Belmont House Care Home

Belmont House Care Home is a residential care home providing personal and nursing care to up to 106 people. The service provides support to both older people and younger adults, some of whom are living with dementia. At the time of our inspection there were people 69 people using the service.

Belmont House Care home is a large purpose-built home split across five separate units. One of these units had recently been refurbished but was not in use at the time of the inspection. Two of the units specialise in supporting people living with dementia.

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

Care records did not always provide enough guidance for staff around how to deal with people’s known needs or behaviours. Records to monitor and document care provided, and the related risks, were not always completed.

Feedback about staffing levels in the service was varied and improvements had been made to staffing with a reduction in the use of agency staff over recent months. However, people still felt they needed more staff to assist them and run activities in the service. The registered manager was actively trying to recruit more staff. There is a continued recommendation about the review of staffing levels and deployment within the service.

Audits and checks were in place to ensure the safety and quality of the service. However, these were not effectively embedded and had therefore not highlighted issues we found on inspection.

Staff had a good understanding of safeguarding and action was taken to mitigate risk.

The environment was clean, well maintained and safe for the people living there. Regular checks were completed to ensure the premises were safe and staff carried out regular fire drills and evacuations.

Feedback about the registered manager and leaders in the service was positive and people felt supported. Staff had a positive approach towards their work and the people they supported, they had a strong desire to improve the quality of the service they provided.

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 Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 December 2020). 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 some improvement had been made but the provider was still in breach of regulations.

Why we inspected

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 changed from requires improvement to good based on the findings of 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 Belmont Care 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.

We have identified breaches in relation to records and governance at this inspection and have made recommendations around staffing levels and deployment.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Belmont House Care Home is a care home providing personal and nursing care to up to 106 people aged 65 and over some of whom may be living with dementia. When we inspected 64 people lived in the service.

Belmont House Care Home can accommodate people across five separate units spread over three floors, each of which has separate adapted facilities. The unit on the top floor was not in use. One of the units provided residential care and three of the units in use provided nursing care.

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

People were at risk of avoidable harm because the systems in place to protect them were not used effectively. This included lack of correct details in care plans for staff to follow and poor monitoring of people’s health outcomes such as hydration, nutrition and pressure area care. Records in relation to people’s health and well-being and advice from professionals were not a complete record of care and treatment provided. There was a lack of management oversight of accidents and incidents to ensure lessons were learnt to prevent a future reoccurrence.

The checks the provider made to understand quality and safety had highlighted most of the areas for improvement we identified. Action plans were in place, but effective action had not been taken to make sustained improvements.

People told us staff were often rushed and they had to wait for support. People also missed important support such as morning refreshments because staffing was disorganised. The provider re-arranged staffing immediately following our feedback. We made a recommendation for the provider to review how they seek and listen to feedback and make observations to ensure staffing deployment is effective and ensure people receive responsive person-centred support.

Belmont House Care Home staff team and people who use the service have lived through the stressful period as the pandemic has continued. They have also seen a turnover of staff and management. This has meant agency workers have supported the team. This experience has affected morale and people’s view of the service. The provider is committed to providing on-going support to the team to impact positively on their morale and people’s experience of using the service.

The introduction of the new manager has been a positive boost and staff told us they all focus their efforts daily on providing the best care possible to people. The provider has a plan to enable staff to do this moving forward. This included support for the team and the recruitment of permanent members of staff.

Medicines were well managed. The environment and equipment safety were managed well. Infection control ensured a clean environment and we signposted the provider to advice around how they can better support people to socially distance and manage staff arrival and breaks in the service to prevent asymptomatic spread of the virus.

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 01 July 2019).

Why we inspected

We reviewed the information we held about the service and this highlighted risks we needed to review. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating 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 Care Home on our website at www.cqc.org.uk.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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 safe care and treatment of people and oversight of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

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

Belmont House Care Home is a residential care home providing personal and nursing care to 90 people aged 65 and over at the time of the inspection. The service can support up to 106 people.

Belmont House Care Home accommodates people across five separate units spread over three floors, each of which has separate adapted facilities. All the units provide care to people living with dementia, three of the units provide nursing care.

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

Since the last inspection the provider and registered manager had reviewed their systems and had made changes. They had worked closely with professionals to review their medicine systems. New quality assurance checks had been developed and were used to identify actions required and drive improvements.

People, their relatives and staff felt engaged in the running of the service. Changes were communicated effectively.

People felt safe living at the service and were satisfied with the support they received to take their medicines. Risks to people were well-managed, supporting them to be safe.

People achieved good outcomes through effective coordinated support by the staff team and healthcare professionals. 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 formed close, supportive relationships with staff. Staff were able to anticipate their needs and recognised their abilities and limitations, promoting their independence.

Care plans were person-centred, including information about people’s preferences and routines. Staff provided responsive care, adapting this as people’s needs changed. People and relatives felt their feedback was welcomed and were confident any concerns would be acted on appropriately.

