Archived: Bellevue Residential Care home

The last comprehensive inspection of this service was undertaken in March 2017. We identified a number of breaches of the legal requirements and found that people were not sufficiently protected against risks, the premises were not clean and there were not always sufficient staff available to support people and meet their needs. After the comprehensive inspection, the provider told us that they were addressing the concerns and we subsequently met with them to discuss the actions that they were taking. We undertook a focused inspection on 28 November 2017 to check that the provider had followed their action plan and to confirm that they now met legal requirements. We found that they had not addressed the issues and were still not meeting the regulations. We rated the service as ‘Inadequate’ and Bellevue went into ‘special measures’.

Following this focused inspection we placed urgent conditions on the provider’s registration with the aim of driving improvement. These conditions meant that the provider was unable to admit any new people into the service and they had to ensure that there was sufficient and suitable food available to meet people’s needs. Appropriate referrals were to be made to health professionals for advice and guidance. We required the provider to commission an independent review of training and health and safety to address some of the issues we found.

This inspection on 21 and 22 February 2018 was unannounced and we planned to check on the progress the provider had made. It was also prompted in part by information we received which indicated that people’s needs were not always being met.

There were ten people living at the service on the day of our inspection. This report only covers our findings in relation to Safe and Well led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bellevue Residential Home on our website at www.cqc.org.uk”

The service had a registered manager who was also a director of the company which owned the service. The registered manager was also registered to manage another care home for older people in Clacton which they also owned. 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 this inspection we found that sufficient progress had not been made and the provider continued to be in breach of multiple regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Practices at the service did not protect people and there was a lack of understanding of the causes of behaviour and how people’s distress should be managed. Staff did not always support people in the least restrictive way possible and in way that promoted their wellbeing.

There were some risk assessments in place but these did not adequately address risk and staff were not always aware of, or followed the management plan. We identified issues with moving and handling, the support provided to people with catheters and those at risk of aspiration or choking. Following the inspection we asked the registered provider to take urgent action to protect people and we raised our concerns with the safeguarding team at the local authority.

Environmental risks continued not to be well managed and we identified that issues were not always addressed in a timely way. We identified continued issues with the management and oversight of medicines. Staff were not always following the recommended guidance and we were not assured that people always received their medicines as prescribed.

At the inspection we found continued issues with the competency and availability of staff which meant that people continued to be at risk of poor care. Staff did not demonstrate that they had sufficient levels of training or expertise to meet the complex needs of the people living in the service. Staff morale was low and they did not feel supported.

There were quality assurance systems in place but these had not been effective in driving change at the service. Sufficient improvement had not been made since our last inspection.

The overall rating for this service remains ‘Inadequate’ and the service remains 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

Following the inspection CQC reviewed the concerns and took appropriate action. There is no one currently living in the service.

We carried out an unannounced comprehensive inspection of this service on 02 March 2017. We identified a number of breaches of the legal requirements and the service was rated as requires improvement. We found that people were not sufficiently protected against risks, the premises were not clean and there were not always sufficient staff available to support people and meet their needs. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the concerns and we subsequently met with them to discuss the actions that they were taking.

We undertook this focused inspection on 28 November 2017 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The inspection was unannounced and there were ten people living at the service on the day of our inspection. This report only covers our findings in relation to Safe and Well led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bellevue Residential Home on our website at www.cqc.org.uk”

The service had a registered manager who was also a director of the company which owned the service. The registered manager was also registered to manage another care home for older people in Clacton which they also owned. 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 this inspection we found that sufficient action had not been taken and the provider remained in breach of the regulations. We found that some parts of the service presented risks to people and there was a lack of robust assessments and controls in place to protect people and keep them safe. The environment was not always well maintained and we continued to find issues with cleanliness. Some improvements had been made to the numbers of staff however we continued to have concerns about the numbers of staff at night and staff knowledge and skills. We identified that staff did not always display adequate knowledge about how to support people safely. We identified shortfalls in the management of risks such as aspiration, moving and handling, infection control and food hygiene.

