CQC report explained · a nursing home
What the CQC found at Bluebell Nursing & Residential 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
- Some risks were not fully identified, assessed or recorded. Inspectors also found problems with fluid monitoring, repositioning records and some medication record gaps, although people told inspectors they felt safe.
- Effective?
- Good
- People's healthcare needs were met, staff had relevant training and support, and meals were provided in a way that reflected people's needs and preferences. Improvements were needed in some mental capacity and best-interest records.
- Caring?
- Good
- People and relatives spoke positively about the care. Staff were described as kind, respectful and supportive of people's dignity, privacy and independence.
- Responsive?
- Good
- Care was personalised to people's needs, preferences and communication requirements. People had access to activities, visitors and support with relationships and end-of-life care.
- Well-led?
- Requires improvement
- Management systems did not always identify and address shortfalls early enough. Some statutory notifications were not sent to the CQC after serious injuries or safeguarding concerns.
What inspectors found, March 2024
Rated Requires Improvement; inspectors found kind, responsive care, but gaps in risk records and management oversight.
This was an unannounced inspection over three days. Inspectors spoke with 14 people, 17 relatives and 9 staff. They reviewed care records, medicines records, recruitment files, training records and management information.
The home was rated Good for Effective, Caring and Responsive. People were described as receiving kind care, having their privacy respected, getting support with healthcare and taking part in activities. Medicines, infection control and staffing arrangements were generally satisfactory.
The home was rated Requires Improvement for Safe and Well-led. Some risks were not properly recorded or managed, including fluid intake, repositioning and catheter care. The home's checks had not found all these problems early enough, and some required notifications had not been sent to the CQC.
Kind and respectful care
People and relatives gave positive feedback about staff. Inspectors found that people were treated with compassion, dignity and respect.
“People received kind and compassionate care. Staff protected and respected people's privacy and dignity.” from the report
Personalised support
Staff understood people's individual needs, likes and dislikes. Care plans described the support people required, including end-of-life preferences.
“People received personalised care that was responsive to their needs.” from the report
Activities and relationships
The home offered regular activities and helped people maintain important relationships. There was a dedicated lead for social activities.
“People using the service and relatives told us there were regular activities available at the service.” from the report
Healthcare and medicines
Staff supported people to attend healthcare appointments and worked with other professionals. Inspectors found that medicines were generally handled safely.
“Medication practices ensured the proper and safe use of medicines in line with good practice standards and relevant national guidance.” from the report
Incomplete risk records
seriousNot all risks were identified and recorded clearly enough for staff to know how to reduce them. This included risks linked to distress, catheters and evacuation.
“Not all risks to people's safety and wellbeing were identified, assessed, and recorded.” from the report
Fluid and repositioning checks
seriousSome people's fluid targets were not met, with no clear record of how this was being addressed. Repositioning was not always recorded as happening at the required intervals.
“Fluid intake records viewed showed people's fluid targets were not always met.” from the report
Mental capacity records
needs fixingRecords did not always explain how decisions had been made when people might lack capacity. Sensor mats and bedrails had not always been considered through a capacity or best-interest assessment.
“Where people had a sensor mat or bedrail in place to keep them safe and to stop them falling, no assessment of capacity was completed” from the report
Management oversight
needs fixingThe home's audits had not routinely found the shortfalls identified by inspectors. The provider said weekly clinical governance meetings had been introduced after the inspection.
“Shortfalls identified at this inspection were not routinely identified by the service.” from the report
Missed notifications
needs fixingThe home had not routinely told the CQC about some serious injuries and safeguarding concerns, including two significant skin tears in September 2023.
“Statutory notifications were not routinely sent to the Care Quality Commission following a serious injury” from the report
- 01How are you now recording and checking each person's risks, including fluid intake, repositioning, catheter care and distress?
- 02What evidence can you show that weekly clinical governance meetings are identifying and fixing problems promptly?
- 03How do you assess capacity and make best-interest decisions for people using sensor mats or bedrails?
- 04What has changed since the inspection to make sure serious injuries and safeguarding concerns are notified to the CQC?