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 (18 May 2018). 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 regulations.

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 re-inspection programme. If we receive any concerning information we may inspect sooner.

Belmont House Care Home is registered to provide residential and nursing care for up to 106 older people and people who may be living with dementia. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service is purpose built and accommodation is provided in five separate ‘suites’, spread over three floors. On the ground floor, the Courtyard Suite provides residential care for up to 30 people and the Garden Suite provides nursing care for up to 14 people. On the first floor, the Park Suite provides residential care for up to 17 people and the Promenade Suite provides nursing care for up to 26 people; both of these units specialise in supporting people who may also be living with dementia. On the second floor, the Springwater Suite provides nursing care for up to 14 people.

At the time of our inspection, 94 mainly older people and people living with dementia and nursing needs were using the service.

The service had a registered manager. They had been the registered manager since August 2013. A registered manager is a person who has registered with the 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.

At the last inspection in January 2017, we rated the service ‘requires improvement’ and identified two breaches of regulation. We asked the provider to take action to ensure medicines were managed safely and to improve the quality monitoring and governance of the service. At this inspection, medicines were still not managed safely. Audits had not been effectively used to identify and address the concerns we found.

This was the third inspection where the service was found to be in breach of one or more regulations and rated requires improvement. This showed us the provider had not operated effective systems and processes to ensure the quality and safety of the service.

We found two continued breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the registered provider to take at the end of this report.

People who used the service told us they felt safe. Staff had training to enable them to identify and respond to safeguarding concerns. Allegations of abuse were investigated in consultation with the local authority safeguarding team. The provider had systems in place to respond to complaints about the service and took action to make improvements when necessary.

Robust recruitment checks helped ensure suitable staff were employed. We received mixed feedback about staffing levels. We found staffing levels were sufficient to meet people’s needs, but spoke with the registered manager about continuing to monitor staff deployment across the service.

The provider had taken positive steps to create and maintain a dementia friendly environment. The service was clean, tidy and generally well-maintained. Systems were in place to reduce the risk of spreading infections.

Staff received a comprehensive induction and regular training to develop the skills needed to provide safe and effective care. The provider was proactive in offering additional training opportunities to support continued professional development. Nurses were supported to develop and maintain their clinical skills.

People gave generally positive feedback about the food and staff provided effective support to ensure people ate and drank enough. Concerns regarding weight-loss were shared with healthcare professionals.

People were supported to make decisions and their rights were protected in line with relevant legislation and guidance on best practice.

People told us staff were kind and caring. Staff respected people’s privacy and dignity.

Care plans contained person-centred information about people’s needs and preferences. Staff showed a good understanding of how best to support people. Staff received training to enable them to provide person-centred care for people reaching the end of their life.

The activities coordinators were creative and enthusiastic and led on arranging a wide range of activities to provide meaningful stimulation for people who used the service.

The registered manager was responsive to feedback. There were clear lines of communication and information was effectively shared. This ensured an organised and coordinated approach to providing care. Whist some people who used the service did not know who the registered manager was; we received generally positive feedback about how approachable they were. Staff told us advice, guidance and support was always available when needed.

We previously carried out an inspection in October 2015, where we found the registered provider was not meeting all the regulations we inspected. We found the registered provider did not have suitable arrangements in place for obtaining, and acting in accordance with the consent of people in relation to their care and treatment as required by the Mental Capacity Act 2005. We also found that the registered provider did not have suitable arrangements in place to ensure the deployment of staff protected people from the risk of harm. We told the registered provider they needed to take action. We received an action plan from the registered provider telling us what they were going to do to address the shortfalls.

During this inspection we found that the assurances from the registered provider had been implemented with the necessary improvements being made across the service. However, we found shortfalls relating to the safe management of medicines. We also identified failings in the quality monitoring systems.

Belmont House provides residential, nursing and personal care for up to 106 people. The home is divided into five separate suites, spread over three floors. The Courtyard suite provides residential care for up to 30 people. The Garden and Springwater suites both provide nursing care for 14 people each. The Park suite provides residential care for up to 17 people who are living with dementia. The Promenade suite also provides care for 26 people who may be living with dementia, but also need nursing care.

The service had a registered manager. 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.

Overall people told us they felt safe. Staff understood how to safeguard people from abuse. We saw from the rotas that staffing levels were based on the registered provider’s assessment of people’s needs. However we recommended that the registered provider review their staffing levels more frequently to make sure there were no gaps in staffing provision. The recruitment process was robust and staff completed an induction when they started work. This reduced the risk of unsuitable people being employed. People were supported and cared for by skilled, well trained staff who took pride in their work.

We found that people were encouraged to exercise choice and control in all aspects of their lives wherever possible. Key people were involved in most of the best interests meetings for people who required additional support with decision making.

Any risks around peoples care were identified. Where risks were identified action was taken to minimise these whilst protecting individual's rights and freedoms.

