Archived: Belmont House Nursing Home

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.

Belmont House Nursing Home is a residential care home providing personal and nursing care. The service can support up to 40 people. At the time of this inspection there were 20 people living in the service. Though the service was over three floors only the ground and first floors were currently in use. Some of these people were living with dementia or were receiving care in bed.

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

Many people were not able to tell us verbally about their experience of living at Belmont House Nursing Home. Therefore, we observed the interactions between people and the staff supporting them.

We last inspected the service in October 2021. At that time, we had concerns regarding the management of the service and the service was rated requires improvement. Since that time the management situation has not improved. Before this inspection we were aware the previous two managers had left, and the company’s operations manager had been overseeing the service. However, they left their post before this inspection started. On the first day of our inspection a new manager had started and they, were being supported by the area manager. Within a few days of this inspection both the new manager and area manager had left the service.

There remained a lack of consistent management of the service since December 2019. The senior management had also changed during this period. Some improvements had been made at the October 2021 inspection. However, since the departure of the operations manager who was overseeing the service at that time there has been a deterioration. Systems and processes had not been completed or updated as required. Systems had frequently been changed and not effectively implemented or embedded.

At the last inspection, October 2021, it was noted that the high use of agency staff had improved. However, only two qualified nursing posts remain employed by the organisation, one nurse on days and one on nights. The remaining qualified nursing post continued to be covered by agency nurses. We received information of concern before and during the inspection, which stated that on some shifts there had been insufficient care workers and qualified nurses to cover all shifts. This had the potential to put people at risk due to lack of knowledge of the service, residents and systems.

At our last two inspections we found many staff had not completed areas of basic training. At this inspection we found some staff were still required to complete basic training, including Personal Protection Equipment (PPE). Staff told us they did not feel safe with the staffing levels on some days. Regular audits had not always been completed since the departure of the last manager.

People were supported by a staff team that were caring. However, people did not always receive care in line with their care plans. Plans were not always reflective of their current needs. People's care was not always delivered in line with their choice or preference.

The service had an activities coordinator however, some staff felt more suitable activities could be introduced.

Improvement was needed to make sure people’s health and quality of life was maintained by effective use of medicines. Support plans had not always been updated to include the monitoring of people’s needs, including behaviours which may challenge the service.

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 (published 1 December 2021) and there were breaches of regulation. The provider had not completed an action plan after the last inspection, this was due in part to the manager, operations manager and area manager all leaving the company and to no consistent oversight by any senior management from the company. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 12 October 2021. Breaches of legal requirements were found. We undertook this focused inspection due to receiving information of concern and also to check that service now met legal requirements. This report covers our findings in relation to the key questions Safe, Effective, Caring, Responsive and Well-led which contain those requirements.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive, and Well Led sections of this full report.

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

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.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding, staffing, staff training, medicines, premises, dignity, consent, person centred care, infection control and good governance 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 updated action plan for the provider to understand what they will do to improve the standards of quality and safety. The provider will continue to submit monthly reports as outlined in the imposed conditions on the providers registration. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.

This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Belmont House Nursing Home is a residential care home providing personal and nursing care. The service can support up to 40 people. At the time of this inspection there were 18 people living in the service. Though the service was over three floors only the ground and first floors were currently in use. Some of these people were living with dementia or were receiving care in bed.

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

Many people were not able to tell us verbally about their experience of living at Belmont House Nursing Home. Therefore, we observed the interactions between people and the staff supporting them. A relative said; "My wife seems safe and well looked after. I have no concerns.”

We last inspected the service in May 2021. At that time, we had concerns regarding the management of the service and the service was rated Requires Improvement. Since that time the management situation has not improved. Before this inspection we were aware the previous two managers had left. The company’s operations manager was currently overseeing the service.

There remained a lack of consistent management of the service since December 2019. The senior management had also changed with the appointment of a new operations manager. Though we found improvements had been made, since the departure of the last manager, some systems and processes had not been completed or updated as required. Systems had frequently been changed and not effectively implemented or embedded.

