Belmont Grange Limited

Belmont Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Belmont Grange is registered to provide accommodation with personal care for up to 25 people in one adapted building, with two of the bedrooms ‘shared’. Belmont Grange is a large Victorian building situated in Ilfracombe, North Devon within a residential area. Access to all floors is gained by a passenger lift. There were 22 people living at the service when we visited, with one vacant room and one person in hospital. The majority of people living at the service experienced some level of a dementia related illness.

We had previously carried out an unannounced comprehensive inspection of this service in March 2017. The safe, effective and well led sections were rated as requires improvement. The caring and responsive areas were rated as good. As a result, the overall service was rated as requires improvement. Two breaches of regulation were found. These related to people not having had assessments carried out relating to their mental capacity and people were not protected against the risk associated with the lack of systems to pick up on environmental issues. We also issued a recommendation in relation to the provider using a dependency tool to help them decide on the number of care staff required to meet people’s assessed needs.

Following the last inspection, the local authority Quality Assurance Improvement Team (QAIT) and North Devon Care Homes Team supported and worked with the service to address the breaches of regulation.

At the last inspection in March 2017, we asked the provider to make improvements and this action has been completed.

There was a registered manager in post. A registered manager is a person who has registered with the 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.

People, visitors and care professionals described the care as exceptional at Belmont Grange and this had an extremely positive impact on people’s care, support and wellbeing. Relatives described how staff went above and beyond what they should. There was a homely, vibrant and happy atmosphere in the home. Staff were compassionate, polite and respectful to people. They spent time with people, developed meaningful relationships and knew what mattered to them. They were familiar with their lives, past histories and their families. One person commented, “I said I’d never come here … but I couldn’t wish for anything better. The girls look after you, you’re not just their job. If I want anything they will do it for me even in their time off.” People’s relatives and friends could visit always and were very complimentary of the service and all the staff group. Regular feedback was sought from residents and their relatives.

The registered manager led by example and had made significant improvements in the care delivery, fabric of the building and the management of the home. This had been recognised by people, relatives and care professionals who were overwhelmingly positive about the changes. Comments included, “… feel that the atmosphere in the home is one that gives a positive feel when you visit, there is both a homely and vibrant atmosphere having known the home previously I feel that the environment and indeed the reputation of the home is now so much improved”, “Belmont Grange is a home which I have always been very grateful to have in our community” and “In my opinion, the manager has continually strived to make improvements.”

Recruitment checks were safely carried out and there were sufficient and suitable numbers of staff on duty to keep people safe and fully meet their needs. Staff received training and supervision to do their jobs properly. There were many positive comments from care professionals about the staff team and how well they did their jobs.

People were protected by staff who had been trained in safeguarding people from abuse. They had undertaken training, knew the right action to take and who to inform if abuse had been suspected.

People’s needs were assessed before they came to live at the service. People had care plans in place to guide staff. Risk assessments had been carried out in a way to ensure people were restricted as less as possible. People were involved in making decisions about their care. They were referred promptly to health care services when required and received on-going healthcare support. Staff acted on any advice given.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Improvements had been made in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed. Staff knew which people had a Power of Attorney (POA) in place to support the person in decision making. Best interest decisions had been made and involved the relevant parties.

People received their medicines in a safe way and effective systems were in place. The registered manager and staff were committed to ensuring people received end of life care at the service in an individualised way. An activities co-ordinator carried out a range of activities people could take part in.

Staff were very motivated, enthusiastic and proud of their jobs. They felt they were listened to, supported and valued by the registered manager. The registered manager ensured there was an open culture at the service and people, relatives and staff’s opinions mattered.

People were complimentary of the food and enjoyed the choice of home cooked meals. They were given choices and assisted by staff where necessary.

A quality monitoring system had been put into place which monitored and improved various aspects of the service. There was a complaints procedure in place and people knew how to make a complaint if necessary.

Ongoing maintenance of the building continued and further updates were planned.

We have made two recommendations about improving the environment and activities for people living with dementia.

