Archived: Belmont House Residential Home

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

Infection control processes did not always protect people from cross infection.

Staff did not always follow the system in place for reporting incidents. This meant appropriate action may not have been taken to safeguard the people concerned or reduce the risk of reoccurrence. Where concerns, complaints or incidents had been brought to the attention of the registered manager or senior staff, action had been taken.

Systems were in place to help ensure staff were recruited safely and people received their medicines as prescribed. However, there were some areas requiring improvement and we have made recommendations about these.

People felt safe, staff understood any risks to people and helped them stay safe.

When people lacked the capacity to make their own decisions, assessments had been completed on their behalf.

Staff received an induction and regular training. People were supported to stay healthy and to eat and drink well. The provider had recently reviewed and changed the use of the environment to better meet people’s needs.

People were well cared for by staff who understood their needs and supported their independence. Staff had time to spend with people and enabled them to make decisions about their day.

Staff knew people well but information about people’s preferred routines, the way they wanted to be supported and how to promote their wellbeing and social needs were not recorded in detail. We made a recommendation about this.

The way people required information presenting to meet their needs had not been assessed or recorded. We have made a recommendation about this.

People, visitors and staff knew the registered manager and described them as ‘hands on’. The provider and senior staff showed they were keen to learn from mistakes and take action to improve the service.

Governance procedures within the service had not been effective in identifying all areas for improvement or ensuring changes were made to reflect best practice.

Following the inspection, the provider shared what action they were taking to improve the service following feedback from the inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Belmont House Residential Home on our website at www.cqc.org.uk.

Rating at last inspection The last rating for this service was good (report published 19 December 2016).

Why we inspected This was a planned inspection based on the previous rating.

Enforcement We have identified breaches in relation to infection control, management of risks to people and how the quality of the service was monitored at this inspection.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This unannounced inspection took place on 1 and 3 November 2016. The service was last inspected in February 2014 when it met the regulations that were inspected.

A registered manager was employed at the service. The registered manager is also one of the providers. They were supported in their role by a deputy manager and a team of senior care staff. 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 received individualised personal care and support delivered in the way identified in their care plans. However, some care plans did not contain detailed information on how staff should meet particular needs. The registered manager was taking action to address this.

There were some regular activities for people to participate in. These included visiting musical entertainers and craft sessions. Staff were able to spend time with people on an individual basis. We saw staff helping one person with a jigsaw puzzle and other staff painting people’s nails.

People’s needs were met as there were sufficient staff on duty. During the inspection we saw people’s needs were met in a timely way and call bells were answered quickly. However, care staff told us around supper time could be very busy as they had to serve supper as well as help people eat. The registered manager told us they were looking to change menus and routines in order to address this.

People’s needs were met by kind and caring staff we saw that people were relaxed and happy in staffs’ presence. One visitor told us “Staff are very good, give people a cuddle if they need one.” One person told us the staff were all lovely, “They will do anything for you.” Another person said “I’m comfortable, warm and well fed – what more can I ask for?” They went on to say “It’s my home.”

People’s privacy was respected and all personal care was provided in private. People were discreetly assisted to their own bedrooms for any personal care. Staff knocked on people’s bedroom doors and waited before they entered. When they discussed people’s care needs with us they did so in a respectful and compassionate way.

A member of staff had been appointed ‘dignity champion’ and their role was to ensure people’s dignity was upheld at all times. However, we saw large stocks of incontinence products stacked in people’s bedrooms. This meant that anyone entering the bedrooms would know the person had continence difficulties. The registered manager agreed this was not dignified and said they would look at alternative storage arrangements.

Risks to people’s health and welfare were well managed. Risks in relation to nutrition, falls, pressure area care and moving and transferring were assessed and plans put in place to minimise the risks. For example, pressure relieving equipment was used when needed. People’s medicines were stored and managed safely. People were supported to maintain a healthy balanced diet. People received regular visits from healthcare professionals and were supported to maintain good health. Visiting professionals told us they had never had any concerns about the care provided by the service.

People and their relatives could be involved in planning and reviewing care if they wished. Visitors told us that they could visit at any time and were always made welcome. They also said that staff always kept them informed of any changes in their relative’s welfare.

Staff knew how to protect people from the risks of abuse. They had received training and knew who to contact if they had any suspicions people were at risk of abuse. Robust recruitment procedures were in place. These helped minimise the risks of employing anyone who was unsuitable to work with vulnerable people.

People’s human rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS).

Staff confirmed they received sufficient training to ensure they provided people with effective care and support. There was a comprehensive staff training programme in place and a system that indicated when updates were needed. Training included caring for people living with dementia, first aid and moving and transferring.

The registered manager was very open and approachable. People were confident that if they raised concerns they would be dealt with. Staff spoke positively about the registered manager. One told us “The management are very approachable and happy to provide any support.”

One staff member told us the values of the service were to, “Make sure people are safe, happy and well looked after.” Another staff member said the values of the service were to, “Provide a good quality of care.” Staff told us they felt well supported by senior staff and management. One staff member told us, “If I ask anything I get answer.” Staff told us home much they enjoyed working at the service. Comments included, “I love everything about it [service], staff and residents,” and “Such a high standard of everything and nothing is too much trouble.”

There were systems in place to assess, monitor, and improve the quality and safety of care. A series of audits were undertaken by the deputy manager. Monthly audits were undertaken including medicines and care plans. A series of surveys were sent out regularly to people, their relatives and staff to ask for their views on the quality of care provided. Responses indicated that everyone was ‘very satisfied’ or ‘satisfied’ in all areas.

We have made a recommendation relating to staffing levels.

We found that people's privacy and dignity were respected and upheld by care staff. People we spoke with confirmed this.

People who live at the home told us they were well looked after and were happy. Another person commented 'I only have to ask for something and it's done, all the staff are very good'.

People had been protected from unsafe or unsuitable equipment. This was because the provider had systems to ensure care staff were trained to use it and that regular servicing was carried out.

Records we looked at confirmed that the provider gave serious consideration to recruitment decisions. People were cared for, or supported by, suitably qualified, skilled and experienced staff. The service had an effective, robust recruitment procedure in place. One person we spoke with said 'All the staff here are very, very good, I can't fault them'.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

We asked people about the care they received and the people we spoke with told us that they were happy with their care. One person who had lived at Belmont for four years said 'I have always been satisfied', another person said staff 'do a wonderful job'.

Staff we spoke to told us how they administer medication and we observed medication being given at lunch time. We saw that staff took time to explain about the medication and followed procedures to ensure people were safe.

We asked staff if they felt they had the time to do their job properly. One carer told us that '99% of the time we have enough staff, we don't feel rushed. It is a calm and relaxed environment'.

We asked a relative of a person receiving care at Belmont what they would do if they were unhappy about something. They told us they would 'go to the manager if they were unhappy about something'. They told us that the manager was 'very approachable'.