At the last inspection it was noted that there was a high use of agency staff. The current staffing situation had improved. However, only two qualified nursing posts were currently employed by the organisation. One on days and one on nights. The remaining qualified nursing post continued to be covered by agency nurses. We received information of concern before and during the inspection, which stated that on some shifts there had been only two care workers on shift with one agency qualified nurse who had not worked at the service before. This had the potential to put people at risk due to lack of knowledge of the service, residents and systems.

At our last inspection we found many staff had not completed areas of basic training.

At this inspection we found some staff were still required to complete basic training, including Personal Protection Equipment (PPE). Staff told us they were feeling ‘burnt out’ and unsettled due to the continued change of management. Regular audits had not always been completed since the departure of the last manager.

Staff were observed as attentive, kind and caring. People were supported by a staff team that were both caring and compassionate and treated them with dignity and respect. We found the service calmer and more relaxed than at previous visits. The service had an activities coordinator however, some staff felt more suitable activities could be introduced.

People received their medicines as prescribed. Support plans had been updated and included monitoring of people’s needs, including their weight, food and fluid intake, skin care and re-positioning records. Staff were aware of the details of people's care needs and supported them accordingly.

People's needs had been assessed and this information was made available to all staff via their handheld computerised care system. 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.

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 (published 2 July 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 2 May 2021. Breaches of legal requirements were found. We undertook this focused inspection to check they had followed their action plan and to check if they now met legal requirements. This report only covers our findings in relation to the key questions Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive, and Well Led sections of this full report.

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

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.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection control, good governance and staff training 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 for the provider to understand what they will do to continue to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress.

We will return to visit as per our re-inspection programme. If we receive any concerning

information we may inspect sooner

Belmont House Nursing Home is a residential care home providing personal and nursing care. The service can support up to 40 people. At the time of this inspection there were 18 people living in the service. Though the service was over three floors only the ground floor was currently in use. Some of these people were living with dementia or were receiving care in bed.

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

Many people were not able to tell us verbally about their experience of living at Belmont House Nursing Home. Therefore, we observed the interactions between people and the staff supporting them. A relative said; "My wife seems safe and well looked after. I have no concerns.”

We last inspected the service in February 2021. At that time, we had concerns regarding the management of the service and the service was rated Requires Improvement. Since that time the management situation has not improved. Before the inspection we were aware the previous manager in post from February 2021 had left. Another temporary manager had been brought in to assist with the running of the service. The company had also employed the services of a consultancy firm to assist.

There remains a lack of consistent management of the service since December 2019. The senior management had also changed with the appointment of a new senior manager. Systems and processes were being frequently changed and not effectively implemented or embedded.

At the last inspection it was recorded that a relative had requested their loved ones notes and had been sent notes belonging to another person, causing this family distress. The previous manager said they would action the correct notes being sent. However, this was not actioned as requested until further phone calls to the previous manager had been made. Causing further distress to this relative.

At the last inspection it was noted that the service had a COVID-19 outbreak. During that time the senior manager, manager and many nurses, care staff and ancillary staff left the service. The manager in post in February 2021 confirmed there was a high use of agency staff and the local authority had supported that manager to cover shifts on a daily basis. Since then the number of residents living in the service has reduced. The current staffing situation had improved. However, two of the five qualified nursing posts continued to be covered by agency nurses, one of whom told us they had only recently started working at the service.

At the February 2021 inspection we made a recommendation about how staff accessed training. We found that staff training had not always been completed.

At this inspection we found staff still required to complete basic training. Staff told us they were feeling unsettled, unsupported and not appreciated due to the lack of a consistent manager. Also, staff had struggled with continued changes, including not all having been made aware of who the consultancy firm was and their role.

Staff were observed as attentive, kind and caring.

