Background to this inspection
Updated
18 April 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act.
As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by 2 Inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Belton House Retirement Home is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Belton House Retirement Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we held about the service and spoke with commissioners, responsible for funding some of the care for people using the service. We used the information the provider sent us in their latest provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 3 people who used the service and 7 relatives. We spent time observing care and support in communal areas to understand the care experience of people who were unable to share their views. We met with the 4 staff including the registered manager and 3 care staff. We reviewed care plans and records for 4 people and sampled medicine records. We reviewed training and recruitment records for staff. We also reviewed other records, including policies and procedures, relating to the safety and quality of the service.
Updated
18 April 2023
About the service
Belton House Retirement Home is a residential care home providing personal care to up to 30 older people. At the time of our inspection there were 13 people using the service, many of whom were living with dementia. The accommodation is over two floors of a large period property with bedrooms on the first floor serviced by a lift.
People's experience of using this service and what we found
The provider had made some improvements to the service. However, not all the requirements of the previous enforcement we took had been met.
The provider and registered manager had implemented systems to monitor, assess and improve the quality of people's care and the environment. However, these systems were not always effectively embedded and sustained at the time of this inspection. Although governance at the service showed some signs of improvement since our last inspection, not enough been done at this inspection and we were still concerned that full oversight had not been established. Concerns we identified at this inspection had not been identified by the provider's own systems.
People's care plans had been reviewed since our last inspection. However, these did not always provide the information and guidance staff needed to keep people safe. In particular, records around positive behaviour support and daily health monitoring were not always accurate or reflective of people's needs. This put people at risk of harm.
Systems to ensure people received their medicines safely required review as these were not always followed or sufficiently robust.
The deployment of staff required review as there were times when people were left unsupervised in and around communal areas which put people at risk of harm.
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. We observed people being offered choice during both days of inspection, and people told us they were offered choice. However, we identified care plan interventions required further review and expansion to ensure correct processes were taken using least restrictive practices.
The provider and registered manager had made improvements to safeguarding processes and structures and worked to establish effective communication with relevant, external agencies. Improvements had been made to ensure people were protected from the risk of infections.
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 27 October 2022) and there were breaches of Regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.
Why we inspected
We carried out an unannounced inspection of this service on 3 August 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the breaches of Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 17 Good governance and Regulation 18 Staffing.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained Inadequate. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Belton House Retirement Home on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to Safe care and treatment, Staffing and Good governance.
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
The overall rating for this service is ‘Inadequate’ and the service remains 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.