Belvedere Lodge

Belvedere Lodge Residential Care Home provides accommodation and personal care for up to 20 older

people, some of whom were living with dementia. People who live at the home access nursing care through

the local community healthcare teams. At the time of the inspection 14 people were living at the home.

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

People living at Belvedere Lodge received safe care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Medicines were managed safely, and people received their medicines as prescribed.

The provider’s care recording system had improved. People had access to meaningful activities which had been adapted in line with current guidelines. Staff consistency enabled people to receive good care from staff who knew them well. Staff knew how to support people during end of life care.

The home was managed by a registered manager who had been in post since the last inspection and was committed to improving people’s quality of life. The service had a management and staffing structure in place. However, this was not always clear to staff and as a result they were not always working well as a team. The provider had established an effective quality assurance system to monitor the quality and safety of the service. The service worked well with external social and health care professionals.

Rating at last inspection

The last rating for this service was requires improvement (Published 20 May 2020).

At this inspection we found improvements had been made.

Why we inspected

We carried out an announced inspection of this service on 11 February 2021. We received concerns in relation to infection control procedures, poor staffing, poor care within the service and poor governance systems. As a result, we undertook a focused inspection to review the concerns raised within the key questions of Safe and Well-led only.

We looked at infection prevention and control measures. 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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. We announced our inspection and requested information relating to infection prevention control policies, audits, contingency plans, staff training in infection control procedures and visiting policy during the COVID pandemic. We found no evidence during this inspection that people were at risk of harm from these concerns.

The ratings from the previous comprehensive inspection were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. 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 Belvedere Lodge on our website at www.cqc.org.uk.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Belvedere Lodge Residential Care Home provides accommodation and personal care for up to 16 older people some of whom were living with dementia. People who live at the home access nursing care through the local community healthcare teams. At the time of the inspection 13 people were living at the home.

People’s experience of using this service:

Care plans we saw contained good person-centred detail about their routines and how staff were to support them. However, records did not always contain consistent information in terms of preferences and social background.

Risk assessments where in place however these had not been consistently completed and had not been reviewed regularly or as required

People received their medicines when they should. The provider followed safe practice for the management of medicines.

Audit systems were in place but had not picked up some areas of shortfalls identified at the inspection. The service lacked an action plan on how identified concerns would be dealt with or how staff would improve their practices.

Staff promoted people's dignity and independence. There was a complaints policy in place and complaints were managed in line with the service's policies and procedures.

People told us they felt safe and happy. There were positive and caring relationships between staff and people, and this extended to relatives and other visitors.

Staff understood the importance of providing person-centred care and treated everyone as individuals, respecting their abilities and promoting independence. Staff knew how to recognise and report any concerns they had about people’s welfare and how to protect them from abuse.

There were enough staff, to support people’s needs. The provider recruited staff safely to ensure they were suitable for their role. Staff continued to receive ongoing training and support to keep their knowledge, skills and practice up to date.

People were supported to maintain good health and to eat and drink well. Staff involved other professionals when people became unwell or required additional services.

People were supported to have choice in their daily lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The registered manager was passionate about putting people at the centre of the service. Staff knew their roles and understood what was expected of them.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Rating at last inspection: The last rating for this service was requires improvement (February 2019) and there were two breaches of the regulations identified. 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 that although some improvements had been made and was no longer in breach of some regulations, the provider was still in breach of regulation 17.

Follow up: We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

The service is registered to accommodate up to 20 people and at the time of the inspection there were 15 people residing in the home. The home is a converted Victorian property with facilities over four floors. There is a stair lift in situ which means there is access to all bedrooms apart from the two bedrooms in the basement. A number of bedrooms had en-suite facilities.

When we inspected the service in November 2016 there were no breaches of legal requirements and we gave the service a quality rating of Good.

There was a registered manager in post (registered in July 2018). There had been a change in registered manager since the last inspection. 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.

Improvements were required with the management of medicines to ensure people were completely safe. There had been a significant number of medicine errors (no harm to people), where the care staff were either not signing to say they had administered medicines, were not checking records correctly or were administering medicines at the wrong time of day. Regular audits were taking place and staff were being spoken with but this was not improving practice.

Improvements were also required with the care records for each person. Each person had a care plan but this was not person centred. The information contained in the care plans was computer generated and not always relevant to the person’s specific care and support needs. The recordings in people’s daily notes was of a poor quality and did not reflect the care and support they received.

Staff received safeguarding vulnerable adult training as part of the provider’s mandatory training plan. Staff would report any concerns about a person’s welfare to the registered manager, the deputy, ‘head office’ or the Care Quality Commission. Safe recruitment procedures were in place to ensure only suitable staff were employed. The appropriate steps were in place to protect people from being harmed.

