Archived: Belmont House Nursing Home

Updated 11 August 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by two inspectors a pharmacy inspector and an assistant inspector.

Service and service type

Belmont House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing as a single package under one contractual agreement dependent on their registration with us. Belmont House Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 7 June 2022 and ended on 16 June 2022. We visited the location’s service on 8 June 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from professionals who worked with the service.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We were unable to speak with people who used the service about their experience of the care provided due to their reduced mental capacity and clinical needs. We therefore made observations of interactions with staff throughout the inspection visit. We spoke with fifteen members of staff. This included the manager, three members of the senior management team, clinical lead, nurse, care staff and ancillary staff.

We spoke with one relative and received information from three professionals.

We reviewed a range of records. This included four people’s care records, and ten medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 11 August 2022

About the service

Belmont House Nursing Home is a residential care home providing personal and nursing care in one adapted building. The service can support up to 40 people. At the time of this inspection there were 16 people living in the service. Though the service had three floors, only the ground floor was currently in use.

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

We last inspected the service in December 2021. At that time, there were continuing concerns regarding the management and operation of the service. The service was rated Inadequate and we took enforcement action. Since that time the management situation has improved. There has been a manager in post for several months. Senior management posts had been filled. There was improved oversight of the operation and management of the service. There is a requirement of registration for there to be a registered manager in post. The current manager had completed the necessary application records and checks ready to submit to the commission for registration.

At our inspections in November 2019, July 2020, November 2020, February 2021, May 2021 and October 2021 the provider had failed to establish satisfactory governance arrangements, to maintain an effective overview of the home or taken sufficient action to make the required improvements identified in the previous inspections. This was a repeated breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection improvements had been made. However, more evidence was required to demonstrate the governance systems were embedded to drive improvement in order to meet this breach of regulation.

In general incidents were recorded and reviewed. However, in one incident there was a lack of records reporting the incident or action taken. This included, the person’s daily care records, handover record and the specific behaviour reporting record for such incidents. We observed daily records had shown heightened behaviours which led up to this incident. We judged this had not had a negative impact on the person but had the potential to disadvantage staff in recognising future triggers. The recording systems were not operating effectively.

Staff had the correct guidance and training to support people with complex or challenging needs. However, where an incident occurred the care plan had not been reviewed or updated to support staff in identifying and responding to triggers.

At the previous two inspections we found there to be inconsistencies in staffing levels and there was a high use of agency staff. At this inspection we found improvements had been made for all levels of staff. There was a skill mix of staff on each shift. Recruitment for nurses and care staff continued, however agency staff had been block booked which meant it gave the provider the capacity to schedule regular shift patterns and enable the service to have continuity of staff. There were enough staff on duty to meet people’s needs. The management team had the authority to cover for staff absences, and apart from the occasional short notice absence, shifts were covered.

At the inspection in December 2021 the provider had not ensured the proper and safe use of medicines. At this inspection all areas of medicine management had improved.

At the inspection in December 2021 we found not all staff had completed training and professional development or received appropriate support. At this inspection all staff, including agency staff, had received and were continuing to receive training to support them in their individual roles. This included safeguarding people. The number of safeguarding referrals and notifications had reduced since the previous inspections and staff told us they felt the training had improved their responses to deter incidents occurring.

At the previous inspection staff had not received training for equality and diversity which had the potential to disadvantage people. At this inspection 86% of staff had received training and staff demonstrated they understood the importance of respecting people for who they were. For example, where a person’s mood elevated, staff went over and asked if the person was alright and what could they do. Another person said they were cold, and staff responded by bringing the person a cardigan. Where a person got upset at some verbal communication a member of staff sat with them to comfort them holding their hand. In all these instances staff intervention had reduced the anxiety in people.

The premises were clean and since the previous inspection the environment had improved internally and externally. This was an ongoing programme where if faults or repairs were needed these were rectified in a timely manner. People had access to equipment where needed.

People were offered a range of healthy meal choices.

Staff knew how to communicate effectively with people in accordance with their known preferences. For example, staff had guidance not to look at a person as they would feel this was a confrontation and would feel threatened. Also, staff were advised to, ‘use simple short sentences and give me time to respond.’

A relative told us they were given information about how to complain and told us they would feel comfortable raising a concern. Another relative told us they thought the service was well managed and communication with the management was good. People were regularly asked for their views on the service provided and feedback was used to make continuous improvements.

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 inadequate (published 19 May 2022) and there were breaches of regulations. We required the provider to share monthly reports detailing actions being taken to meet those breaches. The provider was continuing to complete these monthly reports to show what they were doing to improve. At this inspection we found improvement had been made but the provider was still in breach of regulations.

This service has been in Special Measures since 11 April 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 06 December 2021. Breaches of legal requirements were found. This inspection was carried out to follow up on action we told the provider to take at the last inspection. This report covers our findings in relation to the key questions Safe, Effective, Caring, Responsive and Well-led which contain those requirements.

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 could respond to another COVID-19 outbreak.

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

Enforcement and Recommendations

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 will continue to monitor the service and will take further action if needed.

At this inspection although improvements have been identified the service remains in breach of the regulations relating to failing to ensure staff had the necessary information to support people and embedding operational systems and practices into the governance of the service. 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.

Please see the action we have told the provider to take at the end of this report.

Follow up

The provider will be required to continue sending monthly reports to the commission 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.