At this inspection we found people’s capacity was not always being fully documented, although the registered manager had sought some advice from a nurse educator. Where people were being restricted to ensure their safety, use of bedrails for example, best interest decisions were not fully recorded. We also found that although staff had received training in understanding the Mental Capacity Act (2005) and deprivation of liberty safeguards, they did not all understand how this worked within their practice.

Belmont Grange is registered to provide care and support without nursing for up to 25 people. At the time of the inspection there were 24 people living at the service.

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.’

People, their families and visitors were positive about the care and support provided by staff at Belmont Grange. Comments included “ very good indeed, staff are very pleasant and co-operative, time keeping is very good, some hiccups, sometimes, but I am not one to complain.’’ One relative said ‘‘My relative moved here from another home, we do not live that close so rely on the staff to keep us up to date. I think they are very caring and helpful to us too.’’

Systems were used to ensure the environment was kept clean and safe with audits being completed on all aspects of the building and equipment. These were not always done to the frequency set out within the providers own guidance. For example the testing of fire alarms and emergency lighting had not been completed for the two weeks previous to our inspection. The maintenance person tested these on the second day of our inspection.

We found the hot water temperatures on several of the baths and showers exceeded the recommended temperatures to ensure people were prevented from risk of scalding. They temperatures had been monitored but no action had been taken to ensure people’s safety. We were informed that they had been fitted with regulators but they were taken off as the hot water supply was not strong enough and when regulators were fitted, only cold water came out of the outlets. Since this inspection we have received confirmation that all hot water outlets have been fitted with regulators to keep people safe from scalding themselves. Similarly, a screen had been fitted to the kitchen door and a radiator had been covered to protect people. All these actions had been taken following feedback after the inspection.

There were enough staff with the right skills, training and support to meet the number and needs of people living at the service. Staff understood people’s needs and knew what their preferred routines and wishes were. This helped them to plan care in a person centred way. There had been some concerns prior to Christmas about there not being enough staff. This was due to staffing levels being reduced to three because the number of people living at the service had been reduced. The provider told us they had a tool to decide on staffing levels in line with people’s assessed need, but this had not been used appropriately by staff. It is recommended the provider use their dependency tool to help them decide on the number of care staff required to meet people’s assessed needs.

Staff understood how to ensure people’s rights were protected and people were continually offered choice throughout their day Staff were able to describe how they gained people’s consent and how they worked in a way to ensure people were offered choice in their everyday lives.

The home was cleaned and decorated to a high standard, although the lack of contrast in colours used for both walls and flooring may not be best practice for people living with dementia to differentiate.

There was an activities coordinator who strived hard to ensure people were engaged in meaningful activities throughout the weekdays, although when they were short staffed they were required to assist with care. Activities included sing-alongs, quizzes, flower arranging, visits from various animals as well as regular paid entertainers and visits form community groups such as local school children and local choirs.

Medicines were well managed and kept secure. People received their medicines in a timely way. People were offered pain relief and received their medicines on time.

Care and support was planned to ensure that risks were assessed and monitored. People’s choices and preferences were included within care plans to ensure staff understood how to assist people in way they preferred and wishes met. People were protected from harm because staff were only recruited once they had all the checks in place to ensure they were suitable to work with vulnerable people. Staff understood what may constitute abuse and how and to whom they should report any concerns.

People were offered a variety of meals and snacks to ensure good health. Several people said they did not like the food, but any suggestions they had made had been incorporated. Where people were at risk of losing weight due to their health condition, staff monitored what people ate closely. Some people were on supplementary drinks prescribed by the GP. Additional snacks and higher calorie foods were also offered.

People, visitors and staff were all able to voice any concerns or suggestions to help improve the quality of the service provide at Belmont Grange. The registered manager worked hands on within the home and spent time talking with people, their visitors and with staff to ensure their views were heard. Quality assurance systems included audits on the environment and were being expanded to include documentation relating to people’s daily care and support. However, audits that were in place had not been acted upon. For example, audits showed hot water outlets were a risk to people scalding themselves.

There were two of breaches of regulations. You can see what action we took at the end of the report.