CQC report explained · a residential care home
What the CQC found at Blenheim Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People generally felt safe and medicines, risks, staffing and infection control were managed well. However, one safeguarding concern was not referred appropriately to the local authority at first.
- Effective?
- Requires improvement
- Staff were more skilled and people were supported safely, with good access to healthcare and better mealtime support. Records of speech and language therapy advice for two people with specialist diets could not be found.
- Caring?
- Good
- Inspectors saw staff treating people with kindness, dignity and respect. People were offered choices and supported to remain independent.
- Responsive?
- Requires improvement
- This key question was not covered by this focused inspection. The previous rating was used when calculating the overall rating.
- Well-led?
- Requires improvement
- Leadership and management had improved, and complaints were handled properly. However, audits did not identify concerns about supervision, safeguarding referrals and records for prescribed diets.
What inspectors found, August 2021
Rated Requires Improvement; the home had left special measures after improvements, but inspectors still found gaps in safeguarding, records and management checks.
This was an unannounced focused inspection on 6 July 2021. Inspectors spoke with people, relatives, staff and a visiting professional. They observed care and checked care plans, medicines records, staff files and management records.
There had been serious problems at earlier inspections. The home had been in special measures since November 2018. Inspectors found clear improvements, including kind care, safer moving and handling, better infection control, safer medicines arrangements and improved complaints handling.
Some problems remained. A safeguarding concern had not been referred promptly to the local authority. Records for two people's specialist diets did not include the expected speech and language therapy information. Staff supervision records were too generic, and management checks had not found all these issues.
The overall rating was Requires Improvement. Safe, Effective and Well-led were Requires Improvement, while Caring was Good. The home was no longer rated Inadequate or in special measures. Responsive was not assessed in this focused inspection, so its previous rating was carried forward.
Kind and respectful care
Inspectors saw staff being kind, respectful and discreet. People were offered choices about daily support and where they wanted to sit.
“Staff were observed to be respectful and kind during our observations and people were positive about the support they received from staff.” from the report
Safer care practices
Risks were assessed and staff followed guidance for moving people safely. Medicines were administered safely and records were clear.
“Risks assessments to move people safely were in place and included detail about what sling to use and detail about length of straps.” from the report
Improved leadership
The report found strong leadership and a clear effort to improve after earlier inspections. Staff and relatives gave positive feedback about communication and support.
“The registered manager provided strong leadership and had good oversight in relation to care and support provided by staff.” from the report
Infection control
Inspectors were assured that the home had suitable infection prevention arrangements, including personal protective equipment, testing and visits.
“We were assured that the provider was using PPE effectively and safely.” from the report
Safeguarding referral was delayed
seriousA concern involving the inappropriate disposal of medicines had been investigated but was not referred to the local authority promptly. The referral was made retrospectively after the inspection.
“The registered manager had carried out an investigation but had not referred this concern to the local authority.” from the report
Specialist diet records
needs fixingThe home could not find speech and language therapy advice for two people with specialist diets. One person's information was sent after the inspection and the other person was referred for reassessment.
“However, we could not find evidence two people had been assessed appropriately by the speech and language team (SALT).” from the report
Generic staff supervision
needs fixingSupervision records used the same planned questions and typed answers for every staff member. This did not show that individual practice and wellbeing had been properly discussed.
“Every staff member's records contained the same information.” from the report
Management checks missed issues
needs fixingAudits had improved but did not identify the concerns about supervision, safeguarding referrals and prescribed diet records. The provider said it would improve the relevant risk assessment and records.
“However, the audits had not picked up the concerns found in relation to supervision and ensuring all safeguard concerns were reported promptly.” from the report
- 01How will you make sure every safeguarding concern is referred to the local authority promptly?
- 02How do you record and check speech and language therapy advice for people with specialist diets?
- 03What has changed in staff supervision so that each person's practice and wellbeing are discussed individually?
- 04How are your audits now checking for missed safeguarding referrals, incomplete diet records and weak supervision records?
- 05What is the current plan for the flooring slopes and making bedroom doors easier for people to identify?
