Archived: Belvedere Residential Home

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.

The service provides accommodation and personal care for up to 19 older people. Nineteen people were living at the home at the time of our inspection.

The 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.

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.

At our previous inspection in February 2017, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. One of these related to obtaining people’s consent to care and was a repeat breach from the inspection prior to this in October 2015. The second breach was in relation to failing to have effective systems and processes to monitor and improve the quality and safety of services people received. We gave the home an overall rating of ‘Requires Improvement’.

Following the last inspection we met with the provider and registered manager and asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘Effective’ and ‘Well Led’. They agreed they would make the required improvements and would regularly monitor the quality of the service, to ensure people received safe, effective and responsive care and support.

At this inspection, we found there had been some improvements in regards to gaining consent so that there was no longer a breach of the regulation regarding this. However, we identified there were four breaches of the regulations. The breach regarding good governance remained as there continued to be insufficient systems and processes to monitor the quality of the service. We also found the provider and registered manager had not taken all reasonable measures to minimise risks to people’s health and wellbeing, had not ensured people experienced individualised care, and had not followed safe recruitment procedures. We have invited the provider and registered manager to meet with us again to explain how they will make the required improvements.

People were positive about living at the home but due to lack of detailed records, we could not be assured they always received care and support in accordance with their needs. People had access to healthcare professionals but we found some issues linked to people’s health and welfare that had not been followed up as they should have been.

People spoke positively of the staff and told us there were sufficient numbers of staff to meet their needs. We saw staff were caring and respectful in their approach but people’s privacy, dignity and confidentiality was not always maintained. People were able to make some decisions about their care. Where care and support was delivered that restricted people’s liberty, applications had been made to the supervisory body for the authority to do so.

People’s care plans continued to need improvement so that they were centred on the person, their needs and preferences. People had access to some activities but the time staff spent with people continued to be variable with little time spent on activities linked to people’s interests, preferences and abilities.

Staff had some understanding of their responsibilities and told us the training they completed was effective although training the provider considered essential had not been completed by all staff. Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise concerns under the provider’s safeguarding and whistleblowing policies.

The registered manager told us they had reduced the time they spent delivering ‘hands-on’ care so they had more time to allocate to management tasks. The provider continued to visit the home on occasions to support the registered manager when required. However, systems and processes to monitor the quality of care and services provided were not sufficient to drive improvement within the home.

Accidents and incidents were recorded and actions taken to minimise the risks of a re-occurrence but the overall analysis of accidents and incidents was not sufficiently detailed to help minimise the risk of them happening again.

Health and safety checks were completed such as gas, electrical and water to ensure both equipment and the environment was safe for people. We had identified some potential risks linked to hot surfaces which the provider told us would be addressed as soon as possible.

Most people’s medicines were managed and administered safely to maintain their health. Gaps in recording meant we could not be confident some medicines were administered as prescribed.

People liked the food available and said they had a choice of meals. Those people who needed support to eat were provided with this as required.

We identified four 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.

The service provides accommodation and personal care for up to 19 older people. Fifteen people were living at the home at the time of our inspection.

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.

At our previous inspection in April 2016, we found a breach of the regulations, related to obtaining people’s consent to care and we gave the home an overall rating of requires improvement. The provider agreed they would make the required improvements and would regularly monitor the quality of the service, to ensure people received safe, effective and responsive care and support.

At this inspection, we found the required improvements had not been made. We have invited the provider and registered manager to meet with us to explain how they will make the required improvements.

The registered manager continued to deliver care and support that restricted people’s liberty, but had not applied to the supervisory body for the authority to do so. This was a continuing breach of the regulations.

The provider and registered manager had not implemented an effective system to monitor the quality of the service, although they had agreed they would do so after our previous inspection. They had not taken all reasonable measures to minimise risks to people’s health and wellbeing.

Since our last inspection, no improvements had been made in checking that staff updated people’s care plans effectively when their needs, abilities and daily records were reviewed. The registered manager was not able to demonstrate that they had used an analysis of people’s current needs and abilities to ensure there were enough suitably skilled and experienced staff on duty to maintain people’s health and well-being.

No improvements had been made in ensuring people’s care plans centred on the person and their needs, wants or preferences. This resulted in staff continuing to be focussed on tasks, instead of delivering person-centred care. Activities were arranged, but they were not specifically matched to people’s individual interests or their abilities to engage as a group or their needs for one-to-one engagement.

Accidents, incidents and falls were investigated and actions taken to minimise the risks of a re-occurrence for the individual, but improvements were required in the overall analysis of accidents and incidents to identify any service wide contributory factors.

Staff were kind and compassionate and enjoyed working with people at the home. Staff’s understanding of their responsibilities and their willingness to spend time with people was variable, according to relatives that visited the home regularly.

The registered manager’s decision to deliver ‘hands-on’ care to cover staff sickness absence continued to take up time they needed to spend on managerial tasks. Not all staff respected the manager’s authority and there were gaps in the audit checks staff were asked to make. Gas and water supplies were regularly tested and serviced, but the registered manager was not able to demonstrate that the water supplies and fire protection system were regularly checked and functioning safely.

People’s medicines were managed and administered safely. People were supported to maintain their health and were referred to healthcare professionals when needed. People were supported to eat and drink enough of foods they liked.

People were safe from the risks of harm, because staff understood their responsibilities to protect people from harm and were encouraged and supported to raise concerns under the provider’s safeguarding and whistleblowing policies.

We found two 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.

