This unannounced inspection took place on 5 and 10 December 2018. Bluegrove House provides accommodation, personal care and support for up to 48 people. At this inspection there were 41 people living at the service. Care and support was provided across three floors for people, some of whom were living with dementia. 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.

At our previous inspection on 28 April and 3 May 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a new registered manager who was employed at the service in January 2018. 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.

Staff responded to people’s needs in a way that showed they mattered. Staff celebrated people’s birthdays and each person had a day where they were made to feel extra special.

Staff had creatively organised activities that met people’s preferences and needs and helped them to develop new interests. Staff celebrated cultural events and invited and welcomed people using the service, relatives and people living in the local community to take part. Voluntary organisations actively supported people to learn new skills and knowledge.

Each person had an assessment of their care and support needs. These were developed into care plans that guided staff on how to support people effectively.

People had access to healthcare services. A GP and a specialist physician visited the service. Staff sought advice and treatment from the health professionals when people’s needs changed.

Systems in place ensured people were protected from the risk of abuse and harm. Staff took appropriate actions to report and manage abuse safely. People had an assessment in place that identified and managed potential risks.

The registered manager used a dependency tool to assess the amount of staff required to care for people safely. Safer recruitment processes were followed.

There were established systems for the administration, ordering, disposal and management of medicines that staff were familiar with and followed.

Staff treated people in a caring way and were kind and compassionate. Staff supported people in a way that protected their dignity and privacy.

People had enough to eat and drink. The menu was displayed around the service and people said the quality of the meals was of a high standard and tasty.

Staff were supported by the registered manager through regular training, supervision and appraisal.

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 understood how to support people who were unable to make decisions for themselves. People provided staff their consent to receive care and support.

There was an established system for people to make complaints about the service if they were unhappy with their care.

People received end of life care and support when required by staff who were trained to provide palliative care.

The registered manager supported staff who were confident in their role. There were established systems in place for monitoring, review and driving improvements of the service. Staff had dev

Bluegrove House provides care for up to 48 older people, some of whom have dementia. On the first day of our visit 41 people were living in the home.

The service was last inspected on 21 May 2014 when the regulations we looked at were met. The previously registered manager left the home to take up an area manager position with the provider. A new manager has been working in the home since September 2015 and she has applied to the Care Quality Commission to be registered as the 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.

There were good arrangements to keep people safe from harm at Bluegrove House. Risks were managed well and people were protected from abuse. There were safe arrangements for dealing with emergencies.

People received their medicines as prescribed and they were managed safely. The provider had safe arrangements for recruiting new staff that meant they had enough information to assess them as suitable to work with people.

Staff were trained and supported to carry out their roles. Training was targeted to ensure staff had sufficient knowledge to care for people with particular conditions. People were supported to have enough to eat and drink. The meals met their nutritional, health and cultural needs.

People were cared for in line with the requirements of the Mental Capacity Act 2005. They were not deprived of their liberty unless this was properly authorised under the Deprivation of Liberty Safeguards.

The home worked closely and effectively with health care professionals to make sure people’s on-going health care needs were met.

People experienced compassionate care from kind staff who treated them with respect. People’s privacy and dignity were respected and staff supported them to maintain their independence as far as possible.

People’s individual needs were taken account of in care planning and they, their relative or representatives were included in the planning process. A range of activities was provided and it was anticipated this would be further developed as an activities coordinator was appointed shortly before our visit.

People’s views about their care and the running of the home were sought through meetings, surveys and consultation exercises.

The home had good management and auditing arrangements in place to ensure the on-going improvement of the service people received.

One inspector visited the service, our visit was unannounced. During our visit we gathered evidence to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff and two healthcare professionals told us about the service. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff had been trained in safeguarding vulnerable adults and were aware of how to report concerns about people's safety. People told us they felt safe, one person said, "no one has ever been unpleasant to me." Another person said that staff were, "never rude." People were reminded in meetings for people who lived at the service and their relatives that they could make complaints and raise concerns.

Is the service effective?

