About the service:

Bluebell Residential home provides residential care for up to 40 people, at the time of the inspection there were 39 people living at Bluebell.

People’s experience of using this service:

People and their relatives told us they were happy with the care provided. All staff demonstrated a commitment to providing person-centred care. People had developed positive relationships with staff who had a good understanding of their individual needs.

People were supported to maintain their independence and positive risk taking was encouraged. Systems were in place to support and monitor people’s safety.

People were protected from possible harm. Staff had a good understanding of how to safeguard people and were confident to raise any concerns they identified. Medicines were managed and administered safely. Records confirmed people had received their medicines as prescribed.

People's assessments were detailed and reviewed consistently. Staff applied learning effectively in line with best practice, which led to good outcomes for people and supported a good quality of life.

Minor recording issues were identified throughout the inspection these were addressed immediately and had no impact to people.

Staff completed regular training to support them to fulfil their role. Staff felt supported and received regular supervisions, team meetings and competency checks.

Staff were friendly and polite. Staff took time to get to know people. We observed staff consistently sat chatting with people about their lives, hobbies and interests.

Care plans were person centred and were reviewed on a regular basis. People and their relatives told us they were confident if they had any complaints the registered manager would address them appropriately.

People knew the registered manager and told us they trusted them. Staff told us the registered manager was supportive and approachable.

Rating at last inspection: Good (report published 05 May 2016)

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

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We carried out an announced comprehensive inspection of this service on 5 May 2016. At this inspection we identified a breach of regulation. This was because medication had not been recorded safely. We issued a requirement notice to the registered provider in respect of Regulation 12: Safe care and treatment, with regard to medicine management, as the breach was assessed as having a low impact on people using the service.

We carried out a focused inspection on 20 January 2017 to check whether the registered provider had achieved compliance with the shortfall we identified. This report only covers our findings in relation to the requirement for medicine management. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Bluebell Residential Home Limited on our website at www.cqc.org.uk.

Bluebell Residential Home Limited is registered as a care home without nursing. It offers accommodation and support for 40 older people who may have a physical or sensory impairment or who may be living with dementia. The service is located in Hessle on the outskirts of Hull within the East Riding of Yorkshire. There is car parking on-site and disabled access into the building.

The registered provider is required to have a registered manager in post and on the day of the inspection the manager who was employed at the home was registered with the Care Quality Commission (CQC). 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 our focused inspection we found the staff had completed medicine management training in the last year, to ensure they had the skills and knowledge to safely manage and administer medicines to people using the service. Improvements were seen to the recording of medicines on the medication administration sheets.

The service used a risk based approach to people self-administering their medicines. Those people who had capacity and were able to do this safely were supported by the staff to achieve this goal. The risk assessments gave staff clear and precise information on how to reduce the risk of harm to people and there were detailed care plans for medicine management that reflected and recorded each person’s ability and support needs.

We saw these changes resulted in the registered provider meeting the breach of Regulation12 in respect of medicine management.

Bluebell Residential Home Limited is registered to provide care and accommodation for up to a maximum of 40 people. The service supports older people, people living with dementia and people who have a physical disability or a sensory impairment. The service is located in Hessle, on the outskirts of the city of Kingston-upon-Hull. There is parking on-site for visitors and staff and access to the premises is suitable for people in wheelchairs.

This inspection was unannounced and took place on 5 May 2016.

The last inspection took place on 20 January 2015. At that inspection we identified breaches to Regulation 17: Good Governance and Regulation 18: Staffing. After the comprehensive inspection on 20 January 2015 the registered provider wrote to us to say what they would do to meet the legal requirement in relation to the breaches of regulation. During this inspection we found that these actions had now been completed.

The registered provider is required to have a registered manager in post and there was a manager who had registered with Commission and who had been in post since May 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.

The recording and administration of medicines was not being managed appropriately in the service. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3).

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

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and staff had been employed following robust recruitment and selection processes. We found the service to be clean and hygienic, although some aspects of practice could be improved.

Improvements were made to the number of staff employed in the service. Recruitment was on-going to ensure enough staff were employed to meet the needs of people who used the service. Staff did not appear rushed on the day of our inspection and there was a good atmosphere in the service.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health professionals based in the community. People had risk assessments in their care files to help minimise risks whilst still supporting people to make choices and decisions.

Improvements had been made to staff training. People that used the service were cared for and supported by qualified and competent staff that were regularly supervised and received appraisal regarding their personal performance. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected.