The service remained under whole home safeguarding by the local authority. At the inspection in February 2021 we had received feedback from healthcare professionals and relatives that changes in people's health was not always escalated to the relevant professional and relatives were not always kept informed. During a recent safeguarding meeting, some professionals stated this issue remained a concern. They stated they had called the service, but were not always able to obtain the current clinical information about their patients. However, they did state that if the agency employed clinical lead was on duty, and they were able to speak to them, they received detailed information about people’s health.

People received their medicines as prescribed. However not all medicines audits had been completed monthly as required. Regular checks of the environment and other audits had not always been completed monthly.

Support plans had been updated and included monitoring of people’s needs, including their weight, food and fluid intake, skin care and re-positioning records. Staff were aware of the details of people's care needs and supported them accordingly.

At the previous inspection not all risk assessments had been completed including risk assessments for people receiving visitors. We found this had now been actioned at this inspection.

People's needs had been assessed and this information was made available to all staff via their handheld computerised care system. 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.

People were supported by a staff team that were both caring and compassionate and treated them with dignity and respect. The service had an activities coordinator however, we observed that not all people where engaged in meaningful activities. We noted that not all people were offered activities.

We made recommendations about activities.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014;

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 (published 14 April 2021) and there was a breach of regulation. The service remains rated requires improvement.

Why we inspected

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.

We have found evidence that the provider needs to make improvements. Please see the Safe/Effective/Caring/Responsive/Well Led sections of this full report.

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

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe/Effective/Caring/Responsive/Well Led sections of this full report.

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

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.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection control, good governance and staff training at this inspection.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Belmont House Nursing Home is a residential care home providing personal and nursing care. The service can support up to 40 people. There were 19 people living in the service at this inspection.

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

We last inspected the service in November 2020. Since this time the management situation has not improved. Before the inspection we were aware the previous manager had resigned. A new manager had been in post for five weeks, however they had yet to start the registration procedure with CQC.

There has been a lack of consistent management of the service since December 2019. The senior management had also changed and currently there was no senior manager or representative of the provider visiting the service to support the new manager. Systems and processes were being frequently changed and not effectively implemented or embedded.

At the last inspection it was noted that things had started to improve. However, at this inspection we found this not to be the case. This included failings in the assessing and monitoring of the safety and quality of the service which had deteriorated. Systems to ensure compliance with regulations for example in regard to audit systems, infection control and staff training, deemed as mandatory, were neither consistently applied, or effective to ensure the service was managed to a good standard.

Good practice regarding infection prevention and control was not being followed, particularly in relation to enhanced procedures required to protect people due to the pandemic.

The service had a Covid-19 outbreak, starting in January 2021. Since this time the senior manager, manager and many nurses, care staff and ancillary staff had left the service. Staff were not always recruited in sufficient numbers to keep people safe. We were aware of the staff shortages, some due to the outbreak. However, some were due to ongoing vacancies not being filled. Staff said there had been many staff shortages and the manager admitted there was a high reliance on agency staff. During the recent outbreak the local authority were supporting the manager to find staff to cover shifts. The manager said they were taking steps to improve recruitment including nurses, carers and ancillary staff. Staff were observed as attentive, kind and caring.

A relative contacted us as their loved ones wishes, on their death, had been ignored. They were distressed that though the service had clear instructions on their loved ones wishes it was then too late to implement them. The manager who had not been in post at that time agreed lessons would be learnt from this.

A relative had requested their loved ones notes and had been sent notes belonging to another person causing this family distress. The manager said they would action the correct notes being sent.

At a previous inspection we made a recommendation about how staff accessed training. At the last inspection in November 2020 we found support was in place for staff to complete online training. However, since that time staff training had not always been completed. Staff were still required to complete mandatory training including infection control. Staff told us support from the new manager was good.

We received feedback from healthcare professionals and relatives that changes in people's health was not always escalated to the relevant professional and relatives were not always kept informed. One healthcare professional said they had called the home and were unable to obtain the current clinical information about the person they called about. They had also spoken to the manager who was unable to tell them the current health condition of people as they ‘did not know them’.

