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Archived: Belton House Retirement Home Good

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Reports


Inspection carried out on 18 August 2016

During a routine inspection

We inspected this service on 18 August 2016. The inspection was unannounced.

The service was last inspected on 23 February 2015. At that inspection we found that all areas required some improvements and there was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to implement changes to ensure that they met the regulations. At this inspection we found that the necessary action had been completed and improvements had been made to improve the quality of the service that was provided.

Belton House Retirement Home provides accommodation for up to 22 older people, some of whom were living with dementia. On the day of our inspection there were eight people who lived at the service and nine people were staying for a short break.

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.

People were protected from harm. People had told us at the last inspection visit that they felt safe and there were sufficient numbers of staff who were appropriately deployed. Risks associated with people's care were assessed and managed to eliminate or reduce any harm presented to people using the service.

All staff had received appropriate training that enabled them to meet the needs of people who used the service. People received their medicines as required and medicines were managed, stored and administered safely.

People were supported and encouraged to make decisions about the care and support they received. They had their mental capacity assessed where necessary to support people's dignity and independence. The provider was aware of their responsibility to meet the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were offered and encouraged to participate in meaningful activities and to also follow their interests. People's chosen bath and shower preferences were supported and personal choices were fully detailed in care plans.

At our last inspection we found that while some systems were in place to monitor the service, these were not always effective. We found at this inspection that regular audits had been completed relating to all areas of the service and any actions needed had been taken promptly and these were then dated and signed on the records. The monitoring systems and follow up actions therefore meant that the service was no longer in breach of Regulation 10.

Inspection carried out on 23 February 2015

During a routine inspection

We carried out an unannounced inspection of the service 23 February 2015.

Belton House provides accommodation for up to 22 people who require personal care. On the day of our inspection 14 people were using the service.

There was not a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 time of our visit there was an acting manager working at the service. They were in the process of applying to become the registered manager.

During our last inspection on 30 September 2014 we asked the provider to take action to make improvements to protect people living at the home. The provider was not meeting one of the Regulations of the Health and Social Care Act 2008. This was in relation to people’s care and welfare. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we found that the provider had made some improvements but there were continuing breaches to this regulation (and its equivalent from 1 April 2015).

People told us they felt safe living at Belton House. However, we found there had been a high number of unwitnessed falls and many of these had occurred at night when there were only two members of staff on duty. One person was at risk because they did not receive the assistance they required to eat their meal.

Medicines were not always stored in a safe way and administration records were not always accurately completed. There was no clear audit trail of medicines received and this meant that neither we nor the provider could check to see if medicines had been administered as prescribed by the doctor.

Staff knew how to recognise the signs of abuse and what action to take should they suspect it. This included contacting other authorities such as the CQC and local authority safeguarding team.

People said that staff were competent and knew how to meet their needs. All new staff received induction training and there was an ongoing training programme in place. Not all staff had up to date training about dementia and equality and diversity.

People were asked for their consent before receiving care and support and were able to make choices. Staff did not routinely assess people’s capacity to make decisions. We have made a recommendation about mental capacity assessments.

The risk of malnutrition was assessed and where risk was identified appropriate action was taken. People were provided with sufficient amounts to eat and drink. People had access to the healthcare services they required.

People said they liked the staff and interactions between staff and people were kind and helpful. Some people did not have a bath or shower on a regular basis. Visiting was unrestricted for people’s friends and family and they were made to feel welcome.

People’s care plans were personalised so that people received care and support in the way they preferred. However, there were limited opportunities for people to pursue their hobbies and interests and some people were unoccupied and without interactions for long periods of time.

People said they would feel comfortable raising a concern or complaint.

Systems in place to monitor the quality of service provision were not as effective as they could be.

We found one breach of the Health and Social Care Act 2008 Regulations during this inspection. You can see the action we have told the provider to take at the end of this report.

