Archived: Belmont Care Home

Belmont Care Home provides residential care for up to 40 people. Since our last inspection in March 2017, the service has not accepted any new admissions to the home. During this inspection there were 19 people living at the home.

At our inspection in January 2017. We identified breaches of five of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which were in relation to good governance, safe care and treatment, premises, training and person centred care. We also identified two breaches of the Care Quality Commission (Registration) Regulations 2009 in relation to the provider not submitting statutory notifications as required. We rated the home 'Inadequate' and placed the service into special measures. We then completed a focussed inspection in March 2017 due to concerns we had received. We looked at areas in the safe and well-led sections. The service was again found to be inadequate in safe and well-led, with continued breaches in relation to the safe management of medicines, assessing and taking action to reduce risks to people's health and wellbeing, good governance and staff training and supervision.

Requirement notices were issued for all the breaches of regulations. In March 2017 a warning notice was issued for the breach of regulation 17 Good Governance. The provider sent us an action plan telling us how they would become compliant with the regulations.

During this inspection we checked if the required improvements had been made. We found the provider was still in breach of the regulations identified in our last two inspections of the service and we also found a further two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service remains 'Inadequate' and the service remains in special measures. We are currently considering our options in relation to enforcement in response to the breaches of regulations identified. We will update the section at the back of the inspection report once any enforcement work has concluded.

We also made one recommendation, that the service ensures toilet facilities have appropriate locks on them to ensure that people’s privacy and dignity is maintained.

We found that not all windows were fitted with appropriate restrictors. This did not follow the Health and Safety Executive (HSE) published guidance on the use of window restrictors in care homes. Appropriate window restrictors prevent the windows in care homes from being opened too widely and people falling from the windows.

Health and safety checks and equipment maintenance checks were not completed. Areas of the building were not adequately maintained or secure. Records of fire safety checks were either not available or were incomplete and did not show regular checks or testing had been carried out. Areas of concern identified in the last fire risk assessment had not been addressed.

Medicines were not managed safely. Staff were not provided with sufficient information about medicines that were to be given ‘when required’. Records indicated that medicines storage temperatures were not being monitored and recorded to ensure medicines remained effective and no action had been taken to rectify this. There was little evidence to demonstrate that staffs continued competency to administer medicines had been checked and records of stocks of medicines could not be found.

Systems for the recruitment of staff were not sufficiently robust and did not ensure all required pre-employment checks had been made. Staff had not received the training, induction or supervision they needed to support them to carry out their roles effectively.

Some care records had been updated since our last inspection. We found the new care records to be person centred and gave detail about peoples likes and dislikes and the way they wanted to be supported. However we found that care records had not been reviewed regularly. Care records including risk assessments were not always accurate or had not been updated when people needs had changed. Records of support provided were not always complete.

The provider was not meeting the requirements of the Mental Capacity Act (MCA) 2005. People were potentially being unlawfully deprived of their liberty.

People we spoke with told us staff treated them with respect. However, we found that people’s privacy and dignity was being compromised. We found that two toilet doors that opened onto public areas of the home did not have privacy locks on them. One of these toilets was directly opposite the front door. Had the toilet door been left open people using the toilet area would have been visible from the front door.

We observed staff interactions that were gentle, friendly and caring. Staff took their time when supporting people and no one was rushed. Staff knew people well.

There was a lack of planned activities for people to take part in. People told us they didn’t go outside the home very often.

There was a lack of systems to monitor and improve the quality of the service. We found checks and audits that were carried out by staff within the home were incomplete and not sufficiently robust to ensure best practice was followed and compliance with regulations was being maintained.

The Care Quality Commission (CQC) asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. The completion of a PIR is a legal requirement of a provider’s registration with the CQC. The provider did not return the information we requested.

The service is required to have a registered manager in place. 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. The service did not have a registered manager.

The service are required to notify CQC of events such as accidents, serious incidents and safeguarding allegations. The service had not notified CQC of all events they are required to.