The service addressed people's needs effectively and involved specialists to ensure they were fully informed about how to meet people's particular needs.For example referrals were made to District Nurses, dietitians and podiatrists if people required assistance that was outside the expertise of the service.

Is the service caring?

We observed interaction between staff and people living at the service. They spoke to people in a kindly, patient and respectful way. People who lived at the service said they were fond of the staff and described them as, "very pleasant." A relative told us that each time they visited Bluegrove House they felt there was a, "good atmosphere" and they found the staff, "very caring."

When we visited a celebration, which included visits from the local MP and Deputy Mayor, was taking place for the birthday of a person who lived at the service. The staff had arranged the celebration and it illustrated their caring approach.

Is the service responsive to people's needs?

Staff were responsive to people's needs and made sure that they were met promptly. People told us that when they rang call bells for assistance they did not have to wait a long time. During our visit a person's condition gave staff cause for concern so they called the GP to ensure they received medical attention.

Is the service well-led?

The service was well led. The manager of the service was knowledgeable and experienced. There were systems in place to ensure that the service provided good quality care which took into account health and safety and people's views. The provider carried out checks on the quality of the service. Staff were well trained and supported in their roles.

Bluegrove House had forty-one residents at the time of our inspection. Most people at the home had dementia or memory problems. They required varying levels of help with their personal care and activities of daily living. Some people were able to give us feedback on their experiences in the home and about quality of the service. People who used the service and their relatives we spoke with told us about their positive experiences in the home. Their comments included that they were “Happy with everything”, “Wouldn’t change anything” and they had “No complaints at all”.

We observed during our inspection that people were treated kindly and with patience. We found that there were enough staff to support people when they needed help. People we spoke with told us that they liked the staff and confirmed that they were available when they asked for support.

We found that people were asked for their agreement before care was provided to them. People had care plans which included plans to meet their nutritional needs appropriately. We found that the home was clean and hygienic and that procedures were in place to prevent the spread of any potential infections. Records about people and their needs were accurate and available for staff.

People told us they liked Bluegrove House and felt well cared for at the service. One person said they were happy at Bluegrove House. Another person said they had come to Bluegrove House for a short time but hoped to stay there permanently, saying 'I don't want to leave'.

Two people we spoke with said they found the home 'very clean'. Several people told us that they liked the meals provided at the home. They said that if there was anything that they didn't like on the menu then they could have an alternative. We found that staff were knowledgeable about people's likes and dislikes at meal times.

Staff said they were happy working at Bluegrove House and felt well supported. We were told about some recent training that three staff had undertaken, they felt the training assist them in carrying out their roles.

We carried out an inspection of Blue Grove House on 16 June 2011. At that inspection people told us that staff were kind and caring, the home was kept clean and tidy and they felt safe there. Although these views were borne out by some of the care and interventions we observed, we found that Blue Grove House was not meeting nine of the essential outcomes of quality and safety.

Following the inspection the organisation provided us with an action plan to tell us what they were doing to make improvements. We visited on 3 October 2011 to see whether they had made these improvements.

At this visit people told us that they like living in the home and they get the care and support they need. We found that many of the concerns we identified previously had been addressed. In other areas some progress had been made but Blue Grove House was not meeting three of the essential outcomes of quality and safety concerning personalised care, treatment and support; the care and welfare of people who use the services; and medicines management.

People who live at the home told us that the staff were kind and caring. They told us that they liked the home and it was clean and tidy. They said that if they asked staff for help they came. One person we spoke to said she felt very safe in the home.

We met some visitors and they said that the staff were kind and approachable. They told us that if they had any concerns they knew who to speak to.

The staff told us that they liked working at the home. Some staff told us that they wanted to care for people who lived there as if they were their relatives. They told us that they worked well as a team.

Although these views were borne out by some of the care and interventions we observed, our report identifies concerns in involvement in care, treatment and support, nutrition, cleanliness and infection control, medicines management, safety and suitability of premises and equipment, staffing support and quality assurance. Managers must take action to address these concerns to improve the standards of care.