- 05How do you monitor staffing at busy times, when people may have to wait for personal care or drinks?
This was an unannounced inspection of the care home, including both the premises and the care provided, and it assessed all five key questions. This explanation was written from the published report of 19 March 2024 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, July 2021
Bluebell Nursing & Residential Home is rated Good overall; inspectors found improved care and management, but some medicines, training, choice and dignity practices needed attention.
This was an unannounced, focused inspection on 12 and 14 May 2021. Inspectors spoke with people, staff and relatives, observed care, and checked care, medicine, staffing and management records.
The home was rated Good overall. The report lists Safe, Effective, Responsive and Well-led as Good. Caring was not inspected during this visit. Inspectors found people were generally safe, supported, listened to and given personalised care.
The home had improved since the previous inspection in June 2019, when it was rated Requires Improvement and breached four regulations. Those previous breaches were no longer found at this inspection. Inspectors still identified some areas that needed improvement, including dignity and choice during meals, staff training and medicines records.
Improved since 2019
The home had addressed the four regulatory breaches found at the previous inspection. Inspectors found enough improvement for the provider to be no longer in breach.
“At this inspection we found improvements had been made and the provider was no longer in breach of these regulations.” from the report
People were generally safe
Risks were recorded, staff understood safeguarding procedures and the environment was clean and maintained. Infection prevention arrangements were also judged effective.
“People were protected by the service's prevention and control of infection practices and from the risk of transmission of COVID-19 and other infectious diseases.” from the report
Personalised support
Care plans described people's needs and preferences, and staff understood the care to be provided. People were supported with activities and relationships.
“Staff had a good understanding and knowledge of people's needs and the care to be delivered.” from the report
Good communication with relatives
Relatives generally said communication was positive, including about healthcare and visiting arrangements during the pandemic.
“Most relatives told us communication by the service had been positive, including clear messages and guidance relating to visiting arrangements.” from the report
Dignity and choice at meals
needs fixingPeople needing help to eat were not always offered a choice of drinks or snacks. Some staff stood over people rather than sitting beside them, so inspectors made a recommendation.
“However, where they required staff assistance this was not always provided in a respectful and dignified manner” from the report
Some staff training incomplete
needs fixingMost staff had completed mandatory training, but three of the eight staff records checked needed improvement. Inspectors said this had not affected the quality of care at the time.
“Most staff had completed online mandatory training, but we found improvements were required for three out of eight members of staff.” from the report
Medicine information error
needs fixingOne person's care plan did not accurately match the oxygen prescription, and the concentrator was set incorrectly. The issue was brought to management's attention and corrected immediately.
“the information recorded within the care plan did not accurately reflect the oxygen prescription and the concentrator flow rate was incorrectly set.” from the report
Recruitment records
needs fixingInspectors found missing recruitment checks in one staff file and incomplete evidence for checks involving two other staff members. The provider later supplied documents and inspectors were satisfied the regulation was met.
“We reviewed four staff member's personnel files and found no recruitment checks had been completed for one member of staff.” from the report
- 01What action has been taken to make sure people are offered choices of drinks and snacks at mealtimes?
- 02How do staff support people to eat while protecting their dignity and privacy?
- 03Have all staff now completed their mandatory training, including the three staff members identified in the report?
- 04How are oxygen prescriptions and other medicine instructions checked against care plans and equipment settings?
- 05Which parts of care will you monitor to make sure the improvements found since 2019 continue?
This was a focused inspection of Safe, Effective, Responsive and Well-led; Caring was not inspected during this visit and the report says ratings for key questions not looked at were carried over from the previous comprehensive inspection. This explanation was written from the published report of 25 July 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.
Every inspection of Bluebell Nursing & Residential Home
7 rated inspections over 9 years: the service has slipped, from Good to Requires improvement.
- March 2024Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Bluebell Nursing & Residential Home →
- July 2021Goodup from Requires improvementSafe: GoodEffective: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Bluebell Nursing & Residential Home →
- September 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- November 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2017Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2016Goodstayed GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- July 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- September 2014
Registered with the Care Quality Commission on 30 September 2014.
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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