Archived: Belgarth Care Home

We carried out an unannounced inspection of Belgarth Care Home on 10 and 11 August 2015. One adult social care inspector conducted the inspection.

Belgarth Care Home is situated on the outskirts of Barrowford, approximately one and a half miles from Nelson town centre. The home is registered to provide accommodation, nursing and personal care for 47 people, including a separate unit for people living with a dementia or a mental disorder. At the time of the inspection there were 20 people accommodated in the home.

The registration requirements for the provider stated the home should have a registered manager in place. There was no registered manager in post on the day of our inspection as the previous registered manager had left in March 2015. 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 regional manager was in day to day control of the home until a suitable manager could be recruited.

At the last inspection of 10 and 11 February 2015 we found the registered provider was not meeting the relevant legal requirements relating to ineffective quality assurance and auditing systems, failure to follow safe medicine procedures, failure to meet the requirements of the Deprivation of Liberty Safeguards (DoLS), failure to maintain clear and accurate records about people’s care, failure to follow safe infection control procedures and failure to maintain a safe and suitable environment. The registered provider was asked to take action to make improvements.

From December 2014 meetings had been held with the registered persons, Care Quality Commission (CQC), the local authority infection control lead nurse, the safeguarding team and commissioners of services. Admissions to the home were suspended until commissioners were satisfied improvements had been made. Restrictions on admissions were lifted following our inspection visit. During this inspection visit we found action had been taken and further improvements were ongoing in respect of the premises.

People told us they did not have any concerns or complaints about the way they, or their relatives, were cared for. They said, “It’s alright, they look after me” and “I’m safe and looked after.” Visitors said, “The care has been first class in every respect from day one”, “I am really pleased with the care my relative receives” and “My relative is content and happy; I am happy with the care.”

Each person had a care plan that was personal to them and contained information about their likes and dislikes as well as their care and support needs. The care plans had been updated in line with any changing needs and showed some people had been consulted about their care.

There were opportunities for involvement in suitable activities both inside and outside the home. People said, “There are things to do” and “There is plenty going on.” Throughout the day we heard laughter and friendly chatter. We noted staff spending time to sit and chat with people in a relaxed and friendly way.

People told us they enjoyed the meals. They told us, “I enjoy the meals; the food is very good here and there is always a choice available” and “If I don’t like what is on the menu they will make me something else.” A visitor said, “The meals always look very good.” Staff chatted amiably to people throughout the meal and we saw people being sensitively supported and encouraged to eat their meals. People were offered drinks and snacks throughout the day.

Staff had an understanding of abuse and had received training about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care. We noted appropriate DoLS applications had been made to ensure people were safe and their best interests were considered.

People’s medicines were managed safely and appropriate processes were in place for the ordering, receipt, administration and disposal of medicines.

The home was clean and hygienic. There were effective systems in place to support good practice and to help maintain good standards of cleanliness. One person told us, “My room is always clean and fresh.” A visitor said, “It is always clean when I visit.”

There were sufficient skilled and experienced staff to meet people's needs. People made positive comments about the staff team. They said, “They seem a good bunch and always around to help.” Visitors told us, “The staff are fabulous” and “There are plenty of staff around; they are pleasant, polite and caring.”

Employment checks were completed before new staff started work to make sure they were suitable. Staff had been provided with training and support to help them look after people properly.

People told us they were happy with their bedrooms. One person said, “I like my room very much.” Some areas of the home had been redecorated and refurbished and offered comfortable, bright and interesting communal spaces. However, some areas were in need of further improvement to ensure people lived in a comfortable and suitable environment. We made a recommendation that the service complied with the dates on the development plan for the home.

Effective systems were in place to regularly assess and monitor the quality of the service. The systems had identified shortfalls and that improvements had been made. People’s views and opinions about the running of the home had been sought which would help to monitor their satisfaction with the service provided.

We carried out an unannounced inspection of Belgarth Care Home on 10 and 11 February 2015. Two adult social care inspectors conducted the inspection with a specialist advisor. The specialist advisor had experience of prevention and control of infection.

Belgarth Care Home is situated on the outskirts of Barrowford, approximately one and a half miles from Nelson town centre. The home is registered to provide accommodation, nursing and personal care for 47 people, including a separate unit for people with a dementia or a mental disorder. At the time of the inspection there were 28 people accommodated in the home.

