All inspections: Belgravia Care - Care Quality Commission

This inspection took place on 6 November 2015 and was unannounced. At the last inspection in March 2015 the registered provider did not meet the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 and was rated as ‘Inadequate. As a result of our findings on the inspection we took enforcement action.

After the last inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. During this inspection we checked that they had followed their plan and that they now met legal requirements.

Belgravia Care is situated on the seafront at Blackpool. The home is registered to accommodate up to 19 older people, people with learning disabilities and people living with dementia, who require assistance with personal care. At the time of our inspection there were 17 people who lived at the home.

The ground floor was used as a social and activity area. The first floor had offices and three communal areas, including dining, lounge and crafts rooms. Bedrooms were situated on the upper floors of the home. All rooms were single occupancy with en-suite facilities. There was a passenger lift for ease of access and the home was wheelchair accessible. There was parking to the front of the building.

There was a registered manager in place. 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 staff team were experienced, knowledgeable and familiar with the needs of the people who lived at Belgravia Care.

Procedures were in place to protect people from abuse and unsafe care. Risks to people were minimised because risk assessments were in place. People told us they liked living at Belgravia Care and enjoyed living there.

We looked at the recruitment and selection procedures the provider had in place to ensure people were supported by suitably qualified and experienced staff. We looked at the recruitment records of three members of staff. Suitable arrangements were not always in place to ensure safe recruitment practices were followed.

People said there were enough staff to support them well and give them help when they wanted this. One person told us, “The staff come to the gym with me and I go swimming. There is always someone to help me when I need help.” We could see there were sufficient staff available to support people and staff were not rushed when providing care.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. They received regular support and supervision from senior staff.

We looked at how medicines were managed and found appropriate arrangements for their recording and safe administration. People were given their medicines as prescribed and they were stored safely.

Records were available confirming gas appliances and electrical facilities and equipment complied with statutory requirements and were safe to use. The environment was well maintained, clean and hygienic. There were no unpleasant odours. People told us the home was always clean, tidy and fresh smelling. However the effectiveness of the infection control measures were reduced because two staff were wearing nail varnish and / or long false nails.

We saw the registered manager and management team had improved the care provided to people living with dementia and those with learning disabilities. This had enhanced their experiences in the home.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). The registered manager discussed applications she had submitted. This showed us staff were working within the law to support people who may lack capacity to make their own decisions.

People told us the food and drinks were plentiful with lots of choice. They also said they were offered frequent drinks. We saw staff made sure people got enough to eat and drink with a choice of healthy and nutritious meals.

People we spoke with told us staff were caring and helpful. They told us they felt staff valued and respected them because of the way in which they supported them. Staff were aware of people’s needs around privacy and dignity and made sure they respected these.

Staff had listened to people about the kind of activities they wanted. This helped them develop the variety of and frequency of activities to encourage people to interact and socialise.

People knew how to raise a concern or to make a complaint if they were unhappy with something. One person told us, “If something was not right I would tell the boss.”

People told us the registered manager and staff team were approachable and supportive and listened to their views. They said that residents meetings were now carried out. Surveys were also sent to people who lived at the home, relatives and staff.

The registered manager showed us the quality assurance audits the management team and the consultant they had hired had carried out. We saw a number of improvements had been made as a result of these.

This inspection took place on 03 March 2015 and was unannounced.

Belgravia Care Home is situated on the seafront at Blackpool. The home is registered to accommodate up to 19 older people, people with learning disabilities and people living with dementia, who require assistance with personal care. At the time of our inspection there were 17 people who lived at the home.

The ground floor was generally unused except for an activity room. The first floor had offices and three communal areas, including dining, lounge and crafts rooms. Bedrooms were situated on the upper floors of the home. All rooms were single occupancy with en-suite facilities. There was a passenger lift for ease of access and the home was wheelchair accessible. There was parking to the front of the building.

