Belvidere Residential Care Home

Belvidere is a residential care home providing personal care and accommodation for up to 28 people some of whom may live with Dementia. The service was supporting 23 people at the time of the inspection in one adapted building.

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

Improvements were required with the systems in place to manage people’s medicines. This is to ensure people received their medicines as prescribed and records supported when these were given to people. Risks to people were not consistently well managed and left people at potential risk of harm. Safeguarding procedures were in place but required further improvements to ensure they included all aspects of potential abuse. We were somewhat assured with some of the measures in place to prevent the spread of infection.

Improvements were required with the systems in place to submit and manage deprivation of liberty applications and authorisations. 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; however, the policies and systems in the service did not always support this practice.

Timely action was not always undertaken to ensure people’s healthcare needs were addressed. Although staff received training for their role, they would benefit from more in-depth training to support people with complex needs. The environment was not always dementia friendly and homely and lacked signage to enable people to orientate themselves. A renewal programme was in place and improvements were being made.

The systems and processes in place were not robust to enable the provider to identity where areas for improvement were needed and to take action to address these. The registered manager did take immediate action when information of concern was shared with them to protect people from potential harm.

Staff felt supported in their role. Systems were in place to support people to maintain contact with their loved ones. People and relatives were happy with the care provided. The registered manager was described as approachable, open and transparent. The registered manager demonstrated a commitment to make the improvements required.

Rating at last inspection: The last rating for this service was good (published 22 November 2018).

Why we inspected

We received concerns in relation to the management of medicines and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this 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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. The provider had started to take action to mitigate the risks we had identified.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Belvidere residential care home on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to the management of medicines, and risk and to the overall governance of the service. We have issued the provider with a warning notice.

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

We found the following examples of good practice.

The home had clear zoning and cohorting procedures in place to reduce the spread of infection. A second lounge was established for people with dementia and at risk of falls who had tested positive for COVID-19 where they could be supported safely.

The outbreak of COVID-19 in the home meant visits were not supported at the time of inspection. The provider had a clear plan in place when visits could safely resume which included visitors taking the lateral flow test for COVID-19 prior to their visit and wearing Personal Protective Equipment (PPE).

A bedroom which had its own access had been converted into a visitor room with handwashing facilities and a PPE station. A voice controlled device for visitors to play music during their visit without the need to touch the device was installed in the room.

The home arranged for families to drop of Christmas gifts to people early so they could be stored in a designated room for 72 hours before Christmas day.

Staff were observed wearing appropriate PPE in line with current government guidance. The home had PPE stations located in key areas around the home.

The provider supported staff wellbeing through incentives and support when they were required to isolate.

On the day of our inspection 23 people were using the service.

At our last inspection on 21 October 2015 we rated the service good in all the key questions and at this inspection; we found the service remained ‘Good’ again in all areas. At this inspection we found the evidence continued to support the rating of good There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks associated with people’s needs including the environment, had been assessed and planned for and these were monitored for any changes. There were sufficient staff to meet people’s needs and safe staff recruitment procedures were in place and used. People received their prescribed medicines safely and these were managed in line with best practice guidance. Accidents and incidents were analysed for lessons learnt and action was taken to reduce further risk.

People continued to receive an effective service. Staff received the training and support they required to meet people’s individual needs. People were supported with their nutritional needs. Staff identified when people required further support with eating and drinking and took appropriate action. The staff worked well with external health care professionals, people were supported with their needs and accessed health services when required. People were supported to have maximum choice and control of their lives. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Staff knew how to comfort people when they were distressed and made sure that emotional support was provided. People’s independence was promoted.

People continued to receive a responsive service. People’s needs were assessed and planned for with the involvement of the person and or their relative where required. People had opportunities to pursue their interests and hobbies, and social activities were available. There was a complaint procedure and action had been taken to learn and improve where this was possible.

The service continued to be well-led. There was an open and transparent culture and good leadership, oversight and accountability. People received opportunities to share their feedback about the service and staff felt valued. The provider had quality assurance checks in place on quality and safety.

Further information is in the detailed findings below.

We spoke with four people, three relatives, two visiting professionals, the manager and six staff members.

All of the people we spoke with were happy with the care and support they received. Care was described by people as, 'Brilliant' and, 'Marvellous.' A relative said, 'It's the best.'

People appeared comfortable and relaxed around staff and each other. All of the people we spoke with all said they felt safe. We saw that safeguarding policies were in place to guide staff as to the action to be taken when reporting abuse. Staff knew what they should do.

The building was of a suitable design and layout for the people who used it. All of the people we spoke with told us that their rooms were nice and that the home was a nice place to live.

All of the people and relatives that we spoke with were very complimentary about the staff and the management at the home. A relative said, 'They are lovely, every one of them.'

There was an effective and easy to access complaint system. People told us they would feel confident to raise a complaint if they needed to.