CQC report explained · a residential care home
What the CQC found at Bluebell House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found medicines were managed safely and people received them as prescribed. Risks including falls, pressure damage and hot water were assessed and monitored.
- Effective?
- Good
- This question was not covered by this focused inspection. Its previous rating was carried forward into the overall rating.
- Caring?
- Good
- This question was not covered by this focused inspection. Its previous rating was carried forward into the overall rating.
- Responsive?
- Good
- This question was not covered by this focused inspection. Its previous rating was carried forward into the overall rating.
- Well-led?
- Good
- Inspectors found regular and stronger audits, provider oversight and clearer management arrangements. People were encouraged to share their views and care plans recorded their preferences.
What inspectors found, October 2020
Rated Good; inspectors found safer medicines management and stronger oversight, but some staff did not always wear masks correctly.
This was a focused inspection on 11 September 2020. Inspectors checked whether earlier problems with medicines had been fixed and looked at concerns about people's safety and care. They reviewed records, medicines, staffing and quality checks, spoke with people, staff and health professionals, and observed infection control practice.
The home was rated Good for Safe and Well-led. Medicines were given as prescribed, risks such as falls, pressure damage and hot water were monitored, and recruitment checks were in place. Inspectors also found stronger audits and oversight than at the previous inspection.
The overall rating improved from Requires Improvement to Good. However, this inspection did not reassess Caring, Effective or Responsive. Inspectors recommended that staff follow guidance on wearing surgical masks correctly at all times.
Medicines managed safely
The earlier medicines problem had been addressed. Records showed medicines were given as prescribed, stored securely and checked through audits.
“People received their medicines safely and in the way prescribed for them.” from the report
Risks monitored
The home monitored hot water valves and had risk assessments and equipment for falls and pressure damage. Staff also recorded repositioning and people's food and fluid intake where needed.
“At this inspection we saw these measures were being monitored monthly to ensure the valves were working” from the report
Stronger oversight
Quality checks had improved since the previous inspection. The provider reviewed audits weekly and monthly, and a representative visited at least monthly, although some visits were remote during lockdown.
“At this inspection we found the necessary improvements had been made to the way risks and quality performance was monitored” from the report
Personalised care plans
Care plans recorded people's routines, preferences and what mattered to them. This helped staff provide care in a person-centred way.
“Plans were written in first person and detailed people's preferred routines, such as morning and evening.” from the report
Masks were not always worn correctly
minorInspectors saw one or two staff members whose masks did not fully cover their noses. They recommended that the home review the relevant guidance and ensure staff follow it at all times.
“We did note one or two staff did not always have their mask fully covering their nose.” from the report
- 01How do you check that all staff wear surgical masks correctly at all times?
- 02How many staff are normally on duty in the afternoons, and how do you make sure people have enough activities and social time?
- 03How are medicines audits completed, and what happens if an error or missing record is found?
- 04How will you keep families in contact with residents if visiting restrictions change?
- 05What checks are made on hot water valves and how often are they recorded?
This was a focused inspection of Safe and Well-led, including medicines, safety concerns and infection control; Caring, Effective and Responsive were not assessed and their previous ratings were carried forward. This explanation was written from the published report of 2 October 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.
What inspectors found, May 2019
Rated Requires Improvement; inspectors found kind, personalised care, but medicines safety and quality checks were not reliable.
This was a planned inspection on 20 and 25 March 2019. The inspection team spoke with people living at the home, relatives, staff, the manager and the provider. They reviewed care plans, daily records, 12 medicine records, complaints, incidents, staff records and quality checks.
People generally said they felt safe and well cared for. Staff knew people's needs and there were enough staff for the assessed needs. Care plans and activities had improved since the previous inspection. People were treated kindly, had choices about daily life and were offered a range of food, drinks and activities.
There were important safety problems. Medicines were not always given as prescribed, records had gaps, and some hot water outlets could cause scalding. The home's checks had not found these problems. The overall rating stayed at Requires Improvement, for the third time.
Kind and respectful care
Inspectors saw staff treating people as individuals and protecting their dignity. People and relatives also spoke positively about the staff's kindness.
“Our observations showed people were treated as individuals, their dignity was upheld, and staff were kind and patient in all their interactions.” from the report
Personalised care
Care plans included people's preferences, interests and preferred routines. Inspectors said this was an improvement since the previous inspection.
“Care and support were well planned because people were asked about their preferences and interests.” from the report
Choice and activities
People had choices about their daily routines, food and activities. Activities included crafts, games, chats, community access and visits from local school children.
“People were supported to engage in a variety of activities to suit their personal interests.” from the report
Enough staff
The rotas showed staffing levels matched people's assessed needs. Staffing had recently increased in the morning because needs and numbers had increased.
“There were sufficient staff available throughout the day and evening to meet people's needs.” from the report
Medicines were not always safe
seriousTwo medicine errors were found, including an expired dose and a medicine given once daily instead of twice daily for more than three weeks. Five people's records had gaps, so it was not clear whether medicines had been given as prescribed.
“Medicines were not always administered safely in the way prescribed for people.” from the report
Quality checks missed risks
needs fixingThe home's audits and monitoring did not identify the medicine errors or the missing hot water risk assessments. The manager carried out a further medicine audit after the inspection.
“Although there had been some improvements in the quality monitoring and auditing of the service, these had failed to pick up on areas of concern we identified during the inspection.” from the report
Concerns were not always recorded
minorPeople said they could raise concerns, but issues such as laundry problems had not always been logged as formal complaints. The manager agreed to record concerns in future.
“She agreed for the future she would log all concerns raised even if these were not raised on a complaints form.” from the report
- 01What action has been completed to make sure every medicine is given as prescribed and recorded correctly?
- 02How are staff checked as competent to administer medicines and apply external preparations?
- 03Have mixer valves been fitted to all hot water outlets, and how are temperatures now checked?
- 04How do you make sure audits identify medicine errors and other safety risks promptly?
- 05How are concerns, including laundry problems, recorded and reviewed for repeated themes?
This was a planned inspection of the care home, including its premises and care, covering all five key questions and checking improvements since the previous inspection. This explanation was written from the published report of 1 May 2019 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 Bluebell House
6 rated inspections over 5 years: the service has improved, from Requires improvement to Good.
- October 2020Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2019Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- March 2018
Location report published without a new overall rating.
- March 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2016Requires improvementstayed Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Good
- June 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 20 December 2010.
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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