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Inspection carried out on 20 April 2017

During a routine inspection

This inspection took place on 20 and 24 April 2017 and was unannounced.

Belmont House Nursing Home is registered to provide nursing care for a maximum of 40 people most of whom have a form of dementia. At the time of the inspection, there were 33 people living at the service.

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 and their relatives told us the service was safe. People were supported by staff who understood how to recognise and report any signs of suspected abuse or mistreatment. Staff had been safely recruited, and had undergone checks to help ensure they were suitable to work with people who were vulnerable.

During the inspection, we observed suitable staffing levels. This meant staff were available to meet people’s needs in an unhurried way. People had their medicines as prescribed and on time. People were supported by staff who had undergone training to help ensure they could meet their needs effectively.

Staff were supported by a thorough induction process which including shadowing more experienced staff. During their induction, staff familiarised themselves with people’s care records so they had a good understanding of the needs of those they were supporting. All staff were supported by an on-going programme of supervision as well as an annual appraisal.

People’s rights were protected through the correct use of legal frameworks. For example, when required, people had been assessed under the Mental Capacity Act (MCA) by staff. When people were assessed as lacking capacity to make certain decisions for themselves, staff ensured that best interest processes were followed, reflecting the principles of the MCA. The registered manager had sought authorisations under the Deprivation of Liberty Safeguards (DoLS) when needed.

People and their relatives told us the staff were kind. One relative said; “I can’t fault this place”. We witnessed positive, caring interactions between people and staff. Staff knew the needs of the people they supported well and were able to describe their likes, dislikes, history and routine. Staff spoke about the people they supported with fondness and affection. People’s dignity was protected by staff who were respectful and compassionate. The atmosphere at the service was pleasant and relaxed and people appeared comfortable and at ease. People had access to advocacy services as required. People’s confidential information was securely stored.

People’s health care needs were effectively managed and monitored at the service. There were suitable numbers of nursing staff on duty to provide nursing care. If people became unwell, the service made prompt referrals to doctors or specialists. People had access to a range of health and social care professionals including social workers, chiropodists and speech and language therapists.

People’s care records were comprehensive, detailed and regularly reviewed and updated. Care plans contained personalised information to help staff understand how to provide care which was reflective of their preferences. People were provided with opportunities to engage in a variety of activities as well as personalised, one to one time. There was a broad range of visitors to the service, including a massage therapist, entertainers and petting animals. People were able to enjoy the secure garden which had recently been updated and to access activities in the community.

People told us they enjoyed the food. Meals appeared plentiful and people were offered a range of alternatives. Special dietary requirements were catered for. Relatives were made welcome at the service and could stay and have a meal with their family member if they chose to. People were encouraged to maintain relationships with those who mattered to them and there were no restrictions on visiting times.

The registered manager promoted an ethos of openness and transparency. The service had notified us of all notifiable incidents as required. Quality assurance surveys were sent to relatives and professionals regularly. Feedback was sought through a range of forums including relatives’ meetings and a suggestion box. There were a range of audits which took place to monitor the quality of the service.

Inspection carried out on 25 March 2015

During a routine inspection

The Inspection took place on 25 March 2015 and was unannounced. Belmont House is a nursing home providing care and accommodation for up to 40 older people, some of whom are living with dementia. On the day of the inspection there were 32 people living at the home, the reduced number was due to the use of double bedroom now being used as single rooms. Belmont House Nursing Home is owned by Almondsbury Care Limited. The company has five nursing homes providing 180 beds for older people.

The service had a registered manager in post. 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.

During our inspection we observed people and staff relaxed in each other’s company. The service was calm and had a friendly atmosphere. We saw people and staff chatting and enjoying each other’s company. Comments included; “It’s excellent living here.” People told us they were happy and felt safe and one person said; “Pretty good in everything, I can’t find fault.”

People had their privacy and dignity maintained and we observed staff being kind and compassionate while supporting people. People and their relatives were very happy with the care they received from staff. People were encouraged and supported to make decisions and choices whenever possible in their day to day lives. People, relatives and professionals said the staff were knowledgeable and competent to meet people’s needs.

People were protected by safe recruitment procedures. There were sufficient staff to meet people’s needs and staff received an induction programme. Staff told us they had sufficient time to support people and didn’t need to rush them. Staff had completed appropriate training and had the right skills to meet people’s needs.

People had access to healthcare professionals such as dementia liaison nurses and GPs to make sure they received appropriate care and treatment to meet their health care needs. Staff acted on the information given to them by professionals to ensure people received the care they needed to remain safe.

People’s medicines were managed safely. Medicines were managed, stored, given to people as prescribed and disposed of safely. Staff were appropriately trained and confirmed they understood the importance of safe administration and management of medicines.

The registered manager and staff had sought and acted on advice where they thought people’s freedom was being restricted. This helped to ensure people’s rights were protected. Applications were made and advice sought to help safeguard people and respect their human rights.

Safeguarding of vulnerable adults training had been completed and staff knew how to report any concerns and what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were supported to maintain a healthy, balanced diet. People told us they enjoyed their meals and did not feel rushed. One person said, “If you want anything (food and drink) you only have to ask and they will get it”.

