Blyford Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Blyford Residential Home is registered to provide support to 43 people, some of whom may be living with dementia. At the time of inspection there were 40 people using the service accommodated across three units.

There was a registered manager working at 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. Statutory notifications received by the Care Quality Commission showed us that the manager understood their registration requirements.

At the last inspection on 2 and 6 March 2017, the service was rated Requires Improvement overall and was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service provided us with an action plan stating how they intended to make the required improvements. At this inspection we found that the necessary improvements had been made to comply with the previously breached regulation and all recommendations made at the last inspection had been acted on. However, we identified that there were shortfalls in the management and administration of medicines which constituted a breach of the regulations. The service continues to be rated ‘Requires Improvement’ overall.

Medicines were not managed and administered safely. We found that the medicines for 13 people had not always been administered in line with the instructions of the prescriber. Staff had not identified these issues and raised them with the management of the service to ensure action was taken.

Improvements were required to ensure that the quality assurance system in place was capable of identifying shortfalls in all area’s of service provision. Significant improvements had been made in some area’s of service provision following our previous inspection. However, an audit of medicines had been carried out by the deputy manager the day before our visit but this audit had not identified the issues in medicines administration which we identified.

The service was meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS.) 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.

Risks to people were appropriately planned for and managed. People and their relatives told us they felt safe living in the service and that staff made them feel safe.

Checks were carried out to ensure that the environment and equipment remained safe. The service was clean and measures were in place to limit the risk of the spread of infection. The service had taken on board recommendations made previously by infection control specialists and had taken action to improve practice.

People told us there were enough suitably knowledgeable staff to provide people with the care they required promptly. Staff had received appropriate training and support to carry out their role effectively. Staff received appropriate supervision which helped them develop in their role.

People received appropriate support to maintain healthy nutrition and hydration. The support people needed to reduce the risk of malnutrition and dehydration were set out in their care plans. People told us the food was good quality and they had a choice of meals.

People told us staff were kind to them and respected their right to privacy and that staff supported them remain independent. Our observations su

Blyford residential home provides accommodation and personal care for up to 37 people.

The service also provided short stay admissions for people who require assessment to determine their eligibility for NHS Continuing Healthcare (NHS continuing healthcare is the name given to a package of care that is arranged and funded solely by the NHS for individuals who are not in hospital and have been assessed as having a "primary health need").

Short stays were also provided to people who required a period of reablement (The purpose of reablement is to help people who have experienced deterioration in their health and have increased support needs to relearn the skills required to keep them safe and independent at home).

The service is divided into three units; Foxfield and Rosedene (residential care for people permanently living in the service) and Woodleigh, for people admitted for a short period of time.

When we inspected on 2 and 6 March 2017 there were 35 people using the service. This was an unannounced inspection.

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 inspection, we found that the registered provider was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was a lack of opportunity for people to engage in meaningful activity outside of the day centre provision, which people did not always wish to attend. People were not always protected from social isolation, particularly those people who were cared for in bed due to illness or frailty. The range of activities available were not always appropriate or stimulating for people living with dementia. This constituted a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staffing level arrangements were being reviewed by the management team to ensure they met the needs of people using the service at all times. The provider increased staffing levels in some areas of the service, but on-going review is required due to the unpredictability of some admissions into the service on a short term basis. We have made a recommendation about this.

Quality assurance systems were in place to monitor the quality of provision, however, accidents and incidents were not always analysed to identify trends and patterns and to ensure people were kept safe. The auditing systems in place did not identify all of the issues we found during the inspection.

People’s nutritional needs were assessed, but this was not always monitored effectively. Food and fluid charts were not always completed or totalled, but the management team took action to address this.

The service was meeting the requirements of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS). Staff understood the need to obtain consent when providing care. 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.

The culture in the service was welcoming, friendly, and person-centred. The management team presented as open and transparent throughout the inspection, seeking feedback to improve the care provision.

Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

Safe recruitment procedures were in place, and staff had undergone recruitment checks before they started work to ensure they were suitable for the role.

Appropriate arrangements were in place to ensure people’s medicines we