Staff were positive about working for the service and the improvements that had been made since our last inspection.

The provider was displaying the rating of the last CQC inspection as they are required to do.

The overall rating for this service is 'Inadequate' and the service is in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This inspection took place on 27 March 2017 and was unannounced. At our last inspection in January 2017 we rated the home ‘Inadequate’ and placed the service into special measures. The overall rating for this service remains ‘Inadequate’ and the service remains in special measures. We identified breaches of the regulations in relation to the safe management of medicines, assessing and taking action to reduce risks to people’s health and wellbeing, good governance and staff support and supervision. We are currently considering our options in relation to enforcement and will update the section at the end of this report once any enforcement action has concluded. Due to concerns we identified during the inspection we also made a referral to the local safeguarding authority.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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 Care Home provides residential care without nursing for up to 40 older people. The home is situated in Cheadle close to local shops and other amenities. Car parking is available to the front and side of the building. At the time of our inspection there were 33 people living at the home.

Prior to this inspection we were made aware of concerns in relation to how the service managed risks relating to pressure ulcers. We found staff were aware of signs to look for that might indicate someone was developing a pressure ulcer, and further training was scheduled to further improve staff knowledge in this area. However, we found staff were not consistently following directions in people’s care plans to reduce the risks of them developing a pressure ulcer.

The service assessed risks to people in relation to pressure ulcers and falls. However, risk assessments were not always re-visited following a change in a person’s condition or circumstances, and risk management plans were not always up to date. This meant there was a risk that staff would not provide the support people required to keep them safe.

Staff told us there were sufficient numbers of staff on duty to allow them to complete their duties and supervise people who were at risk of falls. However, care plans were not clear about how frequently ‘checks’ should be completed.

Staff were aware of procedures to follow in the event that someone sustained a fall, and additional staff had received training in first aid since our last inspection. However, records in place to monitor people’s falls and other accidents were not always completed. It was not always possible to tell what actions had been taken as a result of falls or other accidents.

All care staff were required to complete care plans and risk assessments. Some staff told us they were not confident in completing such tasks, and only limited support had been provided to staff to enable them to complete these tasks. The registered manager acknowledged that care plans and risk assessments were not always satisfactory.

There was a lack of any robust process to give the registered manager and provider an overview of the safety of the service. Staff told us accidents were not discussed with them, and there was no evidence that learning had taken place as a result of previous accidents and incidents.

Reasonable steps had not been taken to ensure the environment was safe for people living at the home. We found items including razors and cleaning products stored insecurely.

Medicines were left with some people to take without supervision. The registered manager was unable to demonstrate that potential risks to the person or others living at the home had been considered in relation to this practice.

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.

Whilst staff spoke positively about the registered manager, they felt that due to demands of their time that there was limited support available to staff. The records did not demonstrate that all staff had received regular supervision, and those supervisions that did take place were conducted by a member of administrative staff. The registered manager told us they had recently recruited a second member of administrative staff, and were actively recruiting to the role of deputy manager, which they hoped would reduce demands on their time.

We last inspected Belmont Care Home 27 May 2015 when we rated the service as good. At that time we found the service was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to following safe staff recruitment processes. We found the provider was now meeting the requirements of this regulation. However we identified other areas where the provider was no longer meeting the legal requirements. We identified breaches of five of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which were in relation to good governance, safe care and treatment, premises, training and person centred care. We also identified two breaches of the Care Quality Commission (Registration) Regulations 2009 in relation to the provider not submitting statutory notifications as required. You can see what action we have told the provider to take at the back of this report. We are currently considering our options in relation to enforcement in relation to some of the breaches of regulations identified. We will update the section at the back of the inspection report once any enforcement work has concluded.

Belmont Care Home provides care for up to 40 older people. The home is situated in Cheadle close to local shops and other amenities. Car parking is available to the front and side of the building.

At the time of our inspection 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.