There was no registered manager in place. The previous registered manager had resigned at the end of 2014. 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. A new manager had commenced working in the home and had started the process to apply to become the registered manager.

At the last inspection in September 2014, we asked the provider to take action to make improvements to how staff were recruited, people’s medicines were managed and how records were maintained. We carried out enforcement action, serving a warning notice in relation to how staff were recruited, which the provider was required to meet by 14 December 2014. The registered provider provided an action plan to the Care Quality Commission (CQC) which showed they would be compliant with regulations relating to how people’s medicines were managed and how records were maintained by Mid November 2014.

At this inspection we observed improvements had been made to how staff were recruited and the service had met the warning notice. However, we found that they had again not met the requirements in relation to the management of people’s medication and the maintenance of records. In addition there were new breaches of the regulations. These related to the provider not assessing or taking appropriate action to keep people safe. There was not enough suitably qualified, skilled and experienced staff. People were not provided with good nutritional support and infection control was poor. Suitable arrangements were not in place to enable people to participate in and make decisions about their care and treatment or in obtaining consent of people in regard to their care and treatment. The service did not work in cooperation with others through sharing information when people were moving from the home. Suitable arrangements were not in place for assessing, and monitoring the quality of the service and acting upon their findings.

During this inspection, we could not gain access to the home for over 45 minutes on arrival. Staff explained they were unable to hear either the doorbell or the telephone. This would have been a problem if they were unable to be contacted in an emergency.

People we spoke with told us that staff were kind and caring. They told us they were happy and satisfied with life in the home. One person told us “The staff are all good. They look after me.” However it was evident from our observations that care was not safe and people who had high care needs were left sitting unattended, with little stimulation or attention for long periods of time. We saw there were not enough staff available to provide safe and appropriate care and support and to provide social and leisure activities. This meant social and leisure activities were limited and people spent a lot of time without meaningful activities.

We have made a recommendation that the registered provider develops a person centred way of working, and provides suitable activities.

Risk assessments were not always in place and where they were they were not informative. They highlighted risks but did not give staff guidance on how to reduce any risks. Where people had behaviour that challenged the service, there was no guidance for staff or strategies to reduce behaviours or diffuse situations. Where staff did not have sufficient knowledge to support people safely this put people at risk of harm.

We looked at how medicines were managed. We saw medicines were not always given safely. Failing to give people their medicines properly placed their health and welfare at unnecessary risk.

There were poor infection control practices in the home. When we looked around the home we saw furnishings, carpets and equipment were unclean and unhygienic.

Staff told us they had access to training and were being encouraged to develop their skills and knowledge by the new manager. However there were areas of training including safeguarding vulnerable adults and managing behaviour that challenged, where staff were lacking in skills and knowledge. Training information for newer staff was not available.

Although people told us they enjoyed their meals and had plenty to eat, information about each person’s nutritional needs, likes and dislikes was not available. Some equipment to assist people at mealtimes was in place but other equipment was not available or was unsuitable.

Staff had only limited understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We saw that staff had not determined people’s capacity to take particular decisions. There was conflicting information in care records relating to the mental capacity of one person. Although several people had DoLS in place staff had not consistently followed the conditions of the DoLS approval. One individual was being restrained without proper authorisation.

The home was not designed or adapted to effectively support people living with dementia or for people with learning disabilities to develop independent living skills.

We have made a recommendation about the registered provider ensuring staff have guidance about best practice in dementia care and learning disabilities.

We looked at care records. These varied, some were informative, and others had significant pieces of information missing and had not been updated in some areas. Although people and where appropriate their relatives had been involved in initial care plans, this had not continued. This meant people were not involved in updating and developing their care plans.

We were contacted prior to the inspection by professionals who were involved with people where moves to other services had been planned. They told us that the registered provider and previous management team had discouraged moves and were unwilling to share information when people were moving elsewhere. This put people at risk as the staff in their new homes did not have all the information they needed.

