Belvedere House

Belvedere House is a nursing home that is registered to provide accommodation and personal care for up to 68 people. At the time of our inspection there were 63 people living at the service, a number of whom were living with dementia.

People’s experience of using this service:

People were cared for at a service which focused on their lives at sea. People had access to a home that was large, open, spacious and nautically orientated. One relative told us, “The level of care is very thorough and highly professional. I have appreciated the warm welcome my mother has received.”

People’s rights were not always protected as staff and the registered manager had not ensured full compliance with the Mental Capacity Act 2005. People were looked after by caring and attentive staff. Complaints and concerns were recorded, responded to and used to consider improvements in the service.

People’s needs, choices and preferences were recorded in person centred care plans. The food at the service was enjoyed by people as they were able to choose what they ate from a menu with variety. The care records enabled staff to correctly provide care and support for people in a safe way.

People’s end of life care was considered and detailed to ensure that they would be comfortable remaining at the service. There were a range of activities for people to take part in each day which involved the staff and anyone who wanted to join in.

Staff were led by a pro-active and friendly registered manager who consistently considered how to improve the service. The registered manager had an open-door approach for people, staff and relatives.

Rating at last inspection:

At our last inspection in July 2016 the home was rated ‘Good’.

Why we inspected:

This was a planned inspection based on the previous rating.

At the last inspection in December 2013 the service met all the regulations it was inspected against.

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 who use the service describe the best thing about the service as the “excellent staff”. Relatives described the expertise and exceptional ability of staff in caring for people with dementia as a key strength of this service. People complimented the home, the manager and staff; they had great confidence in the service in that it provided outstanding care. People had complete confidence their relatives were safe and well cared for. A relative reviewing the service wrote on the website, “A totally lovely place, Belvedere House is always a welcoming environment to any visitor or relative staying there.”

The service only employed suitably vetted staff who demonstrated the right attributes and values. Valuing and respecting people were practices promoted throughout the service. Staff felt valued by the organisation and staff morale was excellent, they were a highly motivated team who spoke passionately about their job. They understood the importance of providing high quality care to people and reflected this in practice. People spoke about the positive impact this had on the way they were cared for.

They were well supported and supervised in their role, staff retention was excellent, and as a result staff had a great knowledge about the people they cared for and clearly understood how to meet their needs. The stability in the staff team had great benefits and resulted in meaningful relationships and trust being established between people and all the staff. Feedback from people and their relatives was very complimentary acknowledging the exemplary approach of staff.

Staff confidently made use of the Mental Capacity Act 2005 and used innovative ways to make sure that people were involved in decisions about their care so that their human and legal rights were sustained. There were champions within the service who actively supported staff to make sure people experienced good healthcare outcomes leading to an outstanding quality of life. The registered manager was following legal requirements in relation to DoLS. At the time of the inspection, applications had been made to the local authority in relation to people living at the service to protect people’s legal rights.

One person visiting relatives over many years said, “This home has a great reputation and justly deserves it".

Staff worked very well as a team, the team included nurses and care staff, but also maintenance and housekeeping, as well as catering staff, each one playing an important role in delivering a consistently high quality service. The staffing levels fully considered individual needs and allowed staff to focus on the individual thus delivering person centred care, and these arrangements were regularly reviewed.

Staff were well trained, skilled and experienced due to the excellent training and development programme. They were inspirational in their attentiveness to people’s changing needs. Staff demonstrated important qualities such as affection and warmth in their relationships with people.

People’s care and support was planned proactively and in partnership with them. Staff used innovative and individual ways of involving people so that they felt consulted, empowered, listened to and valued. Professionals visiting the service said it focused on providing person-centred care and it achieved exceptional results. On-going improvement was seen as essential. The service continued to strive to be known as outstanding and innovative in providing person centred care based on best practice. They adopted guidance from NICE and SCIE and reflected this in training and care practice. As a result people experienced a level of care and support that promoted their wellbeing and meant they had a meaningful life.

There was a strong emphasis on the importance of eating and drinking well. Innovative methods and positive staff relationships were used to encourage those who were reluctant or had difficulty in eating and drinking. This approach made sure that people’s dietary and fluid intake, especially those living with dementia or those with a learning disability, significantly improved their wellbeing.

The registered provider demonstrated their commitment to provide an innovative environment that enabled people to have the best quality of life they could possibly have. There was a specialist dementia unit, and the provider had sought specialist advice on the selection of colours, lighting, flooring and furniture. All communal areas and corridors, contained pictures, plaques and other items such as telescopes, binnacles, uniforms and other memorabilia of a nautical and naval theme appropriate to the group using this service.

The dementia needs of people were fully considered and positive outcomes were experienced. There was a reminiscence room that people enjoyed; it had seafaring memorabilia such as life sized figures in naval uniforms. People could relate with these from their days at sea and were the subject of conversation for many as they helped remind people about their many years at sea. The ceiling of the dining room had been fitted with acoustic tiles to reduce noise and enhance the dining experience for people and their guests. A university research project underway had helped enhance the lives of people with dementia, they used music and song to help engage people and facilitate an improved quality of life.

People were proud of their surroundings and welcomed friends and family. They commented on feeling part of a wider community, volunteers from organisations and people from the sheltered housing complex came and joined in mealtimes and activities.

There was an effective complaints procedure in place. Complaints received were responded to in a timely manner with lessons learned and plans developed to lessen the likelihood of a reoccurrence. Investigations were comprehensive and the service used innovative ways of looking into concerns raised, including the use of people and professionals external to the service to make sure there was an independent and objective approach.

Dignity and privacy was promoted. Staff understood the importance of promoting a pleasant meal time experience. Snack baskets were on each unit with snacks and cold drinks available, staff encouraged and prompted people who may otherwise forget to take these and be at risk of poor nutrition or dehydration.

There was an open and inclusive culture within the service. The leadership and management of the service were focused upon providing a consistently high quality, person-centred service.

The service had established and sustained a track record of being an excellent role model, actively seeking and acting on the views of others through creative and innovative methods. The service worked in partnership with other organisations to make sure they following current good practice and provide a high quality service. They strove for excellence through consultation, being involved in research and reflective practice. They demonstrated clearly how they sustained outstanding practice and continued improvement over time. The manager provided excellent leadership and stability, she was an excellent role mode who promoted the visions and values of the service, she valued and understood the staff team.

There was great teamwork with staff from all departments working well together. This helped make sure people lived life to the full, people enjoyed the home environment and gardens which were beautifully maintained.

A relative posted the following comment, “Care staff at all levels were always there to help and support all of us - Mother, myself and the family, Maintenance and ground staff who kept the rooms in tip-top condition and the large grounds immaculate I can honestly say that everyone was excellent. This is an Outstanding Care Home that really cares! “

We saw that people's consent was obtained where possible before care and treatment was undertaken. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from the risks associated with poor medication management. We noted that medicines were properly handled and administered in line with the provider's policy. We noted that there were adequate numbers of skilled and experienced staff to deliver safe and appropriate care. We also found that systems were in place for people and relatives to make a complaint about the service if necessary. We saw that complaints were handled in an appropriate and timely fashion.

People we spoke said that they were happy with the care that they received. They said "we have lots of help to keep us as independent as possible but the staff were always willing to help if we need it",they continued to say that they visited the home on "quite a few occasions before they decided to move in".

When we asked them about the staff people told us that the staff were, "very caring and sweet to all of us". Another said, "The staff appear to take a genuine interest in our care and always try their level best to make our days bright".

People said that they thought there was always enough staff on duty. We observed staff interacting with people in a friendly and caring manner.