Belvedere Residential Home is a care home which provides personal care for up to 19 older people. There are 17 single rooms and one double room to accommodate two people who consent to share. At the time of our visit, 17 people lived at the home.

The home has 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.

The provider had not met their legal responsibilities under the Deprivation of Liberty Safeguards. They had not obtained authorisation from the local authority to place restrictions on how people received their care in order to keep them safe. The registered manager had not followed best practice when making decisions in the best interests of people who lacked capacity.

The provider and registered manager did not have sufficient systems and processes in place to assure themselves that the home was providing a quality service and all regulations were being met. Systems that were in place had not been fully implemented as the registered manager had been supporting staff on 'the floor' to meet the day to day needs of people. The lack of quality monitoring, had not impacted badly on people, but we were concerned there was a risk it would. We have recommended the provider support the registered manager by developing formal monitoring processes to assess and improve the quality and safety of the service provided.

Care records were not up to date, and did not reflect the current needs or risks of people. They were not centred on the person and their needs, wants or preferences.

The service was not always responsive to people's needs. During the day people's choices were mostly respected and listened to. However some people were not given the flexibility of waking up when they wanted to in the morning. There were activities which people enjoyed but these were not always linked to people's preferences and personal histories.

People, their relatives and staff spoke positively about the registered manager and felt she was a ‘hands on’ manager. They were able to talk with the manager if they had any concerns and felt their concerns would be dealt with.

There were sufficient staff to meet people's needs and staff had to go through recruitment checks to ensure their suitability prior to working with people in the home. People told us they felt safe living at Belvedere Residential Home.

People received a good choice of food and drink, and people’s individual food requirements were well catered for. People enjoyed the home cooked food provided.

People’s health needs were met. The registered manager ensured people were referred to the appropriate health care professional when concerns about their care and well-being were identified.

Staff treated people with kindness. Staff had a good understanding of people’s needs. They supported people with respect and ensured people’s dignity was maintained.

We found a breach 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.

If you wish to look at our findings in detail please see the full report.

Is the service safe?

The environment was safe and clean.

There were sufficient staff on duty to meet the needs of the people living at the service.

Staff ensured that people's opinions were heard and that people were able to make choices about their daily lives.

There were clear procedures around the management of medicines, including good quality training in order to monitor staff competence regarding administering medicines.

People told us that they felt safe. Staff understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

Several people told us that they trusted the staff to resolve any issues that arose.

Is the service effective?

Each person in the service had care records that clearly described their care requirements.

People told us that they were happy with the care that they received.

It was clear from our observations that staff had a good understanding of people's support needs. One person told us, 'The staff are very good and always help me when I ask them to.' whilst another person who did not use speech to communicate, smiled when we asked if staff supported them as they wished.

Medicines were being managed in accordance with best practice.

Is the service caring?

People were supported by kind, professional staff. During our visit, we saw that staff gave people plenty of time to make their own decisions. People confirmed to us that they were not rushed and our observations throughout the visit confirmed this.

Is the service responsive?

People's needs were always assessed before they were admitted to the service.

As people's needs changed, relevant healthcare professionals were contacted for advice.

Records confirmed people's preferences, interests and any diverse needs were recorded, and care and support was arranged in accordance with people's wishes.

We saw that all care records were regularly reviewed to remain up to date.

People's opinions were sought regarding a range of aspects that affected them, such as activities.

People knew how to make a complaint if they wished to do so.

Is the service well-led?

The service worked well with other agencies, such as local healthcare professionals, to ensure people were supported well.

Staff had a good understanding of the ethos of the service and clear quality assurance processes were in place.

Staff told us they were clear about their roles and responsibilities and were regularly supervised by senior staff.

People's personal care records were accurate and complete.

During our visit we observed the care provided by staff, and spoke with four people living in the home.

We saw staff were kind and supportive to people living in the home.

We saw staff and people having fun with each other, and a good rapport was observed.

We saw there had been improvements made in record keeping and in the management of medicines. However medicine management required further improvement.

We saw a good rapport between people living at Belvedere, and the staff and manager supporting them. People told us they thought the staff did a good job. They said:

Staff are, 'Very good, we get along really well.'

'The staff are very friendly and they do anything they can for you...as long as there is enough of them.'

'Staff are excellent, very good.'

We observed staff treating people living in the home with dignity and respect. We saw people freely expressing their views and opinions.

People told us they were well cared for and they appeared well cared for.

Care records did not reflect the changes in care during people's time at the home. They were not always up to date or accurate.

We looked at how the service managed the medication of people living at Belvedere. We had some minor concerns about the management of medication records.

We looked at the safety and suitability of the premises. We noted improvements had been made to the premises since our last visit. The premises were clean and homely.

We checked care files. These demonstrated that the physical care and welfare needs of people were properly assessed and supported. People's changing care needs were well documented and care plans updated to ensure people received the care they needed. One person's file did not have sufficient information about their emotional needs and how this impacted on their behaviour.

We looked to see whether people were protected from the risks of inadequate nutrition and dehydration. We saw that people received a choice of suitable and nutritious food and drinks to meet their needs. We saw good support given to those who had specific needs in relation to eating and drinking.

We looked at how the service managed medication. We were satisfied there were good systems in place to ensure medicines were administered safely to people.

We checked the service's recruitment practice. We were satisfied the service had effective recruitment procedures which helped to ensure staff were safe and had the right skills, knowledge and experience to work with people.

We looked at how the service assessed and monitored quality. We were satisfied there were processes in place to ensure people were safe.