals were not always followed. We found that risk assessments, care planning and care actions did not always ensure that people’s needs were met or that they were safe. We found that care relating to dementia needs was inadequate. Our observations showed that the care provided was ‘task’ orientated rather than being person centred.

We saw that systems were in place to report and deal with abuse. However, further assessment and action regarding the high number of incidents of aggression between the people living at the home would make people less at risk of harm.

All people we spoke with were very complimentary about the staff. However, we found that staffing levels were not always adequate which meant that staff did not have the time to fully meet people’s needs or keep them safe.

We saw that the registered provider had some processes in place to monitor the service being provided. However, we found that improvements were needed to make sure that the service was being operated in the best interests of the people who use it.

There were 44 people living there on the day of our inspection. We spoke with eleven people, eight staff, the manager and a health care professional.

Due to health conditions or complex needs not all people were able to verbally share with us their views about the care they received. We looked at other areas for evidence to support their experience including observation. The eleven people we spoke with told us positive things. One person told us "I am very happy here". Another person said "It is very good here. It cheers me up no end".

We saw that people expressed their views and were involved in making decisions about their daily routines. One person told us "They do ask me how I want things to be done".

We found that people's needs had been assessed by a range of health professionals including physiotherapists, doctors and the optician. This meant that people's health care needs had been monitored and met.

Staff gave a good account of what they would do if they suspected or witnessed abuse. Staff told us that they felt that people living there were safe and people told us they felt safe.

We found that recruitment checking processes had been robust which meant that unsuitable staff were less likely to be appointed so people had been at less risk of harm. Staff told us that they liked working at the home and were supported in their work.

We saw that processes had been in place to monitor the overall quality of the service provided.

We carried out this review to check on the care and welfare of people using this service.

We visited the home as part of this review, and looked at information we have received about this provider since our last visit in September 2011.

We checked the systems for planning care, documentation and paperwork produced by the organisation. Although we identified improvements, there are still gaps in some of the records. This means that people may be at risk of not getting the care they need when they need it.

We spoke with a range of people whilst at the home. These included visitors, managers, staff and people who live at the home. Staff told us that there had been improvements in the staffing levels since the last visit. People who lived at the home gave us examples of how the staff supported them when they needed it. People appeared happy and when they were not, we saw staff support them in a sensitive way.

We saw that people were called by their preferred name. We saw that people were encouraged to be involved in activities.

Staff told us that although the staffing levels had improved, on occasions they could do with more staff. The manager assured us that further increases would be made from 23 December 2011.

Visitors and people who live at the home told us they were happy with the care and support provided by the staff.

The people living in the home and their representatives who we spoke with generally expressed satisfaction with the service offered by the home and the support people received. We could not hold conversations with a lot of the people living at the home so we observed the care being provided on all floors throughout the visit. There were occasions when large communal areas such as the lounges were left unattended during our visit. This was because the staff were needed elsewhere on the floor or within the home.

Relatives told us that they felt the staff would contact them if they had concerns about their relative's welfare. We observed that appropriate referrals were being made to access other health professionals when needed including GPs, district nurses, opticians and chiropodist.

We observed that people had good relationships with the staff and responded positively when they were supporting people.

Relatives and staff all commented that they felt there should be more staff on duty especially for social activities and getting people out into the community.

The manager was registered with us as is required by law. A registered manager is a person who is 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 medicine management systems needed some improvement so that people would consistently receive their medicine safely and as it had been prescribed by their doctor.

Staff had received training about safeguarding the people in their care. People had not suffered any abuse or bad treatment. People and relatives had no concern about their family member’s day to day safety.

There was not always enough staff to meet peoples needs and to keep them safe. A number of staff had left and that had caused a shortage. New staff had started work and agency staff were being employed but they did not always have the experience or full knowledge to meet some people’s needs.

Falls management monitoring processes needed further exploration as there continued to be a high number of falls.

Although most people and their relatives told us that the service was effective in meeting identified needs, we found that people’s complex behaviour needs and weight loss were not always dealt with effectively.

Staff had understanding and knowledge regarding the Mental Capacity Act and the Deprivation of Liberty Safeguarding (DoLS). This ensured that people who used the service were not unlawfully restricted.

Processes were in place to induct new staff to ensure that they had some knowledge when they first started work. Staff received one to one supervision sessions and had the opportunity to attend staff meetings which provided support and development.

People who used the service described the staff as being nice and kind. Relatives felt that the staff were polite and showed their family member respect.

A complaints procedure was available for people to use. However, complaint documentation did not give full assurance that they had been followed through to an outcome.

Activity provision was not tailored to meet the individual needs of people who lived there.

We found that cleanliness regarding carpets, some bedrooms, and the kitchenette area on the ground floor was not adequate. We found that some arm chairs were in a poor state of repair.

There was a consistent management team that people and relatives could access if they had the need. The registered manager and provider had established systems to ensure a quality service. The systems, however, did not always ensure that people would be safe or that their needs could be met.

You can see what action we asked the provider to take at the back of the report.