Archived: Belton House Retirement Home

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.

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 21 people using the service. 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

People were not supported safely. Risks to peoples' safety were not assessed or monitored effectively and were not well managed. Incident records were not reviewed, and not enough action was taken to minimise the risk of further incidents. Care plans did not contain sufficient information to guide staff as to how to support people to manage specific risks associated with their needs. Accidents and incidents were not always recorded and analysed in a timely manner. An allegation of abuse had not been reported to the Care Quality Commission or the safeguarding team, which meant we were unable to check the provider had taken appropriate action in response to these events. Medicines were not always managed safely.The risk of the spread of infection was not well managed.

The providers' governance processes did not highlight the concerns we found at this inspection. Quality monitoring and management oversight continued to be ineffective at identifying and addressing shortfalls in areas such as medicine administration, the prevention of infection, health and safety and care planning.

Staff did not receive the support and guidance they needed to be effective in their roles and meet people's needs. The provider had not identified that staff required training around individual health needs and conditions, such as distressed behaviours and mental health. Staff did not always support people to access healthcare and treatment in a timely manner.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support good 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 15 May 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 we found the provider remained in breach of regulations.This is the third consecutive inspection where the provider has been rated requires improvement.

Why we inspected

We carried out an unannounced inspection of this service on 19 March 2021. Breaches of legal requirements were found. We served Warning Notices in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We carried out an infection prevention and control inspection in January 2022 and found the breach of Regulation 12 had been met.

We undertook this focused inspection to check the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective 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 changed to inadequate. 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 COVID-19 and other infection outbreaks effectively.

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

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.

We have identified continued breaches in relation to consent to safe care and treatment 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

Belton House Retirement Home is a residential care home providing personal care to older people with a physical disability, sensory impairment, dementia and mental health needs.

The service is registered to support up to 30 people across two separate floors. 17 people lived at Belton House Retirement Home at the time of inspection.

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

This was a targeted inspection that considered safe. Based on our inspection of safe we found checks were in place to screen visitors for symptoms of COVID-19 before they entered the service.

All visitors were screened for symptoms of COVID-19 and were required to show a negative Lateral Flow Device (LFD) test result before they entered the service. Signage was displayed outside the service, detailing the requirement for visitors to wear personal protective equipment (PPE), such as face masks.

The acting manager understood the requirement to make sure all non-exempt care staff and other professionals visiting the service had been vaccinated with a complete course of an authorised vaccine for COVID-19.

The manager was reviewing systems and processes to align the recording of COVID-19 testing outcomes; staff and professional visitor’s vaccination status and screening checks to make it easier to access.

A separate area had been allocated for staff testing to be undertaken. Staff took part in regular 'whole home testing' to ensure they were not infected with COVID-19.

People were able to speak with friends and family via telephone and video calling. Visits to the service were supported in line with government guidance. A mobile café visited the service once a week, enabling people to meet for coffee outdoors.

The service was clean. Whilst the housekeeper was employed to work on weekdays only, care staff working at the weekend had cleaning schedules to follow, which included cleaning of frequently touched points such as light switches or door handles.

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 (15 May 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 we found improvements had been made in Safe and the provider was no longer in breach of regulation 12.

Why we inspected

We received concerns about the cleaning at the service. We undertook this targeted inspection to look at these concerns and to review whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The warning notice detailed our concerns about infection prevention and control measures at the service.

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 COVID-19 and other infection outbreaks effectively.

CQC have introduced targeted inspections to follow up on Warning Notices or to check 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.

Follow up

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

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.

The service can support up to 26 people across two separate floors. 21 people lived at Belton House Retirement Home at the time of inspection.

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

The registered manager failed to implement all the required infection prevention and control procedures. They failed to implement recommendations and advice given to them from reports from other agencies regarding these.

The service did not consistently screen visitors for symptoms of COVID-19. Social distancing was not promoted in the service. Bedrooms were not consistently deep cleaned, and weekend staff had not recorded the cleaning of frequently touched areas such as door handles and light switches. People’s COVID-19 risk assessments did not consider their individual risks associated with their diagnosed conditions.

Improvements were required to the monitoring of the quality and safety of the service as planned audits had not been completed consistently or to a sufficient standard. There was a potential for people to be placed at risk due to the length of time between checks as areas that required repair or improvement had not been identified.

We found the following examples of good practice

Testing was completed for staff and people living at the service. This meant prompt action could be taken should anyone test positive for COVID-19.

Staff were observed wearing the correct Personal Protective Equipment (PPE) in line with government guidance. PPE was accessible throughout the service.

People were supported to maintain contact with family members and friends via phone and video calling.

People were admitted to the service safely and were supported to isolate on admission in line with government guidance.

Staff understood the principles of isolation, co-horting and zoning should there be a COVID-19 outbreak. The service had learned lessons from a COVID-19 outbreak during November 2020.