There were procedures in place to monitor the quality of the service. Audits were being completed by the registered provider. Yet the audit systems were not picking up the areas of concern identified during this inspection process.

Staff recruitment had improved since the last inspection. We found that it was robust, with all necessary checks carried out. This meant it reduced the risks of unsuitable staff working in the home.

People told us that their views were sought on a regular basis. There were surveys about the person’s experience of living in the home and residents meetings. These gave people the opportunity to voice their opinions. They told us they had no complaints about the home and were happy there. They told us they were aware of how to make a complaint and felt these would be listened to and acted upon.

Staff were aware of people’s individual needs around privacy and dignity. When they interacted with people they spoke with people in a respectful way. A relative said of their family member, “She is always treated with dignity and respect at all times”. They told us staff were welcoming to them and there were no restrictions on visiting.

A large part of the staff team had changed in recent months. There had been a change of manager, the previous manager left the home at the end of December 2014. A new manager had commenced in post in January 2015. People told us the new manager was approachable and willing to listen to people. One person said, “She is nice.” Relatives were also complimentary. A relative said, “I was worried about lack of staff and did feel that I could speak to the manager – I did feel listened to.”

We found a number of breaches of the Health and Social Care Act 2008 and associated Regulations. You can see what action we told the provider to take at the back of the full version of this report.

At our previous inspection in June 2014 we found the home was not meeting some of the standards we assessed. Care and support provided to some people was not effective or safe, staff recruitment was not safe and some areas of record keeping were not in place, accurate and up to date.

We asked the service to provide us with an action plan demonstrating what they had done to address these issues of non-compliance. We received an action plan from the registered manager. This detailed the procedures put in place to address the concerns. This inspection was to see what actions had been taken. We also looked at how medicines were managed.

On this inspection, the care and welfare of people had improved and was compliant. One person who we had previously had concerns about, had the information they needed to understand any restrictions placed on them. Staff had also been given this information. This helped them to support the person effectively.

There were some improvements in record keeping on this inspection, but still some areas of concern. We saw that a new computer system for care records was in place and was person centred and informative. However some confidential information was being recorded in the general communication book and was therefore not kept securely and confidentially. We also saw that one person who had stayed at the home, did not have care records. This meant that staff did not have the information they needed to support the person.

At the last inspection the provider had not been notifying the Care Quality Commission (CQC) of events which affected the home. After that inspection the home began informing CQC of any incidents without delay. This meant that we were able to monitor the service effectively and carry out our regulatory responsibilities.

Recruitment had not improved on this inspection. Recruitment practices were still non - compliant and unsafe. Prospective staff were not providing sufficient information about themselves and the provider and manager were not making the necessary checks. This put people at risk of being cared for by unsuitable staff.

The management of medicines was not always managed safely, with occasional errors and omissions of medicines.

The inspection was led by two inspectors. Information we gathered during the inspection helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us that they were comfortable and content at Belgravia Care. People told us that the staff were good and caring and always willing to help. One person said, 'I like this home. I have made lots of friends and I have a really good time here.' Another person told us, "The staff are very good here.' One person's friend said, 'She looks really well.'

We saw that most people were receiving safe and appropriate care which was meeting their needs. However we saw from observation and care records that some people did not receive the care they needed.

Staff were aware of The Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and made applications. However they did not always follow these through if there were delays. We were concerned that the home had a 'locked door policy' for everyone without assessing if they were able to leave the home unaccompanied. This meant that people who were able to leave the home safely had to ask staff to let them out of the home.

We looked at a sample of care records. Care plans had been maintained and regularly updated, most were recording the care and support people were receiving. However sometimes records were not in place, were inaccurate or needed additional information to provide good care. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to meeting their care needs.

There were enough staff on duty during the inspection to support people as they needed. Religious and cultural needs were taken into account and these were being met appropriately.

Service contracts were in place. Maintenance records we looked at showed that regular safety checks were carried out. Any repairs were completed quickly and safely. These measures ensured the home was maintained.

