Bluebell House

Updated 2 October 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

This was a focused inspection to check whether the provider had met the requirements of the breach in relation to Regulation 12- Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations. We also wanted to seek assurances that people were receiving safe and timely care following CQC receiving some information of concern.

Inspection team

The inspection was completed by one inspector and a member from the CQC medicines team.

Service and service type

Bluebell House is a ‘care home’. 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave a short period notice of the inspection because we needed to check the service had no active Covid and to discuss how and where they wished us to enter and put on the PPE. This was to ensure the safety of people, staff and the inspection team.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

We reviewed all information the provider had sent us prior to the inspection. This included information we had requested in relation to some concerns raised. We also reviewed statutory notifications (key information providers are required to send us). We completed a chronology of concerns, whistleblowing and safeguarding concerns as well as positive feedback to see if there were any trends. We sought feedback from the local authority and other professionals who work with the service. We used all of this information to plan our inspection.

During the inspection-

On the first day the inspector spent time with the manager, deputy manager and director. We also spent a short time touring the building, observing staff to check they were wearing and using PPE correctly. We spoke with four people living at the service. To minimise time at the service we asked for and received some information. This included two care plans and risk assessments, daily records, staff rotas, staff training matrix.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

On the second day of inspection we checked 11 people’s medicine administration records in detail. We checked storage arrangements, policies and procedures, medicines audits and records.

After the inspection –

We arranged video calls and spoke with five staff. We also contacted and received information from two healthcare professionals. We asked the provider to send two care plans and risk assessments along with electronic daily notes which we reviewed. They also sent staff rotas, training matrix and the provider’s monthly report. These documents helped us to judge how well the service was being run and what areas were being reviewed in terms of quality audits.

Updated 2 October 2020

About the service

Bluebell House is a residential care home that provides personal care and support to 24 people aged 65 and over at the time of the inspection. Lounge and dining areas are available on two floors and bedrooms on three floors. These can be accessed by a passenger lift. Most people living at Bluebell house are living with dementia and/or conditions associated with frailty and old age.

People’s experience of using this service and what we found

People said they were comfortable and being well cared for. One person said, “It’s not been fun with lockdown but the staff have been great and we are certainly well cared for.”

At the last inspection we found medicines were not always managed safely. We issued a requirement in relation to this as people were at risk. We asked for and received an action plan which showed what the provider was doing and had implemented to ensure this requirement was met. At this inspection we found medicines management had improved since our previous inspection. People received their medicines safely and in the way prescribed for them.

At the last inspection we found risks to hot water outlets had not been risk assessed. We were made aware following the inspection that thermostatic valves had been fitted to all hot water outlets. At this inspection we saw these measures were being monitored monthly to ensure the valves were working and where temperature changes noted the valves were adjusted to keep people safe from the risk of scalds from hot water.

At the last inspection we found the provider quality assurance processes were not robust as they had failed to identify the risk areas we had highlighted during the comprehensive inspection. At this inspection we found regular and robust audits were being completed to keep people safe. These were being monitored by the providers quality assurance manager and by visits from the directors. During the pandemic some of this had been completed remotely, but in more recent month’s visits to the home for quality monitoring had been resumed.

Most staff said there were always sufficient staff on duty for the number and needs of people they cared for. Two staff felt they would benefit from additional staff during the afternoons, but said people’s needs were being met. One staff member said they sometimes struggled to keep people entertained throughout the day. They said they were aware the service had recently employed an activities person to work at the home and believed this would benefit people.

Since the last inspection there had been several safeguarding alerts raised. One was raised by the registered manager and was handled well to keep people safe. Two others had been raised by other agencies and were reviewed with the local authorities safeguarding team. We discussed these with the registered manager and provider who were looking at lessons learnt and sharing with their other services where practice could be improved.

Recruitment processes ensured people were protected as only staff who had been assessed and checked as being suitable to work with people who may be vulnerable, were employed.

Infection control and measures to keep people safe from risk of the spread of Covid were reviewed during this inspection. Training and the right personal protective equipment (PPE) were in place. Measures for visitors to the service were in place. This included ensuring temperature checks were completed. Visitors were also asked to sign a health declaration and wear PPE.

We made one recommendation in respect of ensuring staff were using surgical masks correctly at all times.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection –

The last rating for this service was requires improvement (Report published 1 May 2019)

We identified a breach of regulation 12 in regard to safe medicine practices. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We had also received several individual pieces of information of concern about people’s healthcare needs not being met in a timely way and the attitude of the registered manager in one incident.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We found no evidence during this inspection that people were at risk of harm from these concerns. The provider completed a full investigation into each of the concerns and have shared any lessons learnt. Please see the safe and well led sections of this report.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bluebell House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.