We received information of concern that some staff were using restrictive practices. The manager confirmed no staff at the service were using these practices as no staff employed at the service had completed this training.

People were relaxed and comfortable with staff and had no hesitation in asking for help from them. Staff were caring and spent time chatting with people as they moved around the service.

People we spoke with were all happy with the service. One person said. “They are kind” and another who remained in their bedroom, when asked, said the staff called into see them regularly.

The home had introduced a new computerised care plan system. Therefore, when people’s needs had been assessed as needing to have specific areas of their care monitored, such as their weight, food and fluid intake, skin care and re-positioning records of these checks, had improved.

The manager confirmed all risk assessment were now completed and stored on the new computerised care system. However, risk assessments to enable visitors to visit their loved one safely had not been completed.

There was an activity worker in post to carry out some activities with people. Staff spoken with were passionate about what they do, and said, “We have supported each other to get through a very difficult time.” This was in reference to the Covid outbreak and the unfortunate deaths of many of the residents.

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 requires improvement (published 01 January 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

At this inspection enough improvement had not been made and the provider was still in breach of regulation.

Why we inspected

The inspection was carried out to check if standards had been maintained in relation to the management and safety of the service. We carried out this focused inspection to review the key questions of Safe and Well-led only.

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 Coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Belmont House is a care home with nursing and accommodates up to 40 people in one adapted building. The service provides care and support to people who are living with dementia. At the time of our inspection there were 27 people living at Belmont House.

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

Since the last inspection improvements had been made to the cleanliness of the environment and the layout and design of the service. Cleaning routines had been improved and there were no unpleasant odours. The dining room and a quiet lounge had been re-designed to make them more suitable for people’s needs. Many areas of the building had been re-decorated, and this was on-going. There was a calm atmosphere and people appeared happy in the changed environment.

Improvements had been made to how risks were identified, assessed, monitored and reviewed. Risks were identified and staff had guidance to help them support people to reduce the risk of avoidable harm.

Where people were assessed as needing to have specific areas of their care monitored, such as their weight, food and fluid intake, skin care and re-positioning records of these checks had improved. Any changes in people’s health were escalated to the relevant professional and relatives were kept informed.

Medicines were now being well managed. Improvements had been made to the recording of when people’s medicines were given, stock control, medicines audits and medicines care plans.

At the last inspection we made a recommendation about how staff accessed training and at this inspection support was in place for staff to complete online training. The training programme had been updated and courses were booked, although not all completed at the time of this inspection. However, health and safety and infection control training had been completed by all new and existing staff. Staff told us support from managers was good and formal supervision, under the new management, had started.

There had been a lack of consistent management of the service since December 2019. This had resulted in systems and processes being frequently changed and not effectively implemented or embedded. At this inspection we found the assessing and monitoring of the safety and quality of the service had significantly improved. However, a robust auditing system for the provider and manager to have oversight of the service was still being developed and was not yet fully embedded.

In August 2020 a new manager took over the running of the service and a new management team had been appointed including head of care and clinical lead. During June and July several care and nursing staff left. Some returned a few weeks later and new staff had been recruited, and this was on-going, to fill the remaining vacancies. There was a positive culture and staff had quickly become a cohesive team. Staff told us they had confidence in the new management and felt completely supported. Relatives also said they had confidence in the new management and told us this had resulted in more positive outcomes for people living at the service.

People were relaxed and comfortable with staff and had no hesitation in asking for help from them. Staff were caring and spent time chatting with people as they moved around the service. Relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, “Staff treat people well and I feel [person] is safe” and “Until the last couple of months I was very worried about [person], but they are safe now.”

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 recruited safely, and deployed in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction and activity with staff. Staff knew how to keep people safe from harm.

Cleaning and infection control procedures had been updated in line with Covid-19 guidance to help protect people, visitors and staff from the risk of infection. During the summer months families had met people in the garden. A bedroom next to the main entrance had been converted into a visitor’s room to enable people to see their families during the winter months. Several relatives were making regular visits to see their loved ones, and this was welcomed.