Medicines were not always managed safely. For example, we found medicines stored in a fridge that was not lockable, located in a room that was freely accessible. We also found thickener kept in an unlocked cupboard. This presented a risk as these medicines could be accessed by people living at the home, and had the potential to cause them harm. The registered manager took action during the inspection to address this concern. We found evidence that one person had not received their antibiotic medicine as prescribed; despite the records indicating it had been administered.

Risks to peoples’ health and wellbeing were not always well managed. There were sometimes gaps in the monthly review of risk assessments, and we found evidence of instances where timely actions had not been taken in relation to identified risks. For example, staff had been unable to put a pressure sensor mat in one person’s room that would help manage their falls risk. However, this had not been possible as the equipment was not working. No other measures had been identified to manage this risk until the inspection team raised this concern with the manager. No assessment had been completed in relation to any requirement for first aid provision, and at the time of the inspection only four staff had current first aid training. The registered manager confirmed after the inspection that sufficient staff had received this training to ensure there was always a member of staff trained in first aid on duty.

Care plans contained details about peoples’ preferences in relation to how they received their care, as well as information on their interests and social history. However, there was not always evidence that care plans had been regularly reviewed. Staff were able to demonstrate they knew about peoples’ care needs and preferences, although this information was not always up-to date in the care plans.

Staff told us there were sufficient numbers of staff to complete their duties and to meet peoples’ needs. The registered manager did not use a formal dependency assessment, but told us they would respond to changes in people’s needs by bringing in extra staff if required. During the inspection an additional member of staff was on duty in response to a persons’ potentially increasing needs.

People told us they liked the food provided, and we saw alternatives were available if people did not want the days’ choices. People were given adequate support and encouragement to eat and drink.

People told us they had good relationships with the staff who they felt knew them well. Relatives also said that staff were friendly and approachable. People told us they would feel comfortable to raise any concerns they might have with staff or the registered manager.

Peoples’ care plans contained information about their communication support needs. We observed that staff communicated clearly and effectively with people. One person spoke about receiving good information from staff in relation to their medicines.

The environment at Belmont Care Home was not ‘dementia friendly’. There was limited signage or and other adaptations that would help make the home more accessible to people living with dementia. We found few staff had received training in dementia care, although we received evidence shortly after our inspection that this had been booked by the registered manager.

The registered manager had limited support in the day to day running of the home. They acknowledged they had an excessive workload and regularly worked a 70 hour week. Following the inspection we received information that the provider was actively recruiting for a deputy manager to support the registered manager in their role.

Accurate and complete records of care provided were not always maintained. For example, staff were not able to locate a record of consultation with a person’s GP in relation to their weight loss, although they were able to recall the advice given. The registered manager and provider had submitted some notifications to CQC, but they had failed to notify us of all deaths, safeguarding and deprivation of liberty authorisations occurring at the home as is required.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Below is a summary of what we found. The summary is based on speaking with the registered manager of the service, speaking with care staff, observation of staffs interaction with people using the service and looking at staff rotas.

Is the service safe?

We found the service to be safe.

The registered manager and care staff we spoke with all confirmed that improvements had taken place in the way in which care staff rotas were now covered.

The rotas seen indicated that sufficient staffing levels were organised to make sure people received appropriate support to meet their assessed needs and their needs on a day to day basis.

The registered manager retained full authority for ensuring care staffing rotas were appropriately covered at all times.

We considered the evidence collected under the outcomes and addressed the following questions: Is the service safe; is the service effective; is the service caring; is the service responsive; is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

Many people living in the home were able to express their views about the care and support they received in the home. People told us they were very happy with the way staff provided care and they told us that they felt staff were well trained. People told us they felt safe and that they were confident in raising any issues of concern and believed they would be addressed.

When we looked at records we saw that people who lacked capacity were fully protected when decisions were necessary for their health and personal care needs.

We saw evidence to demonstrate that staff had received training relevant to their role. And this meant people using the service were met by a trained staff team.

Is the service effective?

