We inspected Belmont View on 23 and 26 January 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.
Belmont View is a residential care home situated in Guisborough. The home can accommodate up to a 50 people over two floors and offers a care service for older people and individuals who are living with dementia. At the time of the inspection 49 people used the service.
The home had a registered manager in place and they had been in post since January 2012. 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.
People we spoke with told us they felt the staff did a wonderful job and made sure their needs were met. We found that people were encouraged and supported to take responsible risks and positive risk-taking practices were followed. Those people who were able to were encouraged and supported to go out independently and others routinely went out with staff.
We saw that on the units for people, who experienced dementia, staff matched their behaviour to people’s lived histories (the time of the person’s life they best recall) and this enabled individuals to retain skills and work to their full potential.
People told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice. We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff that were jovial and supportive. Staff were kind and respectful, we saw that they were aware of how to respect people’s privacy and dignity.
Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training and understood the requirements of the Act. Where people had difficulty making decisions we saw that staff gently worked with them to work out what they felt was best. We saw that when people lacked the capacity to make decisions staff routinely used the ‘Best Interests’ framework to ensure the support they provided was appropriate. This meant staff worked within the law to support people who may lack capacity to make their own decisions.
People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.
People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained comprehensive and detailed information about how each person should be supported. We found that risk assessments were very detailed. They contained person specific actions to reduce or prevent the highlighted risk.
We reviewed the systems for the management of medicines and found that people received their medicines safely.
People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.
People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. They found the staff worked very hard and were always busy supporting people. Two senior care staff and six care staff were on duty during the day and two senior care staff and four staff on duty overnight. We found information about people’s needs had been used to determine that this number of staff could meet people’s needs.
Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Staff had received a wide range of training, which covered mandatory courses such as basic food hygiene as well as condition specific training such as working with people who lived with dementia. We found that the provider not only ensured staff received refresher training on all training on an annual basis but offered staff regular access to a wide range of course and educational material. They worked closely with local colleges, accessed a variety of distance learning courses and provided an educational library in the home. The home offered apprenticeships and placements for students. The registered manager completed a staff training session on a quarterly basis and these covered various topics with the latest being the change in the Health and Social Care Act 2008 regulations. We found that the staff had the skills and knowledge to provide support to the people who lived at the home.
We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. A designated infection control champion was in post and we found that all relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.
The provider had developed a range of systems to monitor and improve the quality of the service provided. We saw that the registered manager had implemented these and used them to critically review the service. This had led to the systems being extremely effective and the service being well-led.
The registered manager had enrolled the home in a number of pilots for encouraging best practice in care and the home had won several awards for instance an award of supporting people with oral hygiene and a food award. Plus the provider had been achieved ‘Investors in People’ award over consecutive years. They were completing the ISO award (which is an accredited scheme for ensuring quality assurance processes are effective) and staff were part way through completing the Gold Standard Framework (which promotes good end of life care). The provider supported the local college and sponsored awards.
We saw that the provider had a system in place for dealing with people’s concerns and complaints. The registered manager had ensured people were supported to access independent advocates when needed. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.
Regular surveys, resident and relative meetings were held. We found that the analysis of the surveys showed the majority of people believed the home delivered an excellent service and this view was echoed in our discussions with people during the visit.