Care plans were individualised, and detailed people’s needs and preferences. A newly recruited well-being co-ordinator provided personalised and responsive activities in line with each individual person’s needs and wishes.

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 rating for this service at the last comprehensive inspection was requires improvement (report published 19 December 2019). The rating was not changed at the targeted inspection (report published 14 August 2020). Across the two inspections there were four breaches of regulations. The provider completed an action plan after both of these inspections to show what they would do and by when to improve.

At this inspection not enough improvement had been made and the provider was still in breach of one regulation.

Why we inspected

The inspection was carried out to follow up on the action we told the provider to take at the last two inspections. As a result, we carried out this focused inspection to review the key questions of Safe, Effective, Responsive and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the caring key question and therefore we did not inspect that key question. Ratings from previous comprehensive inspections for that key question were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

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

We have identified a continued breach in relation to the governance of oversight of the service.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Belmont House Nursing Home is a residential care home providing personal and nursing care. The service can support up to 40 people. There were 29 people living in the service at this inspection.

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

People were at risk of harm because the systems in place to ensure they received safe and appropriate care were not effective. Care plans held inconsistent information to direct staff to provide safe care and treatment. There was no oversight of the daily work carried out, for example the completion of food and fluid charts for people deemed at high risk. Management systems in place were not robust to ensure people remained safe.

Staffing levels were satisfactory, however on the day of our visit three agency care staff had been used due to sickness. One of the two qualified nurses on duty was also an agency worker.

People did not always receive personal care in a timely manner. Though we were informed some people had received personal care that morning, no documentation had been completed to evidence this. Turning charts and food and fluid charts were not always completed as directed in the care plan. One person was found to be very thirsty when offered a drink.

The management of the care staff including the monitoring of the completion of all charts was not sufficient.

Some rooms where found to have a strong odour of urine.

Medicines systems were not robust enough to keep people safe.

Policies were not implemented. Improvements identified in action plans were not always reflected in practice.

The governance of the service was not sufficient.

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. (published January 2019)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about people living in the service, the time people waited for personal care in the mornings and the amount of weight some people had lost. Other issues included poor staffing levels, poor completion of charts to monitor people’s health and wellbeing. For example, food and fluid charts, turning charts and that personal care was not completed in a timely manner. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have found evidence that the provider needs to make improvements. Please see the Safe section of this full report.

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 will continue to monitor the service and to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and the oversight of safety and risk.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Belmont House is a care home with nursing and accommodates up to 40 people in one adapted building. The service provides care and support to people who are living with dementia. At the time of our inspection there were 33 people living at Belmont House.

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

Some people were not able to tell us verbally about their experience of living at Belmont House. Therefore, we observed the interactions between people and the staff supporting them.

People were not always safe because health and safety requirements were not always met. A cupboard on a landing containing cleaning materials was not locked. There was a poster advising staff to ensure this cupboard was locked. This meant people could have been at risk.

Changes to the layout and design of the building had not been carried out in people’s best interests. A first-floor lounge had been made into two single bedrooms reducing communal space on the ground floor. The dining room had been integrated into the lounge. This meant people mainly took their meals on tables in front of their lounge chairs or in their rooms. The dining experience had been affected negatively by this action. The lack of space meant there were limited opportunities to hold private meetings, training, interviews and supervisions.

The environment was not dementia friendly. The service had been decorated in a bland colour. There were no contrasts of colour which has been proven to support people living with dementia to move around a service independently. One small area of a corridor had been decorated with murals and textured wall coverings. However, this was limited to a small area of the service and did not benefit most people.

The premises were not always well maintained. There was damaged woodwork throughout due to the use of equipment. Most rooms had furniture which was scratched and chipped and looked unsightly. Two rooms had some furniture suitable for people living with dementia. However, this was limited and there was no evidence other furniture would be improved in a specific timescale.

Some areas of the service had malodours. The management team had recognised this and work was underway to replace floor coverings to mitigate this.