When we spoke with relatives visiting the home they told us they were fully informed regarding their relatives care needs and were kept up to date with any changes. They told us that if they had any concerns they felt confident in raising their concerns and confident that they would be addressed.

Is the service caring?

During our observations we saw staff supporting people in a kind and sensitive way and in a manner that that promoted the dignity of people.

All the comment made by people living in the home and their families stated consistently that the staff were caring and kind. Comments included:

'The care staff here are so pleasant. They all seemed well trained and know what they are doing. The meals are not restaurant cuisine but they are perfectly adequate. I have no complaints, but if I did I would speak to a member of staff and I am sure it would be sorted out for me.'

'It's lovely here. In fact it's marvellous. The staff are kind and they listen to me.'

'I have no complaints. Now and then we have activities, there could be more.'

'The staff are absolute gems. I am happy with the staff, they are well trained and caring.'

We saw that care plans and medication records were checked regularly to make sure people's changing needs were being fully met.

Is the service responsive?

We saw that people's care needs were assessed before they were admitted to the home to ensure that the staff had the right skills to meet these assessed needs.

Records showed that when any new care needs were identified a new care plan was put in place. We saw that staff had a good understanding of people's individual care needs and monitored situations where appropriate and recorded their findings.

People told us that staff were good at listening. When we spoke with visiting professionals they told us that staff were good at identifying any care needs that required healthcare intervention and making appropriate referrals. This demonstrated that staff were responsive to people's changing care needs and took appropriate action to ensure people care needs were met.

Is the service well led?

There was a manager in post who was registered with the care Quality Commission. Systems were in place to assess and monitor the effectiveness of the service. There were systems in place to regularly audit and monitor all key aspects of care delivery including the auditing of medication, care plans and the environment.

We found that people who lived at the Belmont Care Home were cared for by staff who were supported to deliver care and treatment safely and who were trained to an appropriate standard.

When we visited the Belmont Care Home on this occasion we spent time talking with the people who used the service, their visitors, and three professionals who were visiting the home. People told us 'It's lovely here ' it's a very happy place'. Another person told us that they liked being able to choose in which lounge they sat according to whether they wished to join in an activity or not.

One professional told us that they thought that staff turnover in the home was low and that this made it 'really good here'. They said they were confident that any care they recommended was always carried out by the staff and that they were 'always pleased when one of my patients comes to live here because I know they will get the care they need'. Another professional said that they felt that sometimes communication with the home could be better but that recent staff shortages in their own service may not have helped with this. All the professionals we spoke to said that they thought that there had been improvements in care at the home over the last months.

We talked with staff and confirmed that they understood the importance of gaining people's consent to care and treatment and that this was appropriately recorded. We checked care records and found that these allowed the home to provide people with safe and appropriate care. We checked that there was appropriate training to support staff in providing care for people.

People told us that they liked living at Belmont Care Home and that the staff working there were 'like a big family'. Some people also said that they thought Belmont Care Home 'could do with some more staff' but that they could call staff when they needed to 'We've got call buttons. They (the staff) come when we call them'. People who used the service all spoke very highly of the manager.

We looked around the home and also inspected records and policies. We found that the home was adequately staffed for the numbers and needs of the people who were using the service at the time of our inspection. We saw that for most people consent was implicit in the way they used the service and that staff respected this.

We had concerns about the overall care plans for some people where poor nutrition was identified as a risk as well as certain other aspects of the care provided at Belmont Care Home.

Comments form people who used the service included "The staff are lovely", "Nothing is too much trouble" and "I like it here."

We spoke with a relative who commented "The home is clean and the staff seem nice" and "I am always offered a drink."

We looked at four care records and all had assessments for their health and social care needs completed. The details in the care plan documentation were good and they were evaluated on a regular basis. This meant the home could demonstrate they could meet people's needs and maintain their health and well being.

We found the provider had effective systems in place in relation to training its employees. We spoke to five staff members. They said "We all work well together", "The manager is good and knows her job well", "The training is brilliant" and "The staff care about the people who live here."