Inspection carried out on 30 September 2014

During an inspection to make sure that the improvements required had been made

We spoke with three people who used the service and two members of staff. People told us the quality of care and support they received had improved since our last visit. We saw that interactions between staff and people who used the service were positive and respectful. We saw that people were able to make choices about how they spent their time and there were more opportunities for social and recreational activities.

We found that care plans and risk assessments had been updated. Records showed that one person was at significant risk of falling. The provider took action to reduce this risk shortly after our visit.

Staffing numbers were not based on the needs of people who used the service. There was not always sufficient numbers of staff on duty to meet people’s needs or to keep them safe.

The provider had installed an air conditioning unit in the main hall and we found that the temperature of the service was comfortable. Window restrictors had been fitted on all first floor windows. This meant that the risk of falling from a first floor window had been reduced.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Inspection carried out on 6 July 2014

During an inspection in response to concerns

During our inspection we spoke with four people who used the service and one relative. The summary describes what people using the service and the staff told us and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

People we spoke with told us they liked the staff. One person said “the cook is exceptionally good, kind and accommodating. Another person said “I get on well with all the staff, we have a laugh”. We observed interactions between staff and people who used the service. We saw that staff were respectful, kind and helpful.

Care and support was not always planned or delivered to meet people’s individual needs and ensure welfare and safety. We saw that not all care plans were reflective of people’s current needs. People had not had their capacity assessed about making decisions or giving consent. We saw that people were given choice about the care and support they received. However some people’s choices may put their safety at risk. In this case people must have their mental capacity assessed and proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards must be followed.

During our visit we found that the premises were uncomfortably warm. Staff were not able to control the environmental temperature and some people who used the service told us that this was an on-going problem. Not all windows on the first floor were fitted with restrictors and this put some people who used the service at risk.

Inspection carried out on 31 July 2013

During an inspection to make sure that the improvements required had been made

We carried out this inspection to follow up non compliance identified during our inspection of 10 May 2013. We spoke with three people who used the service and to one relative. They told us they were happy with the care and support they received. One person said "staff have a good attitude, I am able to make choices". Another told us "its very nice, the staff are very good".

We saw that people were receiving the care and support they needed and in a way they prefered. Staff worked flexibly in order to meet people's individual needs. A new cook had recently been employed and people were very happy with the quality of meals and variety of menu.

The acting manager was carrying out audits to check that the quality of service provision was up to the required standard. This included seeking the views of people who used the service.

Inspection carried out on 17 January 2013

During an inspection in response to concerns

We carried out this inspection because we received some concerning information about the care and support provided to some people who used the service and about staffing levels. We used a number of different methods to help us understand the experiences of people who used the service. We spoke with one person who used the service. We used observation, looked at care records and spoke with staff. We observed that staff treated people with kindness and respect. Staff were working towards improving the standard of care plans and care records. Care plans we looked at were person focused and included people's preferences. Some risk assessments had not been reviewed in some time and may not have reflected current risk levels. Not all staff had received the training and support they required. The provider had identified this shortfall and was taking steps to improve in this area.

Inspection carried out on 10 May 2013

During a routine inspection

We spoke to two people who used the service and to one relative. They told us “we have the best carers you could possibly have. The night staff are very good indeed". Some people were unhappy with the quality of meals provided. They told us they had sent meals back because they were of poor quality. Meals were not always hot enough. Some people had limited opportunities for meaningful recreational or social activities. Staffing levels were not sufficient to meet people's needs or ensure there welfare and safety.

Inspection carried out on 19 September 2012

During a routine inspection

We spoke with three people who used the service. People said they were very satisfied with the service they received. One person told us; this place is as good as any, I wouldn't want to go anywhere else. Another person said; there is great flexibility and you are able to do the things you want to.

Inspection carried out on 23 December 2011

During a routine inspection

People told us they liked living at Belton House and thought the staff were very nice. People did not fully understand the care, treatment and support choices available to them and felt that staffing numbers were not sufficient.