Blyton Court

About the service

Blyton Court is a residential care home providing personal and nursing care to 15 people at the time of the inspection. The service supports people living with learning disabilities, autism and physical disabilities. The service can support up to 18 people.

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

Right Support

People were supported to engage in social and meaningful activities of their choice. Staff promoted people's independence as much as possible. People received were supported with medicines safely. Support plans, risks, health and wellbeing, was consistently monitored and reviewed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

People were protected from poor care and abuse. There was information on display about safeguarding and whistleblowing. People were treated with dignity and respect by staff who knew their care needs.

Right Culture

The service promoted improvement or acted on people and their relatives' views through the support of people's key workers and good communication strategies. Relatives felt confident to approach the provider with any concerns and were positive about the communication they received. The registered manager worked hard to improve and then sustain good quality care for people at the service through the provider's quality monitoring processes.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published24 April 2022) and there were breaches of regulations. 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 undertook this focused inspection to follow up on action we told the provider to take at the last inspection. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk as the provider had worked to make the necessary improvements to people’s care to ensure their safety. Please see the Safe, Responsive and Well Led sections of this full report.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Blyton Court is a nursing home, providing accommodation, personal and nursing care to 14 people at the time of the inspection. The service can support up to 18 people. The service supports people with a learning and/or physical disability and autistic people. The service also supports people living with an acquired brain injury.

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

Right Support

• Improvements were needed to activity planning to ensure that people could pursue their interests in a more meaningful way.

• People did not always receive medicines safely.

• Monitoring and reviewing support plans, risks, health and wellbeing was not consistent.

Right Care

• Staff were trained and understood how to protect people from poor care and abuse.

• There was information on display about safeguarding and whistleblowing.

Right Culture

• The provider did not obtain feedback from people and stakeholders and there was no evidence on how the service promoted improvement or acted on people's views.

• Relatives felt confident to approach the provider with any concerns they had and were positive about the communication they received.

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 good (published 23 January 2020).

Why we inspected

We received information of concern about staffing levels at this service. This was initially a targeted inspection looking at the infection prevention and control measures the provider has in place. We also asked the provider about any staffing pressures the service was experiencing and whether this impacted the service. We inspected and found concerns with the provider's management and oversight of the service. As a result, we widened the scope of the inspection and undertook a focused inspection looking at the key questions safe, responsive and well led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Blyton Court on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safety, good governance, leadership and management of the service at this inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Blyton Court is a nursing home registered for the support of up to 18 people, at the time of our inspection 14 people were using the service. The service primarily supports people with learning and physical disabilities. The service is a large home which had dining, lounge and activity spaces.

We found the following examples of good practice.

¿The provider ensured that current guidance was shared in a timely way with the service. When the guidance was updated the risk, parameters were reviewed, and changes made. This reduced any potential risk of infection.

¿ All staff used a company ‘Application’ (APP) on their mobile phones. This provided updates and benefits to the staff, including discounts and support networks.

¿ Staff had received training in the appropriate use of personal protective equipment (PPE), and the provider ensured they had enough supplies.

¿ The provider was sourcing clear face masks to support people who used lip reading to assist their communication. Other people found the masks difficult to cope with in relating to the staff. For these people a risk assessment was completed, and staff wore visors instead.

¿ All visits were risk assessed and arrangements were in place to support visits linked to personalised needs. For example, one person did not like to go outside, so arrangements were in place for a safe visit in the activity space.

¿ A range of communication methods were in place to support people to understand the changes to their home. These included easy read documents and pictures to support the use of PPE.

¿ Planned external activities had been refocused on activities within the home. The provider noted a reduction in behaviour that challenged since these changes had occurred and felt these were areas they would continue to develop.

Further information is in the detailed findings below.

Blyton Court is a nursing home providing personal and nursing care to 12 people at the time of the inspection. The service primarily supports people with learning and physical disabilities.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 18 people. This is larger than current best practice guidance. Despite this, we found the values were based upon those that underpin Registering the Right Support. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People had a positive experience of being supported by the team at Blyton Court. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People’s relatives told us they felt their relations were safe. Staff and the registered manager had a good understanding of safeguarding adults’ procedures to protect people from harm. Risks associated with people’s care and support were managed safely and action was taken to learn from accidents and incidents. Staff were recruited safely and there were enough staff to meet people’s needs and ensure their safety.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff were knowledgeable, trained and competent. People had enough to eat and drink, they had access to healthcare when they needed it, and advice was sought from specialist health professionals. The environment was homely and adapted to meet people’s needs.

People were supported by staff who were kind and caring, staff knew people well and people, where possible, were involved in making decisions about their care. People were treated with dignity and respect and their right to privacy was upheld.

The service was flexible to meet people’s needs. Staff had a good understanding of how to support people and people chose how they spent their time. There were systems in place to respond to complaints and concerns. People were provided with caring and compassionate support at the end of their lives.

There was a positive culture which placed people at the heart of their care. There were effective systems to ensure the safety and quality of the service. Strong leadership meant people received high quality care and staff felt supported and valued.

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 good (published 28 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered and managed safely. Although PRN protocols were usually in place we found occasions where they were not.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

People had limited choices at mealtimes. The mealtime experience meant that some people did not receive their meals in an environment conducive to their needs. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day. Where people had special dietary requirements we saw that these were provided for.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received supervision. People were encouraged to enjoy a range of social and leisure activities. They were supported to maintain relationships that were important to them.

Staff and people who lived at the home felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Accidents and incidents were recorded and investigated.