Any risks to people’s health and welfare were assessed and people’s care plans detailed how these risks were managed to reduce or eliminate the risk. The premises were well maintained with regular maintenance checks being completed. Checks were also made of the fire safety systems, the hot and cold-water temperatures and any equipment to make sure it was safe for staff and people to use.

The number of staff on duty for each shift was based on the number of people in residence at any given time. Consideration was also given to the dependency level of each person and any social activities that were taking place in, or outside of the home. Staffing levels were adjusted as and when necessary. Staffing levels were appropriate at the time of the inspection.

People received an effective service. The staff team received training to ensure they had the necessary skills. New staff had an induction training programme to complete. Staff were well supported by the registered manager and the deputy although improvements were necessary to ensure improvements were made in work performance.

People’s capacity to make decisions was part of the care planning process. People were always asked to consent before receiving care. They were encouraged to make their own choices about aspects of their daily life. We found the service to be meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were provided with sufficient food and drink. They were asked what they liked to eat and any specific dietary needs were catered for. The staff monitored those people where there was a risk of weight loss. Arrangements were made for people to see their GP and other healthcare professionals when they needed to.

On the whole people were provided with a caring service but the approach of some staff members required improvement. Some of the staff did not interact with people with respectfully. People were given the opportunity to take part in a range of different meaningful social activities. There were group activities and external entertainers visited the service on a regular basis.

The service was responsive to people’s individual needs. People received the care and support they needed however their care plans were computer generated and not person centred. People and relatives were asked to provide feedback about the service they received, were listened to, and actions taken where appropriate.

The service had a good leadership and management structure in place however, at the time of the inspection the staff team were working against the registered manager and deputy who were trying to change the culture of the staff. The registered manager was experienced and had worked for many years in various care services. At the start of shifts, care staff received a handover report and were informed of any changes or happenings and staff meetings were held regularly.

The registered provider had a regular programme of audits in place which ensured that the quality and safety of the service was checked. These checks were completed on a daily, weekly or monthly basis. Although persistent shortfalls were identified during these checks, the whole staff team were not working together to make the required improvements.

In addition to this, at the inspection in May 2015 we served requirement actions for two other regulations. We found there were not always enough staff on duty to meet people’s needs and care records did not always include full information about people. The provider wrote to us following this inspection in May 2015 and told us how they would achieve compliance with the standard. During this inspection in November 2016, we found that sufficient improvements had been made.

Belvedere Lodge provides accommodation and personal care for up to 20 people. The service mainly provides support for older people who are living with dementia. At the time of this inspection in November 2016, there were 18 people living at Belvedere Lodge.

There was a registered manager in post. 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 felt safe and we observed they were at ease with the staff that supported them. There were sufficient staff on duty to support people and recruitment procedures operated by the provider were safe. People received their medicines when they needed them. However we highlighted to the registered manager that the depth and robustness of the current audit system may need to be reviewed. Staff understood their responsibilities in relation to safeguarding people from abuse and care plans contained risk management guidance. People were cared for in a clean and maintained environment.

Staff understood the Mental Capacity Act 2005 and how it impacted on their work. The service had complied with the Deprivation of Liberty Safeguards (DoLS), however it was highlighted to the registered manager that staff knowledge varied. People living in care homes can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). The application procedure for this is called the Deprivation of Liberty Safeguards (DoLS).

People received the appropriate support from healthcare professionals when required and staff received training relevant to their roles. Staff confirmed they received supervision and were able to develop themselves through additional training. The provider had an induction aligned to the Care Certificate. People in the service received the support they required in relation to eating and drinking sufficient amounts.

People spoke positively of the staff and we saw good relationships between people and staff. Staff understood the people they cared for and knew how to meet their needs. The service had created personalised care plans for people that reflected their needs and showed their life history. People’s communication preferences were noted and where needed the service had translated people’s care plans into their first language to allow them to be involved in their care more. There were activities for people to partake in and the provider had a complaints procedure.

People were positive about the management of the service. Staff also spoke positively about the management of the service and expressed satisfaction in their employment. There were systems that monitored the quality of service provided. The registered manager communicated with people and staff. The registered manager spoke positively about the support they received from the provider. The provider had separate quality assurance systems that were undertaken periodically. There were staff performance incentive schemes and the registered manager had recently been nominated for local and national awards.

Not all people were able to verbally tell us about the care they received or if they were happy. This was because some people were living with a form of dementia. Therefore we observed how staff interacted and supported people in communal areas and crossed referenced this with their individual care plans. This enabled us to make a judgement on how their needs were being met.

Overall people we spoke with who used the service were happy with the care they received. Comments included; 'it's lovely here'. 'The nicest people in the world'. 'they are kind to me'.

One visiting relative told us 'first class care is given. Anything I need to know they tell me. Staff are very good and my X is contented here'.

The provider had systems in place to monitor and review the quality of the service provided.