Archived: Belvedere Residential Home

Updated 1 March 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was undertaken in response to information of concern which indicated that people were not kept safe. This information is subject to a safeguarding investigation, and as a result, this inspection did not examine the specific circumstances relating to the concerns.

Information shared with the CQC indicated potential concerns about the management of risk in relation to injuries people obtained at the service. This inspection examined those risks. Where appropriate, information was shared with the Local Authority and Police for them to investigate issues further.

At the time of our inspection, areas of immediate risk were brought to the attention of the provider to enable them to take the necessary action to keep people safe.

The inspection took place on 6, 8 and 14 November 2018 and was unannounced. The inspection was undertaken by two inspectors.

As part of planning the inspection, we reviewed information we held about the service. We looked at information received from Local Authority commissioners and the statutory notifications the registered manager had sent us. A statutory notification is information about important events, which the provider is required to send to us by law. These can include unexpected deaths and injuries that occurred when people received care. Commissioners are people who work to find appropriate care and support services, which are paid for by the local authority.

During our inspection visit we spoke with eight people about their experiences of the home. We also spoke with six staff, including a cook and a cleaner about working at the home. We spoke with the registered manager and the deputy manager about their management of the service. Some people who lived at the service were not able to tell us in detail, about how they were cared for. We observed care and support being delivered in communal areas and we observed how people were supported at lunchtime.

We looked at information in six people’s care plans and other care records related to people’s care, to see how care and treatment was planned and delivered. We looked at records related to staff recruitment, staff training, medicines, accidents and incident records, and records used for quality monitoring to see if actions to improve the service were identified and acted upon.

Updated 1 March 2019

We inspected this service on 8, 9 and 14 November 2018. The inspection was unannounced.

Belvedere Residential Home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides accommodation and personal care for up to 19 older people and accommodation is located over two floors. There were 16 people living at the service at the time of our inspection. A number of people there lived with dementia.

The provider has a history of non-compliance of Regulations. During our last inspection on 30 April and 01 May 2018 we found there were four breaches in the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. These related to the care and treatment people received, systems to employ fit and proper persons, person centred care and quality monitoring of the service. We gave the home an overall rating of ‘Requires Improvement’. This was a repeated rating from the previous two inspections to the home.

Following that inspection, we met with the provider and registered manager who gave us assurances that actions would be taken to bring about improvement. This was reflected within an action plan.

However, at this inspection we found the service had not sufficiently improved and the quality and safety of service people received had deteriorated further. We identified six breaches of Regulations including a continued breach in relation to quality and safety monitoring.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We have met with the provider to discuss the significant concerns identified at this inspection. We, and the provider, are liaising closely with the Local Authority to ensure people’s safety.

There was a registered manager in post who had worked at the home for over 18 years. 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.

We found systems and processes to monitor the quality and safety of care and services were inadequate. This placed people at significant risk of harm. Areas needing improvement were not always identified and acted upon. People did not feel involved in contributing to decisions made about how the home was run.

People did not always receive safe care that met their needs because risks were not always identified and managed. People’s care plans continued to need improvement, so they were centred on the person and contained sufficient information for staff to recognise and manage risks. Staff were not always able to work in accordance with people’s needs and preferences due to environmental restrictions such as limited access to baths and shower rooms.

Health and safety checks were ineffective. We identified a number of potential risks which had not been assessed by the provider to ensure people were kept as safe as possible.

Accidents and incidents were not always recorded, and action was not always taken to minimise the risks of a re-occurrence.

People’s medicines continued not to be managed and administered safely to maintain people’s health. We could not be confident some medicines had been administered as prescribed.

Staff had completed some training to support them in meeting people’s needs. However, we identified some poor staff practices and staff competencies had not been checked.

Improvements to the staff recruitment system had been made which minimised potential risks to people. Staff understood their responsibilities to protect people from harm. Staff were encouraged and supported to raise concerns under the provider’s safeguarding and whistleblowing policies. However, they did not feel their concerns were always acted upon.

People liked the food available and said they had a choice of meals. Risks related to people’s nutritional needs were not always identified and action was not always taken to minimise risks.

Some social activities were provided at the home and some people enjoyed these. People had limited opportunities to access activities outside of the home.

Overall, people were mostly positive about the staff that supported them. We saw staff were caring in their approach. People’s privacy, dignity continued not to be maintained consistently. People were able to make some decisions about their care but were not involved in ongoing reviews of their care. When care and support was delivered that restricted people’s liberty, some applications had been made to the supervisory body for the authority to do so.

People had access to healthcare professionals although this was not always sought in a timely manner.

We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.