Archived: Bellevue Residential Care home

Updated 13 April 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by information received about how risks at the service were managed. This inspection was unannounced and focused on the areas of Safe and Well led.

Two inspectors undertook the inspection on the first day of the inspection and one inspector on the second day. Prior to our inspection we reviewed information we held about the service. This included any statutory notification that had been sent to us. A notification is information about important events which the service is required to send us by law. We also spoke with the quality team at Essex County Council about their visits to the service.

We spoke with four members of staff, a member of staff who had recently left, the registered manager and the management consultant. We observed how people were supported throughout the day of the inspections. We reviewed care and support plans, medication administration records, staffing rotas and records relating to the quality and safety monitoring of the service.

Updated 13 April 2018

Bellevue Residential Care Home is registered to provide care and support for up to ten older people. The service supports people living with a diagnosis of dementia and or mental health needs.

The last comprehensive inspection of this service was undertaken in March 2017. We identified a number of breaches of the legal requirements and found that people were not sufficiently protected against risks, the premises were not clean and there were not always sufficient staff available to support people and meet their needs. After the comprehensive inspection, the provider told us that they were addressing the concerns and we subsequently met with them to discuss the actions that they were taking. We undertook a focused inspection on 28 November 2017 to check that the provider had followed their action plan and to confirm that they now met legal requirements. We found that they had not addressed the issues and were still not meeting the regulations. We rated the service as ‘Inadequate’ and Bellevue went into ‘special measures’.

Following this focused inspection we placed urgent conditions on the provider’s registration with the aim of driving improvement. These conditions meant that the provider was unable to admit any new people into the service and they had to ensure that there was sufficient and suitable food available to meet people’s needs. Appropriate referrals were to be made to health professionals for advice and guidance. We required the provider to commission an independent review of training and health and safety to address some of the issues we found.

This inspection on 21 and 22 February 2018 was unannounced and we planned to check on the progress the provider had made. It was also prompted in part by information we received which indicated that people’s needs were not always being met.

There were ten people living at the service on the day of our inspection. This report only covers our findings in relation to Safe and Well led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bellevue Residential Home on our website at www.cqc.org.uk”

The service had a registered manager who was also a director of the company which owned the service. The registered manager was also registered to manage another care home for older people in Clacton which they also owned. 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.

At this inspection we found that sufficient progress had not been made and the provider continued to be in breach of multiple regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Practices at the service did not protect people and there was a lack of understanding of the causes of behaviour and how people’s distress should be managed. Staff did not always support people in the least restrictive way possible and in way that promoted their wellbeing.

There were some risk assessments in place but these did not adequately address risk and staff were not always aware of, or followed the management plan. We identified issues with moving and handling, the support provided to people with catheters and those at risk of aspiration or choking. Following the inspection we asked the registered provider to take urgent action to protect people and we raised our concerns with the safeguarding team at the local authority.

Environmental risks continued not to be well managed and we identified that issues were not always addressed in a timely way. We identified continued issues with the management and oversight of medicines. Staff were not always following the recommended guidance and we were not assured that people always received their medicines as prescribed.

At the inspection we found continued issues with the competency and availability of staff which meant that people continued to be at risk of poor care. Staff did not demonstrate that they had sufficient levels of training or expertise to meet the complex needs of the people living in the service. Staff morale was low and they did not feel supported.

There were quality assurance systems in place but these had not been effective in driving change at the service. Sufficient improvement had not been made since our last inspection.

The overall rating for this service remains ‘Inadequate’ and the service remains 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

Following the inspection CQC reviewed the concerns and took appropriate action. There is no one currently living in the service.