This was a focused inspection of Safe, Effective, Caring and Well-led; Responsive was not looked at and its previous rating was carried forward. This explanation was written from the published report of 21 August 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2020
Rated Inadequate and remains in special measures; inspectors found improvements but continuing risks, weak oversight and complaints handling failures.
This was an unannounced focused inspection in September 2020. Inspectors checked Safe and Well-led, reviewed records, observed care and infection control, and spoke with people, relatives, staff and professionals. The other areas were not inspected again.
There had been clear improvements since the March 2020 inspection. There were enough staff for the 18 people living at the home. Infection control had improved, staff understood safeguarding, and the new manager had brought more stability.
Important problems remained. Some choking risks and fire evacuation plans were not recorded accurately. Medicines records were incomplete, including missing signatures and continued use of out-of-date eye drops. The provider's checks did not reliably find these problems.
The overall rating stayed Inadequate, although Safe and Well-led improved from Inadequate to Requires Improvement. The home remained in special measures because CQC judged that significant improvement was still needed.
Improved infection control
Inspectors found that infection prevention arrangements had improved. Staff followed the new policies and the home had equipment for cleaning commodes properly.
“A review of the infection control and prevention measures found significant improvements had been made.” from the report
Enough staff
Staffing levels were consistently maintained for the 18 people living at the home. Staff were visible and responded promptly to people's needs.
“There were enough staff employed to meet the needs of the eighteen people currently residing in the service.” from the report
Better leadership culture
Staff and relatives reported that the culture had improved. Staff said the new manager provided more support, direction and stability.
“Feedback from people's relatives and staff is that the culture in the service has improved under the direction of the registered manager.” from the report
Safeguarding awareness
Staff had received safeguarding training and understood how and when to report concerns. Inspectors also found fewer visible bruises and injuries than at the previous inspection.
“All eight staff spoken with told us they had completed safeguarding training and were aware of their responsibilities to raise concerns about safety incidents.” from the report
Incomplete risk plans
seriousOnly one of three people identified as being at risk of choking had a suitable assessment and care plan. One fire evacuation plan contained information that did not match the person's abilities.
“However, only one of three people identified at risk of choking had an assessment and care plan in place informing staff of the risk and actions they should take to mitigate that risk.” from the report
Medicines checks
seriousThere were missing signatures for eye drops, and out-of-date eye drops were still being used. Staff did not consistently record or follow up repeated refusals of medicines.
“Additionally, the box had been dated 05 August 2020, on opening, and should have been discarded after 28 days, however these were still in use.” from the report
Weak provider oversight
seriousAudits did not reliably identify medicine, care-record or premises problems. Action plans did not consistently show who was responsible or when work would be completed.
“We found provider oversight and governance systems were not effective in identifying where improvements were needed to ensure the safety and quality of the service and ensure sustainability.” from the report
Complaints not handled properly
seriousThe provider did not initially acknowledge complaints and took too long to respond. Relatives told CQC that responses were defensive and did not properly investigate the concerns.
“The provider failed to adhere to their own complaints, suggestions and compliments policy and procedure, when responding to these complaints.” from the report
- 01How are choking assessments and care plans checked now, and how are staff told what actions to take?
- 02How do you check that medicines are in date, recorded correctly and followed up when someone refuses them?
- 03How are personal emergency evacuation plans checked against each person's current abilities?
- 04What measurable deadlines are now in place for repairs and other improvements identified in the action plan?
- 05How will you acknowledge, investigate and respond to complaints within the timescales in your complaints policy?
This was a focused inspection of Safe and Well-led, with infection prevention and control also checked; the other ratings carried over from the previous comprehensive inspection. This explanation was written from the published report of 7 November 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Blenheim Care Home
5 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- August 2021Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- November 2020Inadequatestayed InadequateSafe: Requires improvementWell-led: Requires improvement
- May 2020Inadequatedown from GoodSafe: InadequateEffective: InadequateCaring: InadequateWell-led: Inadequate
- November 2017Goodstayed GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- June 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2013
Report published without a new overall rating.
- August 2012
Registered with the Care Quality Commission on 21 August 2012.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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