Medicines were not managed in a safe way. Staff did not always following the supply pharmacist instructions and the amount of medicines administered did not tally with the records of administration. This meant people did not receive their medicines as prescribed. We also identified shortfalls with auditing and storage of medicines.

People’s nutritional and hydration needs were not well managed and there was a lack of nutritious, fresh food available at all times. There was poor organisation and oversight of menus and over dependence on frozen food. People were not protected from the risks of choking and did not always receive specialist diets as required.

Staff practice was not consistently caring and did not always promote peoples dignity. Care was not always delivered in a way that reflected best practice and personalised care.

There were quality assurance systems in place but these were not robust or effective. They were not driving improvement and had not identified the issues that we found at the inspection.

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

You can see what action we told the provider to take at the back of the full version of the report.

The service has a registered manager, who was also the provider. The manager was also registered to manage another care home for older people in Clacton. 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.

There were not always sufficient staff available. This was a small service providing care for people with complex needs. Staff responsibilities as well as providing personal care support also included cooking, cleaning, providing activities. We identified shortfalls in these areas.

Checks were undertaken on newly appointed staff before they started work in the service but the recruitment process in place would benefit from being further strengthened.

Medicines were not always given as prescribed and there was a lack of clarity about who should be given what medicines and when.

The risks surrounding the care of people diagnosed with diabetes, at risk of acquiring a pressure ulcer and moving and handling were not always managed in a way that minimised the risks to people. Checks were undertaken on the environment and equipment to check that it was safe; however we found a number of concerns which had not been identified or addressed. Following the inspection we asked the fire officer to visit the service to advise the provider as to steps they should take to mitigate the risks to people’s safety. The environment was not consistently clean and hygienic.

Training for staff was provided but it was not effective. The majority of training was provided by manager. We identified concerns about staff understanding of current good practice. For example, staff did not demonstrate knowledge of safe care and best practice in areas such moving and handing and infection control. Mental Capacity and staff knowledge of their responsibilities was not clearly understood and ensuring consent was not embedded into practice.

The food looked appetising and people enjoyed the meals but some individuals would have benefited from more support. People had access to health care support and we saw that the staff referred people appropriately.

Individual staff were kind and caring. However support focused on the provision of tasks and care was not always person centred or individualised. There were some communication issues as some staff skills in understanding and communicating in the English language were limited. Interactions were warm and respectful but staff did not fully understand issues such as privacy and confidentiality. The environment did not fully promote peoples independence.

Efforts had been made to develop care planning and ascertain people’s wishes and preferences however staff were not familiar with the plans. This meant that care was not always delivered in a consistent way or in a way that reflected best practice. Best practice for example in supporting people living with dementia was not consistently being delivered to promote peoples mental stimulation and meaningful activity.

The manager and the deputy manager worked across both of the provider’s services and covered care shifts as well as providing leadership to the staff team. Staff told us that they were approachable but we had concerns about their accessibility and their ability to drive improvements at this and the other provider service. There were quality assurance systems in place but these had not identified some of the issues we identified at this inspection and further work is needed to ensure that they are effective.

During this inspection we identified 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 this report.

We looked at the care records of four people using the service. These contained assessments of people's needs, including risks assessments and care plans to address these. There were signed and dated staff entries in daily care records, to ensure communication between staff. Records held life histories and noted personal interests. These interests were supported where possible, for example, one person using the service had a piano in the lounge and keyboard in his room. During our inspection, we were informed by staff and people who used the service about musical and singing activities.

There was evidence of good working relationships with health and social care professionals, details noted the input to care of people using the service.

Staff records showed that appropriate recruitment procedures were in place and we interviewed staff and reviewed personnel records to ensure necessary induction, training, supervision and appraisal systems were in place and being followed.

People who used the service were supported in raising concerns.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

People told us that they felt comfortable talking with the staff about any issues that they had and that the manager was also always available for them to talk to.