Bathing facilities were limited. A first-floor assisted bathroom could not be used as the size of the room could not accommodate the equipment needed to support people. This meant there were two bathing facilities on the ground floor for up to 36 people. Staff told us it was very difficult to manage at times.

Medicines were generally managed safely. However, there was no system to manage the temperature in the area where medicines were stored on the first floor. We have made a recommendation about this.

People had access to activities, but they were not always meaningful for people living with dementia.

Staff had been recruited safely, received the provider's mandatory training and had supervisions although there were gaps in records to demonstrate supervisions were taking place. Staff told us training using

Governance systems were in place, but not always effective in ensuring people received consistent care. Shortfalls identified at this inspection had not all been identified and addressed by the provider's own quality assurance systems.

People were supported to access healthcare services. Staff recognised any deterioration in people's health and sought professional advice appropriately and followed it.

People told us staff were kind and caring, staff involved people in their care and made sure people's privacy was respected. Staff worked well together and understood the service's aim to deliver good quality care, which helped people to continue to live as independently as possible.

People were supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 27 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well Led sections of this full report.

Belmont House Nursing Home is registered to provide nursing care for a maximum of 40 people most of whom have a form of dementia. At the time of the inspection, there were 33 people living at the service.

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 about how the service is run.

People and their relatives told us the service was safe. People were supported by staff who understood how to recognise and report any signs of suspected abuse or mistreatment. Staff had been safely recruited, and had undergone checks to help ensure they were suitable to work with people who were vulnerable.

During the inspection, we observed suitable staffing levels. This meant staff were available to meet people’s needs in an unhurried way. People had their medicines as prescribed and on time. People were supported by staff who had undergone training to help ensure they could meet their needs effectively.

Staff were supported by a thorough induction process which including shadowing more experienced staff. During their induction, staff familiarised themselves with people’s care records so they had a good understanding of the needs of those they were supporting. All staff were supported by an on-going programme of supervision as well as an annual appraisal.

People’s rights were protected through the correct use of legal frameworks. For example, when required, people had been assessed under the Mental Capacity Act (MCA) by staff. When people were assessed as lacking capacity to make certain decisions for themselves, staff ensured that best interest processes were followed, reflecting the principles of the MCA. The registered manager had sought authorisations under the Deprivation of Liberty Safeguards (DoLS) when needed.

People and their relatives told us the staff were kind. One relative said; “I can’t fault this place”. We witnessed positive, caring interactions between people and staff. Staff knew the needs of the people they supported well and were able to describe their likes, dislikes, history and routine. Staff spoke about the people they supported with fondness and affection. People’s dignity was protected by staff who were respectful and compassionate. The atmosphere at the service was pleasant and relaxed and people appeared comfortable and at ease. People had access to advocacy services as required. People’s confidential information was securely stored.

People’s health care needs were effectively managed and monitored at the service. There were suitable numbers of nursing staff on duty to provide nursing care. If people became unwell, the service made prompt referrals to doctors or specialists. People had access to a range of health and social care professionals including social workers, chiropodists and speech and language therapists.

People’s care records were comprehensive, detailed and regularly reviewed and updated. Care plans contained personalised information to help staff understand how to provide care which was reflective of their preferences. People were provided with opportunities to engage in a variety of activities as well as personalised, one to one time. There was a broad range of visitors to the service, including a massage therapist, entertainers and petting animals. People were able to enjoy the secure garden which had recently been updated and to access activities in the community.

People told us they enjoyed the food. Meals appeared plentiful and people were offered a range of alternatives. Special dietary requirements were catered for. Relatives were made welcome at the service and could stay and have a meal with their family member if they chose to. People were encouraged to maintain relationships with those who mattered to them and there were no restrictions on visiting times.

The registered manager promoted an ethos of openness and transparency. The service had notified us of all notifiable incidents as required. Quality assurance surveys were sent to relatives and professionals regularly. Feedback was sought through a range of forums including relatives’ meetings and a suggestion box. There were a range of audits which took place to monitor the quality of the service.