Belle Green Court

Belle Green Court is a care home that provides accommodation for older people who require personal care, some of whom are living with dementia. The home can accommodate up to 40 people in one adapted building, over two floors. At the time of this inspection there were 26 people living at the service.

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

The service had significantly improved since the previous inspection. The nominated individual and registered manager gave assurance these improvements would continue be further embedded, to ensure there was a continuous approach to improving care. People, relatives, health professionals and staff recognised the service had improved. Health professionals said, “The home has improved so much it is clean and has a warm feel to it.” People and relatives said, “It’s getting back to normal; it is a lovely home where staff care.”

There had been significant improvements to ensure risks identified with people's health, medical and care needs had been assessed and documented. There was clear guidance on how to minimise the risk to keep people safe. People received their medicines safely and as prescribed. Systems and processes were in place to keep people safe.

The premises were clean and there was good infection control practice in place.

There was a friendly atmosphere at Belle Green Court, and we saw people looked well cared for.

Staff were recruited safely and there were enough of them to keep people safe and to meet their care needs. Staff were receiving appropriate training, which was relevant to their role and people's needs. Staff were supported by the management team and were receiving formal supervisions where they could discuss their on-going development needs.

There was a positive culture throughout the service which focused on providing personalised care.

People were supported to eat a healthy balanced diet. A range of meaningful activities were on offer to keep people occupied, according to their individual interests. Complaints and concerns were well managed, and the manager took prompt action to address two issues we raised during the inspection.

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.

The management team conducted audits and checks to further ensure the quality and safety of services provided to people. The operation of the quality assurance processes had significantly improved and actions arising from audits were being recorded and progressed.

Rating at last inspection and update:

The last rating for this service was inadequate and there were multiple breaches of regulation (published 20 August 2021). The provider completed an action plan after the last inspection to show what they would do, and by when, to improve.

This service has been in Special Measures since August 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

The overall rating for the service has changed from Inadequate to Good. This is based on the findings at this inspection.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

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

Follow up

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

Belle Green Court is a care home that provides accommodation for older people who require personal care, some of whom are living with dementia. The home can accommodate up to 40 people in one adapted building, over two floors. At the time of this inspection there were 30 people living at the service.

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

There were not enough staff deployed to meet people’s care and support needs in a timely way. People’s care records were missing important information. Risks assessments had not been updated to reflect significant changes in people’s care and support needs. The systems in place to ensure people received their medicines as prescribed were not effective.

Staff were not provided with regular ongoing support to make sure they had the right skills and knowledge to support people. People were not supported to have maximum choice and control of their lives and staff 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.

Where there were systems and processes in place to monitor and improve the quality of the service provided these were ineffective as they had not picked up on the issues identified at this inspection. The manager and nominated individual had failed to take enough action in response to previous inspections and this had led to ongoing breaches and shortfalls. Only a small percentage of policies and procedures had been reviewed and updated by the manager. There were limited opportunities for people to give feedback on the service or make suggestions for improvement.

People told us they enjoyed the food served at Belle Green Court. People’s dietary needs were met. We saw some kind and caring interactions between people and staff, where time allowed this.

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 24 December 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. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

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.

We received information of concern which suggested some of the breaches identified at our last inspection may not have been resolved. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Belle Green Court on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing, good governance and the need for consent. 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 from 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.

The overall rating for this service is ‘inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Belle Green Court is a care home that provides accommodation for older people who require personal care, some of whom are living with dementia. The home can accommodate up to 40 people in one adapted building, over two floors. At the time of this inspection there were 24 people using the service.

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

There were not enough staff deployed to meet people’s care and support needs in timely way. Staff had not received enough supervision or training to support them to undertake their jobs effectively. People’s care records did not accurately reflect their needs. Risks to people had not been fully assessed and there was not always guidance for staff on how best to manage these risks.

People were not supported to have maximum choice and control of their lives and staff did not always 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.

There were no effective systems in place to monitor and improve the quality of the services provided. People living at Belle Green Court had not been asked for their views on the service or given the opportunity to make suggestions for improvement. Staff feedback had not been analysed, so staff were unaware if their comments had resulted in any positive changes.

We have made recommendations regarding safe storage and disposal of medicines, improving infection prevention and control, and ensuring staff are familiar with food preparation for people requiring specialist diets.

People told us they enjoyed the food served at Belle Green Court. We saw staff were kind and caring in their interactions with people, where time allowed this. They clearly knew people well. The manager had been in post since September 2020 and staff told us they were approachable and supportive. The manager had plans in place to improve the service.

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 17 October 2019). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection.

Why we inspected

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 coronavirus and other infection outbreaks effectively.

We received concerns in relation to people’s care records not accurately reflecting their needs and not containing adequate assessments of risks. Medicines errors had also been reported to us. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same; 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 Belle Green Court on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing, safe care and treatment, need for consent and good governance.

We have found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will 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.