We carried out an unannounced inspection to Belmont Grange on 21 February 2012, as part of our planned inspection programme. We found that some improvements were needed to make the environment safe. We also asked for some improvements to the way medication was being stored and to staff's understanding of safeguarding. We completed a further inspection on 21 August 2012 to review improvements made and as part of our annual review of services checked on other outcome groups not previously looked at.We asked for and received an action plan which told us how the provider was going to address these areas of non compliance. We found that they had installed a separate hand washing sink in the laundry area. This helped to ensure against the risk of any cross infection. We saw that the dip in the floor near the kitchen had been repaired and the provider had purchased a new lockable fridge to store any medications that needed refrigeration.
We asked the manager about how she had made sure that staff fully understood all the processes relating to safeguarding and we were told that they had provided the policies and procedures from the home and those of the local safeguarding team for staff in their staff room for reference. Staff we spoke to told us they had received training in the protection of vulnerable people.
During this inspection we spoke with seven people who currently live at the home, who were able to make their opinions known. They were positive about the care and support they received. Comments included 'I think I have been here a long time now, they look after you very well.' 'We have a good laugh, it's alright and I am quite happy.' 'I have no complaints about the staff, they do their best and do a good job.'
Some people who live at the home have dementia and were less able to give their views of life within the home. To help us understand the experiences of people we used our SOFI (Short Observational Framework for Inspection) This tool allows us to spend time watching what is going on in a service and helps us record how people spend their time, the type of support they get and whether they have positive experiences.
We saw that care and support was delivered in a kind and respectful way. We heard from people that care was mostly provided at a time that suited them. One person said 'if they (staff) are busy, you may have to wait, but they usually come and tell you when they can get to you.'
We found that there were sufficient qualified and experienced staff to meet the needs of people at the home. The staff team had remained stable for a number of years, with care staff having a good understanding of working with frail older people. We heard for example that one person was being cared for in bed due to frailty, and had no pressure damage or red areas, despite them being cared for in bed for a long period of time.
Care and support was planned, with risk assessments in place to minimise any identified risks for people. We saw that daily records gave a good account of how people's personal, health and emotional needs were being met. Care plans had been updated to reflect any changes. The home included within the care plans, an ambulance plan for people to take with them if they needed to go by ambulance in an emergency. This gave paramedics, clear concise basic information about wishes of people, for example whether they did not wish to be resuscitated.
We saw that where people lacked capacity, best interest decisions were being documented. We have asked the home to also make clear within daily records, that consent is gained for care and treatment. We heard staff asking and checking with people about consent, but this was not always clearly recorded.
We saw that some improvements to the general d'cor and fabric of the building were ongoing within the home. Some areas were still in need of refurbishment, but the provider had ensured that it was safe and clean.