People’s care records contained detailed information about how people wished to be supported. Records were regularly updated to reflect people’s changing needs. People and their families were involved in the planning of their care.

People’s risks were considered, well-managed and reviewed to keep people safe. One person said; “They don’t leave me on my own in the shower which makes me feel safe.” Where possible, people had choice and control over their lives and were supported to partake in activities.

Staff confirmed the management of the service was supportive and approachable. Staff were happy in their role and spoke positively about their jobs. Visiting professionals said the management of the home was very good.

People’s opinions were sought formally and informally. There were quality assurance systems in place. Audits were carried out to help ensure people were safe, for example environmental audits were completed.

Environment updates included new flooring and painted walls. However one area was not considered dementia friendly due to both the wall and floor being the same pale colour.The registered manager and provider confirmed this change would be put into action.

 

Inspection carried out on 10 April 2014

During a routine inspection

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them and observing care practices.

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.

Is the service safe? People told us they felt safe. Systems were in place to help the manager and staff team learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

Belmont alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Belmont had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). This helped to ensure that people’s needs were met.

Is the service effective? People’s health and care needs were assessed with them, although people were not involved in writing or reviewing their plans of care. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs.

Specialist dietary needs had been identified where required. Care plans were up-to-date.

We saw that there was good liaison and communication with other professionals and agencies to ensure people’s care needs were met.

The quality of recording seen was of a good standard enabling nurses and care staff to use the information correctly.

Is the service caring? We could not speak with the majority of the people being supported by the service due to their health care needs. We spoke with two people and asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, “wonderful” “Staff are very friendly” and “Very considerate carers”. When speaking with staff it was clear that they genuinely cared for the people they supported.

People’s preferences and interests had been recorded and life histories were evident.

Belmont had regular support from the GPs from the local GP practices and other visiting health professional. This ensured people received appropriate care in a timely way.

Is the service responsive? Many people who lived at Belmont had complex health and care needs and were either not able, or chose not to join in group activities. The care records showed evidence of the lifestyle of these people and we observed that staff spent one-to-one time with people throughout the day.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led? We saw minutes of regular meetings held with the staff. This showed the management consulted with staff regularly to gain their views and experiences and improve support for people who lived at the service.

The service had a quality assurance system, and staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

Inspection carried out on 17 April 2013

During a routine inspection

We met with the Chief Executive, manager, staff and people who used the service. Two people told us they were happy at Belmont and that their care needs were met.

We saw that people who used the service were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted.

During our inspection, we found people’s privacy, dignity and independence were respected. Where people were able to express their views and experiences, these were taken into account in the way the service was provided and delivered in relation to their care.

People were protected from abuse and staff were trained and supported to carry out their roles.

Staff told us that training was provided, and also confirmed that staff supervision took place albeit on a day to day ad hoc basis.

Care plans and associated documentation provided sufficient detail to direct and guide staff of the action they needed to take in order to meet people’s assessed care needs. People's records were personalised and provided clear information about the person’s wishes and abilities.

Inspection carried out on 12 October 2012

During a routine inspection

People who lived at Belmont Nursing Home were complimentary about the staff team. Comments included; “they really care”, “they will do anything for you, always with a smile on their face” and “they always have time for everybody”.

One person told us “you couldn’t get anywhere better” than Belmont Nursing Home. Another said “I am happy to leave my X here, I know it’s safe”.

During our inspection we found, people’s privacy, dignity and independence were respected and people experienced care, treatment and support that met their needs and protected their rights.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines and the provider had an effective system to regularly assess and monitor the quality of service people received.

We found there were enough qualified, skilled and experienced staff to meet people’s needs.

Inspection carried out on 18 October 2011

During a routine inspection

We carried out a site visit on 18 October 2011. Most of the people using the service were not able to comment in detail about the service they receive. We were, however, able to speak to a number of relatives and observe people who use the service and staff throughout the site visit.

We saw people’s privacy and dignity being respected and staff being helpful. There were no issues raised by people using the service or staff. People who use the service were moving freely around the home and staff stopped what they were doing to interact with them at every opportunity.

We saw that the routines being observed during the site visit showed that people are able to get up when they want and have choices about where they spend their time.

We saw that residents were spoken with in an attentive, respectful and caring way.

We observed numerous members of staff and were impressed with the patience and care shown to people using the service, even during stressful incidents.

We saw that people who use the service were very happy to approach any member of staff at any time and that they were asked if they were alright or if they wanted to talk about anything.

Relatives we spoke with said they couldn’t praise the home highly enough and were able to visit at any time. They felt they could approach staff with any questions or concerns.

Staff told us that the management of the home are highly respected. They were very happy with the way they were treated and also the way management regularly help with caring and supporting people when needed.

On the day of the visit general observation showed us that the staffing levels were sufficient to meet people’s care and social needs. People were engaged with staff during personal care, when being assisted with meals and drinks and in group and individual activities throughout the day.

A number of staff told us they like working at Belmont House and feel well supported. They said that they could talk to the registered manager and any other senior staff if they have any issues or concerns.