People’s nutritional needs had been assessed and they told us they were satisfied with the meals provided by the home.

People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

Improvements had been made to the quality assurance system including the safety of the service, the risks relating to the health, safety and welfare of people who used the service and the way feedback from people who used the service and staff was obtained. The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We received positive feedback from people who used the service,

This inspection took place on 20 January 2015 and was unannounced. At our last inspection in April 2013 we assessed five regulations and there was one concern identified. This was in relation to regulation 9: care and welfare of people who use the service. When we visited again in December 2013 we found that the provider was compliant with regulation 9 and with three additional regulations that we looked at.

Bluebell House Residential Home provides care and accommodation to a maximum of 40 older people who may be living with dementia. Nursing care is not provided. There is a 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. At Bluebell Residential Home the registered manager is also the registered provider.

We spoke with people that used the service about feeling safe while living at Bluebell House. They said, “I feel safe here but I like to leave my door open and sometimes people wander in during the night which is a worry” and “I enjoy it here, it's been lovely, I feel safe.” One relative told us, “I know that my mum is safe and secure.”

We found that people that used the service were safe form the risks of abuse or harm because there were systems in place known by the staff to refer allegations of or actual abuse situations to the appropriate safeguarding authorities. Staff had been trained in managing such situations, but some of them needed refresher training.

We found there were some minor safety concerns regarding the premises that had a minor impact on people that used the service. These were unstable wardrobes and missing window closers in some people’s bedrooms. There was a moderate impact on staff. This related to safety in the laundry. Generally the premises were not dementia friendly for people with dementia that used the service.

We found there were insufficient staff on duty to meet all of the needs of people at busy times of the day and that the service was not meeting the overall required staffing hours determined by an acknowledged dependency level tool, as used by East Riding of Yorkshire Council Contract Monitoring Team. Staff had not received training in caring for people living with dementia.

We found there were concerns regarding the recruitment of staff, which we judged had a minor impact on people that used the service. We were told by East Riding of Yorkshire Council in November 2014 that they had found recruitment procedures to be lacking in the areas of written records of interviews, full employment histories and evidence that written references had been obtained. We found there had been improvements in these areas with the exception that references had not always been taken and there was no evidence of staff identification checks (though Disclosure and Barring Service checks could not have been obtained without them). We assessed that the service could have improved in this area.

There were some minor concerns regarding the management of medication and with infection control practices, which the provider needed to address to ensure people were not put at risk of harm form receiving the wrong medication or acquiring a health transmitted infection.

We found that the provider had effective systems in place to ensure staff were knowledgeable in their roles and were appropriately supervised. People were assessed according to their mental capacity where necessary and so had their rights upheld. People’s nutritional needs were met. However, there was room for improvement in both of these areas.

We found that the provider did not use a particular model of care and that the premises were not designed with any particular care needs in mind. These areas could also be improved upon to ensure the provider was providing care according to ‘best practice’ and to ensure people received the best care available to them in the most suitable environment.

We found that the service provided a caring atmosphere to people and the staff were approachable and considerate. People said, “I am well settled and looked after”, “I enjoy it here, it's been lovely” and “I sometimes have trouble starting my crochet but one member of staff is very good at crochet and helps me.” Two relatives we spoke with told us they were satisfied with the care. They said, “The staff are very nice” and “I prefer mum to stay here and be cared for as I have seen how the staff treat her; with compassion and gentleness.” Staff told us they worked well together and were a caring and conscientious workforce.

People received a responsive service of care from the staff and care manager in that they had their needs assessed and planned for and any risk assessments in place to reduce risks. However, this could have been improved upon with regard to people being facilitated when socialising with each other, being assisted with their meals and listened to more when discussing problems or making suggestions. This may have been a result of the need to have more staff on duty throughout the busiest times of the day.

We found that the service was not entirely led by the provider/registered manager on a day-to-day basis and for the required hours of a full time registered manager. An appointed care manager had daily responsibility for people’s care. This had not ensured the service’s leadership was fully in control of all managerial responsibilities and so important areas of the service of care to people had not been fully monitored and developed. This meant people had received a disjointed service because the overall approach to managing the delivery of care had not been consistent or thorough.

An example of this was that there was an incomplete quality assurance and monitoring system in place which did not cover auditing in all areas of the service, information obtained was not analysed to develop action plans for improvement and feedback was not given to those people that had supplied information.

