Archived: Belmont Grange Nursing and Residential Home

Belmont Grange Nursing and Residential Home is a large detached care home set out over two floors.

We found the following examples of good practice.

• The home had a dedicated infection prevention and control lead who was also their clinical lead. They monitored and ensured all staff adhered to current, national guidance and maintained high standards of infection prevention and control throughout the home.

• Staff were observed wearing appropriate personal protective equipment (PPE) at all times. Suitable supplies of PPE were available. Staff received regular training in infection prevention and control measures and appropriate use of PPE.

• The home ensured people moving into the home, isolating or presenting with any symptoms were supported safely in accordance with national guidance.

• The home provided people and their relatives with information to support their understanding of the isolation processes and visiting procedures.

• People were cared for by a dedicated staff team who provided a support bubble to meet all their needs and reduce any feelings of isolation and loneliness. This included a range of individual social activities and contact with friends and family.

• The home had purchased their own visiting Pod to support people to have face to face contact with friends and relatives. This was arranged through an appointment system. National guidance was being followed to ensure visits took place at a safe social distance. Infection prevention and control measures were in place to avoid potential transmission with others.

• The home was aligned with a GP practice and weekly virtual ward rounds had been introduced. Other care professionals who worked closely with the service attended these.

• All staff and residents were actively participating in the Covid testing programme. Staff were tested weekly and people living at the home, monthly. All staff and residents were in the process of having their winter flu vaccinations.

Further information is in the detailed findings below.

Belmont Grange is a residential care home providing personal and nursing care to 29 older people at the time of the inspection. The service can support up to 30 people.

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

We received extremely positive feedback from people, they told us they were exceptionally happy living at Belmont Grange. They told us they enjoyed being an important part of the local community and spoke extremely highly of the staff team and the level of care and support they received. Relatives spoke very highly of the home and were confident in the care and support their relatives were receiving and the improvements being made to their well-being.

People were continually supported to build new and maintain existing special personal relationships that mattered to them; with partners, peers, friends and relatives.

The registered manager and staff supported people at the home to make valuable connections with other voluntary groups to help tackle social isolation and to support each other. People were able to access a superb range of activities in the home and outside which promoted reminiscence, education and improved wellbeing.

People were supported to be ‘resident representatives’ to have their say and to exercise their rights. Access to an advocacy service was available if required. Support was provided in a way which put the people and their preferences first. Information was readily available for people in the correct format for them, including social media, online platforms and audio books.

People received person-centred support and staff knew people extremely well. The care plans in place covered all aspects of peoples care and support preferences, ensuring people received care which was a personal and individualised experience that had a positive impact on their lives.

People were supported emotionally and confidentially to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and leadership in the service ensured this practice was the norm.

Healthcare professionals highly recommended the home and spoke positively of the registered manager and staff team and were included in people’s care and support as and when needed. People were supported to by a ‘fluid buddy’ system to have enough to drink. People who need specialist diets were supported.

The environment was very clean and homely and maintained to a high standard with personalised bedrooms. Audits and monitoring systems were used effectively to manage the service and to make improvements as and when required.

There were enough staff to support people and staff were always visible. Staff received support and a variety of appropriate training to meet people’s needs.

Medicines were managed well, safely administered and recorded accurately. Individualised risk assessments were in place. Staff were confident they would raise concerns to safeguard people. Robust recruitment and selection procedures ensured suitable staff were employed.

There were excellent systems in place for communicating with staff, people and their relatives to ensure they were fully informed, this was via handovers, team meetings, phone calls and emails. People had exceptionally good links to the local community through regular access to local services.

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 (1 March 2017).

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 Grange Nursing and Residential Home provides care and accommodation for up to 30 older people. On the day of our inspection there were 23 people using the service.

The service had a registered manager in place. 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.

Belmont Grange Nursing and Residential Home was last inspected by CQC on 7 December 2015 and was rated Requires Improvement overall and in four areas; Safe, Effective, Responsive and Well-led. Following the last inspection, the registered provider sent us an action plan. During this inspection we checked to see whether these actions had been completed and improvements made.

Accidents and incidents were recorded and analysed. Risk assessments were in place for people who used the service and described potential risks and the safeguards in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Belmont Grange Nursing and Residential Home. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care plans were in place that recorded people’s plans and wishes for their end of life care.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person centred way.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs. The service had links with the local community.

The registered provider had an effective complaints policy and procedure in place and people who used the service and visitors were aware of how to make a complaint.

Staff felt supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service. People and visitors told us the management team were approachable and accommodating.

Below is a summary of what we found. The summary is based on our observations during the inspection and speaking with people using the service, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they were treated with respect and dignity by the staff. They said they felt safe. We found safeguarding procedures to be robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We also found relevant staff had been trained to understand when an application should be made, and how to submit one. This meant people were safeguarded as required.

The service was safe, clean and hygienic. This was confirmed by the Infection Control Team who had recently visited the home. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

The registered manager set the staff rotas, they told us they took people’s care needs into account when making decisions about the staffing numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were met.

Is the service effective?

There was an advocacy service available if people needed it, this meant people could access additional support when required.

People’s health and care needs were fully assessed with them, and they or their representatives were fully involved in writing their plans of care. We saw people's care plans and risk assessments had been signed by people who used the service or their relatives/representatives.

Specialist dietary, social, mobility, equipment and dementia care needs had been identified in care plans where required.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical, memory and mental health impairments.The provider was planning to extend the existing conservatory in order to create additional communal space for people using the service.

People who used the service confirmed they were able to see people in private and that visiting times were flexible.

Is the service caring?

People told us they were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. People commented, “The staff are very good. They put me first,” “This is a really nice place to live. They look after me very well, there is a good choice of meals available each day. It’s a very friendly place." and “They the staff are very good. I feel safe here.” A relative told us that the care at Belmont Grange was excellent. Another told us, “I couldn’t fault the care my relative receives, they have been in two previous homes and this is by far much better, my relative is so much happier here.”

The provider told us they will be asking people using the service, their relatives, friends and other professionals involved with the service to complete an annual satisfaction survey. Where any shortfalls or concerns are raised, the provider will use this information to put things right.

People’s preferences, interests, aspirations and diverse needs were recorded and care and support was provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly.

People we spoke with knew how to make a complaint if they were unhappy.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. The records we looked at showed any shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. This helped to ensure that people received a good quality service.

The service worked well with other agencies and services to make sure people received their care in a joined up way.