The Belmar Nursing Home

The Belmar Nursing Home is an adapted building, registered to provide care for up to 44 people with a mental health condition, dementia or substance misuse. At the time of our inspection 32 people were receiving care and support at the home. Care is provided over three floors, with single occupancy bedrooms, communal areas and gardens.

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

The provider had made improvements to the premises since our last inspection. We have made a recommendation about continuing to improve the premises.

Staff managed people’s medicines well and kept the home clean and tidy. Staff managed risks well and had plans to follow in case of emergencies. The service had systems to protect people from the risk of abuse and improper treatment.

The service met people’s nutritional needs and worked with them to make sure food provision also reflected their preferences. Staff supported people with their healthcare needs and worked well with external healthcare professionals. People were cared for by staff who were well supported and had the right skills and knowledge to meet their needs effectively, following good practice guidance.

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 were treated well, with kindness and compassion by staff who respected their privacy and dignity and promoted inclusion. The service supported people to be independent. We received positive feedback about the caring approach of staff.

The service put people at the heart of the care they received. Staff identified people’s needs and preferences and worked to ensure people were happy with the care they received. The service made sure people were supported to communicate and planned activities to enhance people’s wellbeing.

The service was led by a registered manager who was described as approachable, well-organised and caring. The culture at the service was open and inclusive. Staff understood their roles and responsibilities. The provider monitored the quality of the service using a range of systems.

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 (published 6 January 2021).

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 inspection was carried out to follow up on action we told the provider to take at the last 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.

Follow up

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

The Belmar Nursing Home is registered to provide care for up to 44 people with a mental health condition, dementia or substance misuse. At the time of our inspection, 27 people were receiving care and support at the home.

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

People told us they felt safe living at the home and were complimentary about staff. Staff had ensured risks were managed effectively. The provider had made significant improvements in relation to medicines management since the last inspection, but there were still further improvements required. We have made a recommendation about this. The provider had made improvements in relation to infection control and the service was following national guidance to reduce the risks in regard to COVID-19. Staff were recruited safely and there were enough staff on duty to meet people’s needs safely.

The provider maintained an accurate and contemporaneous record in relation to each person living in the home. Risk assessments and care plans were reviewed regularly to ensure they were up to date. The provider’s systems to assess, monitor and improve the service were operated effectively. Improvements had been made in relation to leadership and organisation of the service. Staff felt the service was better organised and the staff team worked well together. The service engaged with people, staff and external professionals.

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 (published 6 May 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out this focussed inspection to check whether the Warning Notices we previously served in relation to regulation 12 and regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those breaches of regulation.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. 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 The Belmar Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor the provider’s action plan in relation to other breaches found at the last inspection and meet with them to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The Belmar Nursing Home is registered to provide care for up to 44 people with a mental health condition, dementia or substance misuse. At the time of our inspection 31 people were receiving care and support at the home.

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

Although people told us they felt safe living at the home, we found people were not always safe. The provider had not ensured people's individual risks were managed effectively. Medicines were not managed properly and safely. People were not protected against the risks of infection. Staff were recruited safely and there were enough staff on duty to meet people’s needs safely.

People were not supported to have maximum choice and control of their lives and staff supported did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider had not ensured people’s consent to care and treatment was gained. Staff lacked understanding of the Mental Capacity Act 2005. People’s capacity to make decisions was not always assessed when required and the correct processes were not always followed to make decisions where people laced capacity.

Staff received an induction when they started working at the service and told us they felt well supported. We have made a recommendation to the provider about staff training. People were supported to eat and drink enough to maintain a balanced diet. We noted some improvements to the premises, however further work was required to ensure good infection control standards could be maintained.

People were not always involved in making decisions about their care. Staff respected people’s privacy and supported people to maintain their dignity. Staff encouraged and promoted people to be independent. People were treated with respect, compassion and kindness, by staff who promoted equality and valued diversity.

People’s written plans of care did not always accurately reflect their needs. There was not enough detail in care plans to guide staff on how to manage behaviours which may challenge, to achieve positive outcomes for people. The service did not use any recognised recovery models to promote positive outcomes for people living with mental illness. We noted some improvements with the quality of information recorded in care plans around allergies and professional guidance. The service ensured people’s communication needs were met. Provision of a range of activities at the service had continued to improve since the last inspection.

The provider had not ensured they maintained an accurate and contemporaneous record in relation to each person using the service. Risk assessments and care plans had not been reviewed regularly to ensure they were up to date. The provider’s systems to assess, monitor and improve the service were not operated effectively. Some improvements had been made in relation to leadership and organisation of the service. Staff felt the service was much better organised. We found improvements had been made in respect of secure storage of confidential information. The service engaged with people, staff and external professionals.

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 (published 20 May 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, staffing and managing risk. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to the proper and safe management of medicines, risk management, consent, person-centred care and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan and meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The Belmar Nursing Home is registered to provide care for up to 44 people with a mental health condition, dementia or substance misuse. At the time of our inspection 36 people were receiving care and support at the home.