The provider was in breach of two regulations: staffing and good governance. These related to staff training in dementia care and operating an effective quality assurance system. We recommended that improvements be made with the premises, staffing levels, management of medicines and infection control. We also recommended improvements be made with caring for and communicating with people living with dementia, responding to people’s requests and wishes, providing more varied activities, defining management responsibilities and record keeping. You can see what action we told the provider to take at the end of the full version of the report.

We undertook this inspection to follow up on a previous area of non compliance. We found that the manager and staff had completed work in order to improve systems and record keeping in the home and that only minor improvements were now required.

People told us they were happy in the home they said “ They do what they can for me” and “They are all pleasant”.

We saw that people’s care plans were more comprehensively completed, with fewer gaps. This helped to ensure that a full picture was completed about the person and the meeting of their needs.

We saw records of visits from other health professionals which assisted staff with the meeting of peoples needs.

Risk assessments were in place although these were not always completed in a timely manner and a risk assessment for one person in relation to their mobility needs was not in place.

We saw people being supported to receive their meals and choices were offered. When necessary we sw support was obtained from the dietician and food supplements were offered to people.

We saw that systems were in place to ensure that people received their medication correctly; this included the training of staff.

There was a system in place for the recruitment of staff. This included obtaining references and checks to ensure that potential staff were safe to work with vulnerable people.

People who lived in the home and their relatives were happy that their needs were being met and that staff were polite. People felt staff were busy and did not always have time to spend chatting with them but overall were happy with the care provided.

Assessments and care plans were produced to provide information to staff to help ensure needs were known and met. However omissions in these records could jeopardise this.

Additionally there was little evidence that people were involved in their initial assessment when moving into the home or the development of their care plan. Overall people could not recall being involved in these processes. However people told us they were happy in the home.

People felt that they could make choices and decide what they were doing each day. We saw people relaxing in the home, receiving visitors, participating in a game of dominoes and relaxing in their rooms. Again the recording of people’s choices could be improved upon to ensure that staff were fully aware to ensure people’s needs were met.

As part of this visit we reviewed three previous compliance actions and found that the provider had taken action to ensure that these were met. These are detailed further in the report.

People we spoke with told us that staff were polite and felt that their needs were being met.

We observed the interactions between the people who lived in the home and the staff and saw that these were polite and respectful.

People told us they had choices which included the time for getting up and whether they wanted to stay in their room. We saw that when possible people had signed to agree to their care plan.

We saw that people were supported through a care planning process to have their needs met. However plans to deal with emergencies were not in place to help ensure people's safety.

We found that the home was clean throughout and that procedures were in place to ensure that maintenance checks were kept up to date.

There was a recruitment process in place to help ensure that only people suitable to work with vulnerable people were employed.

Quality assurance systems were in place to ascertain people’s opinion of the home and if it was meeting people's needs.

Records were stored securely and kept up to date.

We spoke with people who lived in the home. Everyone we spoke with told us that the staff were polite and kind. Comments included that “It’s lovely here”.

People told us how they felt that their needs were met in the home and that they were happy living in the home.They told us that the liked the food and they felt they were “Looked after”.

People also told us that they liked the staff and felt safe in the home, they said that if they had any concerns they felt able to raise them.

When we spoke with a visitor they told us that they felt there was always adequate staff on duty within the home and they were happy that their relative was living in the home. They described the home as “Really nice” and said that they were kept up to date about their relatives needs. They also told us that they would approach the manager if they had any concerns regarding the home.

A visiting professional told us that they were happy with the home and the support they received from the staff during their visits.

People told us they liked the home and choices were offered to them on a daily basis. Comments were, “I am able to decide when I get up and what I do; sometimes I go out on trips” and “The food is nice and good quality and there is a choice offered.”

People spoken with were complimentary about the staff stating they were helpful and polite. They said their privacy and dignity was promoted. Some comments were, “Yes definitely, the staff are lovely”, “The staff come quickly” and “They always knock on the door.”

People told us they felt safe in the home and they would feel able to complain if they needed to.

People told us they were happy at the home and the care staff were kind and caring. Relatives spoken with told us they were happy with the care their relative received and felt confident they were being cared for well. One person said, “The staff are very nice, I am never rushed”. One person spoken with told us they preferred to see their own chiropodist and optician and said, “I see my GP whenever, I can either ask the staff to organise this or I can do it myself”.

Two people spoken with told us they had choices about where to sit during the day and that if they decided to remain in their bedrooms it was respected. They also told us that their privacy was respected, “they always close the doors and curtains and always knock on doors”.