This inspection took place on 4 and 5 October 2018 and was unannounced. The previous inspection of Blossom Fields was in May 2016. At that time there were no breaches of the legal requirements and the service was overall as Outstanding. At this inspection, we found the service remained outstanding.

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. Blossom Fields is a care home with nursing for up to 43 predominately older people. People have either general nursing care needs or are living with dementia. The service has three units over three floors with a 16-bedded dementia care unit being on the middle floor. The building is a purpose-built care home designed around the needs of the older person and those people with dementia or cognitive impairment. There was one passenger lift and three secured staircases which meant all parts of the service were accessible for people with impaired mobility. At the time of this inspection there were 43 people in residence.

Level access into the service was from the car parking area. The front of the property looked out on to the main Winterbourne road. To the rear of the property there was a secure courtyard area, where people could sit out in the warmer weather. To the side of the property the provider had developed a Memory Lane. This was a mock 1950’s street created within the grounds of the service, providing a unique place where people who lived in the service could spend time with the aim of sparking memories of their younger days. The lane included a greengrocer, a Post Office, a pub, a telephone box and a bus stop with a seat where people could relax. The provider had made some changes to Memory Lane to update the features and introduce additional memorabilia (for example a record shop).

Why the service is rated Outstanding:

At the last inspection we found the service provided an outstanding model of care and support to people with nursing care needs, but in particular, to people living with dementia. The provider has continued to build on this, has made further improvements and sustained the ability to provide an outstanding service.

The provider was forward thinking and innovative in their approach to providing the best possible care. The dignity pledge and the dementia pledge were both at the heart of everything they did. The service and staff have continued to demonstrate their commitment to care for people with dignity and to enhance the lives of people living with dementia. The provider and staff team kept up to date with current practice and linked with care provider forums and support groups. They ensured people had access to the local community and their facilities and the community was invited to enter the home and participate in social activities. The service continued to have a good reputation within the local community and also with health and social care professionals.

There has been a change in the registered manager since the last 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.

People were kept safe. Staff received safeguarding adults training and ensured people were protected from harm and abuse. They knew what to do if concerns were raised and who to report any concerns to. Any risks to people’s health and welfare were well managed. Staff were trained in how to move people one place to another safely, using the appropriate equipment. The premises were well maintained. The management of medicines was in line with good and safe practice.

Pre-employment c

This inspection took place on 24 and 25 May 2016 and was unannounced. The previous inspection of Blossom Fields was in January 2014. At that time there were no breaches of the legal requirements.

Blossom Fields is a care home with nursing for up to 43 predominately older people. People have either general nursing care needs or are living with dementia. The home has three units over three floors with a 16 bedded dementia care unit being on the middle floor. The building is a purpose built care home designed around the needs of the older person and in particular those people with dementia or cognitive impairment. There was one passenger lift and three secured staircases which meant all parts of the home were accessible for people with impaired mobility.

Level access into the home was from the car parking area. The front of the property looked out on to the main Winterbourne road. To the rear of the property there was a secure courtyard area, where people could sit out in the warmer weather. To the side of the property the provider had developed a Memory Lane. This was a mock 1950’s street created within the grounds of the home, providing a unique place where people who lived in the home could spend time with the aim of sparking memories of their younger days. The lane included a greengrocers, a Post Office, a pub, a telephone box and a bus stop with a seat where people could relax. The Memory Lane had featured on local and national News and most recently on Songs of Praise because of the services innovative approach to the care of people living with dementia.

The provider was forward thinking and innovative in their approach to providing the best possible care and had signed up for the dignity pledge and the dementia pledge. The service and staff demonstrated their commitment to care for people with dignity, to further improve and to follow best practice for the care of people living with dementia. They ensured they kept up to date with current practice and linked with care provider forums and support groups. They ensured people had access to the local community and their facilities and the community was invited to enter the home and participate in social activities. The service had a good reputation within the local community and also with health and social care professionals.

The manager was newly registered with CQC but had been at the home as manager since September 2015. 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.

People were kept safe. Any risks to people’s health and welfare were well managed. The premises were well maintained and staff were trained in how to move people requiring assistance from one place to another safely. Staff received safeguarding adults training and were knowledgeable about safeguarding issues. They knew what to do if concerns were raised and who to report the concerns to. Pre-employment checks were robust and ensured that unsuitable workers could not be employed to work in the service. The management of medicines was in line with good and safe practice.

Staffing levels for each shift were calculated to ensure each person’s care and support needs could be met. The numbers were adjusted as and when people’s needs changed. All staff were provided with the training they needed to carry out their roles and responsibilities effectively. The provider placed great emphasis on giving those staff who had proved themselves, extra responsibility. These staff members had taken lead roles in key areas. New staff to the service were well supported and had an induction training programme to complete. They were supported by a buddy and a mentor until they had settled in to their role.

When we visited we were able to speak with six people who lived in the home, four visitors/family members, qualified nurses, care staff ancillary staff and the home manager. People told us “I get the help I need”, “We are very well fed and they make sure we eat our meals” and “Everyone is so kind and I am well looked after”. One visitor said “I am very satisfied with the way my relative is looked after”.

People received the care and support they needed because assessment and care planning arrangements took account of each person's needs, choices and preferences. There were good processes in place for the management of medicines.

Staff completed safeguarding training and had good awareness of safeguarding issues and reporting procedures. The manager had an action plan in place to ensure that any concerns were reported in a timely manner.

People were cared for in a clean, hygienic environment. There were high standards of cleanliness in all areas of the home. The facilities at Blossom Fields were designed around the needs of the older person and in particular those people with dementia or cognitive impairment.

People who used the service, their representatives and staff were asked for their views about the care and support and they were acted upon. Any complaints made about the service were handled appropriately.

Ms Nichols no longer works at the home but her name has not yet been removed from the register. Ms Burch is the registered manager.

Prior to our visit we received information from an anonymous person who raised concerns that dated back between June-October 2012. We investigated these concerns as part of this inspection because they linked with outcomes we were inspecting. Some concerns were too old to investigate and no longer relevant. We can confirm concerns raised were not upheld and Blossom Fields was complaint in all outcomes for the purpose of this inspection.

The area manager and manager were available throughout the day and were knowledgeable about people in their care, policies, procedures and systems in place to ensure the continued smooth running of the home.

Some people had a diagnosis of dementia which meant that they were sometimes confused about the questions we asked them. We spent time in communal areas and individual bedrooms so that we could observe the direct care, attention and support that people received. There was constant interaction between staff and people in the home. Everyone was relaxed, happy and comfortable in each other's company.

People who had capacity shared with us their experiences and we spoke with four people at length. Everyone expressed positive comments. People told us, "I couldn't wish for a better place, I am very happy the staff are wonderful", "Staff are very kind and I have never had any problems" and “I am fairly independent and don’t require much help, I am always very impressed when I watch staff care for people with patience and kindness".

We spent time with people that lived in the home. The atmosphere was calm, happy and

relaxed. People told us that they were very happy living there and that they were looked

after by 'lovely staff'. We saw staff talking to people in a sensitive way and supporting

people with their needs.