People’s experience of using this service

Although people told us they felt safe living at the home, we found people were not always safe. Risk was not always appropriately managed and addressed.

We could not be assured people received their medicines safely. Medicines were not managed in line with good practice guidance.

The environment was not always appropriately maintained to ensure infection control processes could be carried out to a high standard

Care records were incomplete, inaccurate and not always reflective of people’s needs. Consent to care and treatment had not been formally gained and documented.

Care records were not always person-centred and did not reflect the needs of people living with mental health conditions. We saw people were not encouraged to set and work towards person-centred goals. Additionally, care plans did not include information to manage behaviours which could sometimes be considered challenging to the service.

People were not always consistently supported to have their health needs met in a timely manner. We saw when advice and guidance had been provided by health professionals this wasn’t always followed up as requested.

We found the service was not always well-led. Paperwork within the service was not always accurate and complete. Additionally, records were not always secure and stored appropriately in line with statutory guidance.

Leadership at the home was inconsistent. The registered manager had completed audits and had identified concerns within processes and systems and had highlighted these to the senior management team. Not all identified concerns had been addressed in a timely manner to ensure actions were identified and addressed to reduce risk.

The home was not always appropriately maintained to ensure the comfort of people. We have made a recommendation about this.

Processes were in place to report and respond to abusive practice but these were not always followed. We have made a recommendation about this.

Records had been developed and implemented for people who were at risk of dehydration. However, we found the records implemented lacked good practice guidance and instruction and had not always been completed. We have made a recommendation about this.

We found dignity was not always considered and promoted. We have made a recommendation about this.

Good practice guidance was not always considered and implemented. For example, good practice guidance for the safe management of medicines and management of some health conditions had not been considered.

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

At the time of the inspection visit, the service was relying on agency staff to ensure shifts at the home were covered. The registered manager was looking at ways of recruiting and retaining staff.

Safe recruitment processes had consistently applied to demonstrate suitable checks had taken place before staff were employed.

People told us they were happy living at The Belmar Nursing Home. They told us the quality and availability of food was good.

During our inspection, we observed activities taking place. The home had recently recruited a new activities coordinator and people and relatives told us this had started making a difference in people’s lives.

We observed positive interactions between people who lived at the home and staff. We saw staff had a good rapport with people and there was a light-hearted atmosphere within the home.

Rating at last inspection:

At the last inspection the service was rated good (published 10 August 2018).

Why we inspected:

This inspection visit was prompted by us receiving information of concern in relation to the quality of care and treatment being provided to people who lived at The Belmar Nursing Home.

Enforcement

We have identified breaches in relation to safe care and treatment, consent, person centred care and good governance at this inspection.

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We have requested an action plan from the registered provider as to how they plan to address the breaches in regulation and make improvements to the service.

We will liaise with the local authority and clinical commissioning group to ensure all required actions are completed to ensure the health and welfare of people who live at the home.

The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

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

The Belmar Nursing Home is registered to provide care for up to 44 people with a mental health condition, dementia or substance misuse. The home is situated in a residential area of Lytham St Annes close to local shops and public transport. Bedrooms were of single occupancy and spanned three floors. The home provides a number of lounges plus a conservatory. There are gardens to the front, side and rear of the home, plus space for car parking. At the time of our inspection there were 33 people lived at the home.

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.

At the last inspection on 20 January 2016, we found the provider was not meeting the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 The breaches related to safe care and treatment, consent, recruitment of staff, person centred care and good governance. Following that inspection, the provider sent us an action plan which told us how they planned to make improvements for people who used the service. During this inspection we checked to see what improvements had been made. We found the provider had made positive changes and the service was now meeting legal requirements.

Environmental risks and risks to individuals were assessed and measures put in place to reduce or remove them, in order for care and support to be provided safely.

We saw staff operated safe systems when administering medicines. Medicines were safely and appropriately stored and secured safely when not in use. We checked how staff stored and stock checked controlled drugs. We noted this followed current National Institute for Health and Care Excellence (NICE) guidelines.

We found staffing levels were regularly reviewed to ensure people were safe. There was an appropriate skill mix of staff to ensure the needs of people who used the service were met.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff had received safeguarding vulnerable adults training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

People and told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met. We saw staff responded promptly when people had experienced health problems..

Comments we received demonstrated people were satisfied with their care. The management and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people who lived at the home.

Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

People told us they were happy with the activities organised at the home. Activities were arranged for individuals and for groups.

A complaints procedure was available and people we spoke with said they knew how to complain. People and staff spoken with felt the registered manager was accessible, supportive and approachable.

The registered manager had sought feedback from people who lived at the home and staff. They had consulted with people for input on how the service could continually improve. The provider had regularly completed a range of audits to maintain people’s safety and welfare.

The service had 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.