We looked at the recruitment of new staff. This showed that some required recruitment checks into qualifications and experience were not being followed. This put people at risk of being supported by staff without the appropriate skills. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to recruiting new staff.

Is the service effective?

People's health and care needs were assessed and reviewed with them. We saw that most care plans were up to date and reflected people's current individual, dietary, cultural and religious needs. Where they did not this affected their care and support. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care records

People confirmed and records showed that people were able to see their visitors in private and that friends and relatives could visit whenever they wished.

The individual needs of people were taken into account with the layout of the home enabling people to move around freely and safely. The premises were suitable to meet the needs of people with physical impairments.

Is the service caring?

We talked with people and their relatives. They told us that they were well supported by the managers and staff team. They said they could tell them if they were worried about anything or wanted to do things differently.

People said they could make their views known to the manager and staff. One person said, 'I am very happy with the care I get and can always talk to the staff.' Another person said, 'We have meetings to talk about what we want.'

People's specific and diverse needs had not always been recorded. Because of this care and support could not always be provided in the most appropriate way or accordance with people's wishes. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care

We saw there were enough staff on the inspection to support people as they needed. We observed people involved in social and leisure activities and chatting with staff throughout the day.

Is the service responsive?

We found a range of activities were organised to keep people entertained. We observed people involved in social and leisure activities, going out of the home and chatting with staff. People said that they enjoyed the activities.

There were no risk assessments in place and available to staff for one person who had behaviour that challenged and self-harming behaviour. This meant there were no effective procedures for staff to follow to prevent the risk of harm or distress. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to acting on people's changing care needs.

People told us that they were pleased with the care and felt able to tell the manager if they were not happy about anything.

Is the service well-led?

The service had a quality assurance system in place. Records showed that any identified problems were addressed.

Staff had a good understanding of their roles and responsibilities and of the ethos of the home. They felt that they worked together effectively. Staff received training to assist with their development.

Staff supervision, resident meetings, and staff meetings were carried out regularly. This meant that people had involvement in decisions about the home.

We were not always notified of any incidents or issues relating to the home in a timely manner. This meant that we did not receive all the information about the home that we should have done. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to acting on people's changing care needs.

This inspection was carried out to assess the safety and welfare of people living at Belgravia Care. In addition, we wanted to check information of concern we received about the home having untrained staff preparing food. The information also included poor practices in relation to medication, consent to care and assisting people with bathing. We were further informed that the service had no heating or hot water at night

We found concerns at previous inspections. This related to poor care planning and risk assessment. Although Belgravia Care was making improvements in this area, we wanted to check how the service was progressing.

During this inspection we found people's consent to care was inconsistent. There was little recorded evidence of this. The service's care planning and risk assessment systems needed further development. We were told that Belgravia Care's heating was turned off at night. Although the provider refuted this, people told us they were cold during the night.

We found that medication was administered safely and that people had training to underpin this. However, training records we checked confirmed people were preparing food without food hygiene certificates. Additionally, one newly recruited staff member had no training or supervision.

We started this inspection at 7am to enable us to speak to the home's night staff. We did this so we could check the concerns we received. We spoke with the provider, manager, five staff and two service users.

We carried out this review to check whether Belgravia Care had taken action in relation to: -

Outcome 1 ' Respecting and involving people who use services

Outcome 14 ' Supporting staff

Outcome 21 ' Records

This was because the home was not compliant at previous inspections.

We spoke with a range of people about the home. They included the provider, staff and relatives of people who lived at the home. We also had responses from external agencies including the local authority contracts team. This helped us to gain a balanced overview of what people experienced living at Belgravia Care.

We saw that people were relaxed and comfortable during engagements with staff. We observed staff delivering support in a respectful and dignified manner. We reviewed records and observed practices, which included those related to outcomes 1, 14 and 21. We discussed with the provider the action plan developed by the Registered Manager in order to achieve compliance. We confirmed that the home had carried out the actions it had planned.