The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

Blyton Court specialises in the care of people who have a learning disability. It provides accommodation for up to 18 people who require personal and nursing care. On the day of our inspection there were 13 people living at the home. The home is divided into two units the Old Hall which provides accommodation for up to five people and the main unit which provides care for up to 13 people. The units are interconnected but staffed separately.

At the time of our inspection there was not 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.

On the day of our inspection we found that staff interacted well with people and people were cared for safely. The provider had systems and processes in place to safeguard people and staff knew how to keep people safe. Risk assessments were in place and accidents and incidents were monitored and recorded. Medicines were administered and stored safely.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).If the location is a care home Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to other healthcare professionals such as a dietician and GP. Staff were kind and sensitive to people when they were providing support. Staff knew how to provide care to people. People had limited access to leisure activities and excursions to local facilities.

People had their privacy and dignity considered. Staff were aware of people’s need for privacy and dignity.

People were supported to eat enough to keep them healthy. People had access to drinks during the day. People were not offered choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff available to care for people appropriately. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs.

Staff felt able to raise concerns and issues with management. We found relatives were clear about the process for raising concerns and were confident that they would be listened to. The provider recorded and monitored complaints.

Audits were carried out on a regular basis and action put in place to address any concerns and issues.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found-

Is the service caring?

We saw how members of staff treated people and observed care. We saw care was delivered well and in a respectful way. We saw staff were kind and attentive and encouraged people to be independent. We saw staff showed patience and gave encouragement when they supported people.

We observed when staff supported people they did so at the person's own pace and reassured people if they were upset.

We spoke with a relative who told us, 'This home is so friendly.'

Is the service responsive?

We saw people's individual physical, mental and social care and support needs were assessed and met. This included people's individual choices and preferences as to how they liked to spend their day. During our visit people were offered support and activities to meet their needs and preferences. For example one person watched their favourite film whilst another person played a musical instrument.

We observed staff responded to people in a positive manner and respected their individual preferences.

We observed that staff obtained people's consent before they carried out any care. For example, they asked people if they wanted to go outside to be read to and where they wanted to sit.

Is the service safe?

Risk assessments regarding people's individual activities were carried out and measures were in place to minimise these risks.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards in place. Mental Capacity Act (2005) and Deprivation of Liberty Safeguards are laws protecting people who are unable to make decisions for themselves. At the time of our inspection no one was deprived of their liberty.

We found where people lacked capacity their best interests had usually been considered, however the records did not always specify the areas which the best interest decision related to.

Staff had been trained to understand when an application for a Deprivation of Liberty Safeguard should be made and how to submit one. This meant that people would be safeguarded as required.

The relative we spoke with told us, 'Feel xxx is safe.'

We saw where people's behaviour challenged the service plans were in place to assist staff to manage the issues and keep people safe from harm.

The service was safe, clean and hygienic. The home had recently been refurbished and was well maintained therefore not putting people at unnecessary risk.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

Our observations found that members of staff knew people's individual health and wellbeing needs. There was a process in place to ensure staff were aware of people's changing needs.

We saw that people responded well to the support they received from staff members. The relative we spoke with told us their relative had improved since coming to the home.

We observed that staff responded to people's needs in a timely manner.

Arrangements were in place to ensure people's physical health needs were met. For example, where people had specific issues with their health, such as epilepsy guidance, was in place to support staff to provide effective care.

We found gaps in a person's record regarding repositioning which meant it was difficult to monitor care the person had received.

Is the service well led?

Staff said that they felt supported and trained to safely do their job. Training plans were in place to ensure staff had the appropriate skills to meet people's needs.

Quality assurance systems were in place and people were listened to.

We spoke with a relative who told us they felt able to raise issues and if they needed to complain they would know how to do this.

Due to the needs of people who lived at Blyton Court we used different methods to reach a judgement on the quality of the service. We spoke with three relatives about their views. We also spoke with the regional manager, the acting manager, a nurse, two care staff, an activities co-ordinator and the cook. We were aware that the acting manager had only recently taken up the post.

We looked at records and information about how the service was managed. We conducted a tour of the building and observed interactions between the care staff and people residing at the home.

Records we saw showed Mental Capacity Act assessments were inadequate and 'best interest' procedures were not in place. Additionally the records showed that people's needs had been assessed but people did not always receive care, treatment and support which met their needs.

We saw people being offered choices and opportunities which were respected and responded to.

One relative we spoke with said, 'They are happy there, more so than anywhere they have been'.

We spoke with three members of the staff team who told us they had not received training in managing behaviours, de-escalation techniques or how to keep people who lived at the home or themselves safe from physical harm.

We looked at records and found some people did not have correct information about their needs and how these should be met.

During our visit we spoke with the manager and three members of staff, including the cook.

We observed the interaction between people and staff through the use of the Short Observational Framework Tool (SOFI). Throughout our visit we saw staff positively interacted with people.

We also saw people were engaged in activity with staff members at regular intervals. One member of staff said, "The whole staff team have got to know people well enough to understand how each person communicates. This helps us to make sure people are happy in the things they do."

We found that people were supported using records that were maintained and reviewed regularly in order to make any changes needed to support people safely.

The manager told us and records showed meeting people's nutrition and dietary needs was an essential part of the care provided. There was a range of balanced, nutritious meals and drinks available throughout the day that people had access to.

We knew that the manager and home owner had systems in place to effectively monitor assess and evaluate the homes performance.

We also found were people had concerns or raised complaints there was a clear policy and process in place to acknowledge respond to them.