The company that operated the home described Belmar Nursing Home as providing rehabilitation services. Although we found some written evidence and personal testimony from service users that the home was involved in rehabilitation, we found this to be very limited. Staff at the home were not able to clearly demonstrate how the worked with individuals on interventions to help them to recover from their mental health problems, or maintain their mental health, and to (re)gain their skills and confidence to live successfully in the community. We recommend that the service provider revisit the admission criteria for the home, in order to ensure that the service is clear about who they want to target their resources at, thus ensuring that people receive more specialised care and support linked to recovery and rehabilitation, as stated in their advertising literature.

Care was provided to people on an individual basis, however, the registered person did not always fully complete risk assessments based on the needs of individuals living at the home. Where risks are identified, then risks assessments must always be robustly completed so as to ensure people's health and welfare are protected and promoted. The registered person had not ensured that individualised assessments reflected people's needs and preferences, and that in designing services, these needs and preferences were taken into account. Opportunities had not always been created to ensure that both short term and long term goals, based on these needs and preferences, were created and acted upon.

Staff levels were seen to meet the day to day needs of people living at the home; however, some of the personnel records relating to staff were incomplete. The registered person did not operate robust recruitment procedures, including the undertaking of any relevant employment checks. This must include checking on the professional status of qualified staff such as nurses, in order that they have assurances that individuals are fit to practice.

Although there were systems in place to ensure staff received training and support, we recommend that the service provider undertake more frequent supervision and analyse the training needs of the staff team and link them to the assessed needs of people living at the home. Tis would assist in determining if any specialised training is required, and ensure that the assessed needs of people could be more effectively met. The building is a large and spacious one, with a range of facilities, however, we recommend that an environmental assessment is undertaken in the home, to identify which areas of the home require renewal or refurbishment as some of the carpets in people’s rooms appeared to be in need of replacing. The registered person had not ensured that there were appropriate systems in place to ensure that people's capacity to undertake individual tasks was clearly assessed. When assessments are undertaken, then they must be properly considered and acted upon.

We noted that there were the relationships between the staff and people living at the home were positive. Staff responded to people’s needs, and involved them their care. However, we recommend that information relating to advocacy services is provided to people living at the home so they have the opportunity to access these services independently if required. Also, we recommend that when people are involved in the care planning process, then they are provided with the opportunity to sign their care plan to show that they are in agreement with its contents.

The culture of the home was positive, with staff clearly able to make a difference in people’s lives. Some of the systems operated within the home were not as robust as they should have been, and although the service was advertised as undertaking work in the field of rehabilitation and mental health, the evidence supporting this was unsatisfactory. The registered person did not always operate an effective governance system in order to ensure that robust processes were in place to assess and monitor the services provided. Having this in place would assist staff to identify areas of service delivery that require improvement, mitigate risks and ensure that records are accurate, complete and contemporaneous.

We found a number of breaches of the Health and Social Care Act (regulated Activities) Regulations 2014 in relation to notifications, person centred care, good governance, need for consent, safe care and treatment and staffing. You can see what action we asked the provider to take at the end of this report.

Our inspection team was made up of an inspector, and we looked for evidence to answer the following questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, 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 are treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures are in place and staff understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted.. Relevant staff had been trained to understand when an application should be made, and in how to submit one. The service was safe, clean and hygienic. Equipment was maintained and serviced regularly therefore not putting people at unnecessary risk. The registered manager sets the staff rotas, they take people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. Recruitment practice is safe. Policies and procedures are in place to make sure that unsafe practice is identified and people are protected.

Is the service effective? There was an advocacy service available if people needed it, this meant that when required people could access additional support. People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs. People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

Is the service caring? People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'I like the staff. They are very helpful, and give me support when I need it.' People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes, and where resources allowed.

Is the service responsive? People completed a range of activities in and outside the service regularly. People knew how to make a complaint if they were unhappy. We looked at how these complaints had been dealt with, and found that the responses had been open, thorough, and timely. The manager was looking at ways in which evidence could be collected to show how, from time to time, meeting people's short and long term goals could be improved if extra resources were available from Commissioning bodies.

Is the service well-led? The service worked well with other agencies and services to make sure people received their care in a joined up way. The service now has a better quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Staff told us they were now clearer about their roles and responsibilities. Staff had a good understanding of the ethos of the home and wanted to ensure it was implemented.

We were able to speak with people during the day of the inspection about their care and support. We spent time in areas of the home, including lounges and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed.

We observed staff assisting people who required care and support. We saw staff talking to people respectfully. We saw they spent time with people on an individual basis and were patient when required.

People we spoke with told us they could express their views and were involved in decision making about their care. They told us they felt listened to when discussing their care needs. We spoke with people about the care and support they received. One person told us, "The staff are very good." Also, "The staff are very polite and respectful.'

We were able to speak with seven people during the day of the inspection about their care and support. People we spoke with told us they could express their views and were involved in talking about their care. They told us they felt listened to when discussing their care needs.

We spent time in areas of the home, including lounges and the dining areas. This helped us to observe the daily routines and gain an insight into how residents care and support was being managed. We observed staff treated people with respect and provided support or attention as people requested it. We spoke with one person about the care and support they received. They said, "Staff really cared for me when I was unwell.' And, 'There is nothing I don't like about living here.'