One member of staff told us, "I get supervision every month. I find it alright ' we talk about any problems I have and training I need". Staff training and supervision records confirmed that related regulations were now being met. We reviewed records held within the home. This demonstrated that improvements had been made to care planning and risk assessment processes. There was evidence that people and their families were involved in care planning.

The manager and providers were unavailable during our visit and staff were unable to access some records. We spoke individually with five staff and two people using the service. We asked people to tell us about their experiences of living and working at the home. They all described feeling happy and safe.

One person told us, 'The staff are very caring and look after you in a respectful way'. A member of staff said, 'I love this job because you really get to know the residents'.

However, some areas of compliance actions identified at the last inspection had not been addressed. Information supplied by the manager within the action plan could not be confirmed during our visit.

Record-keeping was poor, brief and inconsistent. Arising physical issues had no recorded actions to address them until some considerable time after they were identified. Risk assessments and care plans had limited actions to manage identified needs. We could not confirm specialist training for staff, who had no understanding of Mental Capacity.

We spoke with a number of people using the service throughout the inspection process. They included the registered manager, deputy manager and two staff members. In addition we spoke with a number of people who lived at the home. In some instances communication was limited due to conditions including learning disability and dementia. We made general observations and saw how staff and residents communicated with each other. There were no visitors at the home throughout the inspection.

People we spoke with during the course of the inspection were generally satisfied living at Belgravia Care. Three people commented on its 'relaxed and homely atmosphere'. One person told us, 'I would rather be in my own home, but I get everything I need here and the staff are very helpful.' Another commented on staff supporting him to go out every day. 'Staff come out with me every day. We are going to Cleveleys this afternoon.'

There were a number of activities taking place during the inspection. They included indoor ball games, manicures and background music. People were taking part in the activities and it created discussion between residents and staff. In another lounge younger residents were playing music of their choice. They told us they liked to play music or watch television. They also told us they liked using the lounge area but sometimes preferred the privacy of their own rooms. One person told us, 'I like sitting with others in the lounge but I like my own space.'

People told us they could express their views and were involved in decision making about their relatives' care. One person said 'It's comfortable with plenty of space. We are well looked after and appreciated". A family member told us they had chosen the home after looking around several other care homes and chose the Belgravia because it was spacious, comfortably furnished and clean.

People told us they enjoyed the activities and entertainments at the home. One person said, "I enjoy the arts and crafts and entertainers". Another person told us they went out regularly and said, "I go out every day, it's part of my care . I go out with staff either for a walk or in the mini bus. We go to local places and I decide where I want to go".

People said they decided on their routines and made choices about how they spent heir day but some choices were take away from them. One person said, 'I like to go to bed early and get up early but I can lie in if I want to". Another person said they decided on their daily routines but understood that there were restrictions on the choice they could safely make, "I have to go out with staff as part of my care. If I want to I can be alone, go to my bedroom or make myself a drink in the kitchen". We were told that people could not choose to manage their own medicines and a person said, 'Staff told me they had to manage my medicines and there were no exceptions'.

People told us they enjoyed the variety of meals available to them. One person said they enjoyed breakfast and said, "I have what I had at home, they even have the brand of cereal I enjoy". Another person told us the meals were plentiful and said, "Breakfast was really good, cereal then toast and sausage with scrambled egg. I can't eat it all'.

We were told that people had their health needs met and that staff supported people with their prescribed medicines. One person said, 'Staff give me my medicines or I would forget them. I decided that'.

Archived: Belgravia Care

All Inspections

6 November 2015

During a routine inspection

03/03/2015

During a routine inspection

25 September 2014

During an inspection looking at part of the service

12, 16 June 2014

During an inspection looking at part of the service

17 January 2014

During an inspection in response to concerns

30 July 2013

During an inspection looking at part of the service

4 April 2013

During a routine inspection

18 October 2012

During a routine inspection

15 February 2012

During a routine inspection