People had food and drink to meet their needs. People were supported to receive their medicines as prescribed and to access their health care appointments to make sure they received appropriate care and treatment.

We observed good relationships were present between people who used the service and staff. Staff were knowledgeable about the people they supported. This was confirmed in feedback we received about the service. During the whole inspection we noted multiple examples of good practice, excellent care delivery and an atmosphere of caring, compassion and a relaxed environment.

People had comprehensive care and support plans in place. However, the level of detail varied across the service. The information guided staff on people’s preferred approach to meet their care needs. An example of this was how one person liked to have their clothes protected whilst eating at the table.

A complaints procedure was in place. People confirmed they knew who to speak to if they had any worries or if they were unhappy about something. People told us they had not raised a complaint but said they knew how to if they needed to. People told us they thought they would be listened to if they raised an issue. They said the registered manager and the registered provider would act upon any concerns raised with them.

The registered provider undertook a range of audits to check on the quality of care provided. However, these were not always effective at highlighting issues which needed attention. People were asked for their views and their comments were used to identify improvements.

We found two breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the registered provider to take at the end of this report.

As part of this inspection we looked at records for eight people who used the service. We spoke with the manager and deputy manager. We spoke with nine people who lived in the home and four relatives of people who lived in the home. We also spoke with eight care and nursing staff. We reviewed records relating to the management of the home.

Below is a summary of what we found. The summary describes what people who used the service and staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We had received information prior to carrying out the inspection; this included information regarding the staffing levels and the impact that this was having on the delivery of safe support to people. The manager and deputy manager confirmed during our visit that there had been some changes to staffing structures recently. This had resulted in some vacancies and had caused there to be minor staff shortages on some occasions. When we spoke with people who used the service and relatives, comments included 'I get a general sense that staff are very busy but they do seem to have time to spend with people' and 'I don't have to wait when I ring the bell'.

We found that the service undertook checks on staff before they commenced employment in the home. This included checks of people's criminal records and identification as well as employment history and references from previous employers. Staff also underwent an induction training programme which included shadowing experienced members of staff and completion of mandatory training. This ensured that staff were safe to work with vulnerable people.

There were records showing that staff accessed regular training, both mandatory and specialist. This included training around areas such as dementia, person centred support, infection control and safeguarding. This meant that staff had the appropriate training and experience to deliver support to people using the service.

Is the service effective?

The service was split into five separate units which included a dementia unit, a dementia nursing unit, a nursing unit and a residential unit. This meant that people could be supported according to their individual needs.

People had an individual care plan. We saw that care plans contained useful information and in some cases families had been involved in the development of these. In one case the person had written their own care plan and had recorded how they wished to be supported. This involvement from people themselves or their families meant that the care and treatment being received was effective for those using the service. The risk assessments we saw in the records were sufficiently detailed to identify and minimise risks. The service was appropriately assessing risk and providing guidance for staff about to how to manage and minimise these risks.

When we spoke with people who used the service they were very pleased with the support they received from staff. One person told us 'No complaints, I am very happy with the care'. When we spoke with staff they told us that they felt they were providing good and effective care. None of the staff we spoke with felt that people were not getting the care they needed with regard to eating and drinking, personal care and medication.

Is the service caring?

All the staff we spoke with were enthusiastic to provide a sustainable, effective service. Individual staff spoke confidently about the high standard of care they were expected to provide. The manager and deputy management were also keen to ensure that the service was offering the best quality service it could.

When we spoke with people who used the service they were very complimentary about the quality of support that was provided by staff. One person told us 'Staff are very kind and helpful'. The interactions we observed throughout our visit were very good. Staff spoke with people in a friendly and clear manner. When people were assisted to move or complete an activity instructions and support was straightforward and appropriate in nature. Staff knew people well and offered care that was calm, clear and friendly.

Is the service responsive?

There were audit systems in place regarding the environment, delivery of care, documentation and people's satisfaction with the service they received. This allowed management to monitor the quality of service. The systems in place for highlighting issues and learning from accidents, incidents, surveys and resident meetings, staff feedback and complaints were used to lead to improvements in the service.

The management arrangements had recently been restructured and this had resulted in some changes in the staff team. This meant that there was on-going work being completed with regard to duties and responsibilities within the new structure.

We spoke with people who used the service about the ways they were able to feedback and how this information was used. One person told us 'I feel confident the manager would address any issues'. A relative told us 'We have only had minor niggles which get resolved very easily and quickly'.

Is the service well-led?

Due to changes in the structure at the service there had been some upheaval in staffing arrangements. There were some vacancies that were being recruited to at the time of our inspection and the impact of this was being managed by both the manager and other senior staff.

The manager and the deputy manager and team leaders had spent time defining their roles and this process was now being undertaken for the less senior roles. All the staff that we spoke with felt that the manager and senior management team were focussed on the service being high quality. One staff member told us 'We are a good team all work well together'. Another told us 'I feel the team work well together, I feel able to raise issues with the manager and in staff meetings and I get good support from unit manager'.