People were supported to attend hospital appointments. Staff ensured measures were taken to reduce risks to people such as regular handwashing, use of hand gel and PPE.

People’s risks had been assessed and care plans guided staff on how to mitigate these known risks.

The service deployed enough staff to meet people’s needs. The registered manager ensured people were cared for by staff they knew, even when using agency staff. All staff received an induction and were recruited safely.

People received their prescribed medicines safely. People were protected from abuse as staff understood their responsibilities and how to report their concerns.

Further information is in the detailed findings below.

Rating at last inspection

The last rating for this service was good (published 19 December 2019). 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.

Why we inspected

The inspection was prompted in part due to concerns received about infection prevention procedures, staffing numbers and medicines management. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections 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 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 safety and managerial oversight of safety at this inspection.

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

Follow up

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.

Belton House Retirement Home is a residential care home providing personal care to older people with a physical disability, sensory impairment, dementia and mental health needs.

The service can support up to 26 people across two separate floors. 19 people lived at the home permanently and three people were temporarily staying at the home to receive a short break at the time of inspection.

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

Improvements had been made to quality assurance systems and processes which enabled the management team to identify areas for improvement. People knew the management team by name and told us they were confident any concerns raised would be actioned. The management team sought feedback from people about their care experience to ensure any issues were promptly addressed. People, relatives and staff told us they would recommend the service. A relative said, “I would recommend here. It's a good service, very caring.”

Improvements had been made to medicines systems and processes. People received medicines on time and as prescribed. People were supported by staff that had been safely recruited. Staff kept people safe from harm and abuse. Staff had a good knowledge of risks associated with providing people's care and had received adequate training to meet people's individual care needs.

Staff were kind, caring and compassionate. They enjoyed their work and treated people as if they were a

family member. People and staff had built positive relationships together and enjoyed spending time in

each other's company. Staff were respectful and open to people of all faiths and beliefs. People's privacy

and dignity was respected, and their rights upheld.

People were supported by staff who knew their preferences, wishes, hobbies and interests and supported

them to engage in these. People enjoyed a wide variety of activities and their independence was promoted. People knew how to raise a concern or make a complaint and felt confident concerns would be addressed.

People were supported to have maximum choice and control of their lives and staff supported them in the

least restrictive ways possible; the policies and systems in the service supported this practice. People's

needs were assessed before they moved to the service to inform the development of their care plans. People

were supported to eat and drink enough and received healthcare support as needed.

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 03 January 2019) and there was a

breach 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 we found improvements had been made and the

provider was no longer in breach of regulation.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Belton House Retirement Home provides personal care and accommodation for up to 22 older people some of whom have dementia. On the day of our inspection there were 20 people living at the service.

We inspected on 20 November 2018. Our visit was unannounced. This meant the staff and the provider did not know we would be visiting.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 quality assurance systems in place identified areas that needed improving. The registered manager had developed an improvement plan to enable the service to prioritise areas for action. Whilst we found the registered manager had implemented improvements that impacted positively on people, further improvements were required and we could not be assured these would be sustained or were embedded in practice.

Records kept for people who were at risk of not getting the food and drink they needed to keep them well, were not always accurate or up to date.

People had not always received their medicines as prescribed by their GP. Current systems in place to audit the medicines held, needed reviewing.

People did not always feel safe living at Belton House Retirement Home because other people living at the service sometimes entered their bedrooms uninvited.

Whilst the staff team had received training in infection control, they had not always followed the providers infection control policy for the effective disposal of continence products.

People’s care and support needs had been assessed prior to them moving into the service and the risks associated with their care and support had been identified.

People had plans of care in place, though not all were up to date or accurately reflected people’s current care or support needs.

People felt on the whole there were sufficient numbers of staff on duty with the right skills and knowledge to meet their care and support needs.

The registered manager followed the provider's recruitment process. Appropriate checks had been carried out on new members of staff to make sure they were suitable to work at the service.

On the whole, people were provided with a comfortable place to live and there were appropriate spaces to enable people to either spend time on their own, or with others.

People told us the staff team were kind and caring and treated them with respect. Observations made during our visit confirmed this.

The staff team supported people to make decisions about their day to day care and support and they were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments had been completed to ensure any decision made on behalf of a person had been made in their best interest. Consent to people’s care and support was always obtained.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People had access to relevant healthcare services such as doctors and community nurses and received on-going healthcare support.

The staff team felt supported by the registered manager and the management team and told us there was always someone available to talk with should they need support or guidance.

People knew who to talk to if they had a concern of any kind. A formal complaints process was in place and this was displayed for people’s information.

A business continuity plan was available to be used in the event of an emergency or untoward event and the registered manager made sure lessons were learned when things went wrong to improve the service provided.

The provider and registered manager were aware of their registration responsibilities including notifying CQC of significant incidents that occurred at the service.

At this inspection, we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

Further information is in the detailed findings below.