There was a registered manager in day to day charge of the home. 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 registered manager had been in post since March 2014.

At the last inspection on 20 August 2014 we found the registered provider was not meeting the relevant legal requirements relating to how care and treatment was planned and delivered and maintaining accurate and appropriate records. We also found there were problems with communication between staff at the home and with the district nursing service which could impact on people’s care. We asked the registered provider to take action to make improvements. During this inspection we found appropriate action had been taken.

Following our last inspection on 20 August 2014 a number of safeguarding concerns had been raised with the local authority in relation to cleanliness, the delivery and planning of people’s care, staffing and safe management of medicines. From December 2014 meetings had been held with the registered persons, Care Quality Commission (CQC), the local authority infection control lead nurse, the safeguarding team and commissioners of services. The registered provider was asked to take action to make improvements and provided ‘action plans’ which were currently being monitored. Admissions to the home were suspended until commissioners were satisfied improvements had been made. Prior to the inspection we spoke with commissioners and the infection control lead nurse and were advised the registered persons were working through the action plans and improvements were being made. Restrictions on admissions remained in place at the time of writing this report.

During this inspection visit we found action had been taken and improvements were ongoing. However, we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, relating to ineffective quality assurance and auditing systems, failure to follow safe medicine procedures, failure to meet the requirements of the Deprivation of Liberty Safeguards (DoLS), failure to maintain clear and accurate records about people’s care, failure to follow safe infection control procedures and failure to maintain a safe and suitable environment.

The number of concerns about Belgarth Care Home indicated quality assurance and auditing processes had been ineffective. Checks on systems and practices had been completed but matters needing attention had not been recognised or addressed. The registered provider had increased management support and improved systems to assess and monitor the quality of the service which aimed to improve the service. You can see what action we told the provider to take at the back of the full version of the report.

Prior to the inspection we were told there were concerns about the way people’s medicines were managed. We found there were accurate records and appropriate processes in place for the ordering, receipt and storage of medicines. We were told a new medicines management system had been introduced in January 2015. We observed the morning medicine rounds were completed in a timely way and one person told us they received their medicines at the appropriate time. However, we noted a discrepancy in the medicine amounts for one person, lack of clear instruction in relation to ‘as needed’ medicines and safe procedures not followed in relation to disposal of medicines. There were policies and procedures in place but these were not yet reflective of current practice. All staff who administered medicines had received training. However, regular checks on staff practice had not yet been undertaken to ensure they were competent. You can see what action we told the provider to take at the back of the full version of the report.

Prior to the inspection we were told there were concerns about the standard of the environment. Extensive building work, to improve some areas of the home, had been intended for some time although there was still no formal plan to determine how all areas of the home would be improved and maintained. We noted improvements were being made such as a new bathroom and toilet suite, redecoration of three bedrooms and replacement floor coverings. However, without a formal plan the improvement work appeared to be inconsistent and there was a lack of assurance that appropriate action was to be taken. We also found a number of areas of the home in need of attention. These included stained carpets and furnishings, torn and missing wallpaper, faulty window glazing and broken doors and radiator covers. We found a fire exit door was fastened with string. This was unacceptable as the door could not be opened quickly in the event of a fire and presented a security risk. In addition the door did not close properly and people were still dining in a cold room despite portable heaters being provided. Although the door was repaired following our visit we were concerned people had been placed at risk and that the risk would have continued without our intervention. You can see what action we told the provider to take at the back of the full version of the report.

Prior to our inspection visit there were concerns regarding ineffective infection control systems and areas of the home that were not clean. An action plan was in place to address these concerns and we were advised progress was being made. During our visit we found staff had received appropriate training in infection control and had access to clear policies and procedures. However, we found a number of areas that presented a risk of infection that had not been noted as part of the ‘audit’ systems. You can see what action we told the provider to take at the back of the full version of the report.

Staff told us they were confident to take action if they witnessed or suspected any abusive or neglectful practice and some had received training about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care. We noted appropriate DoLS applications had been made to ensure people were safe and their best interests were considered. However, staff had varied levels of understanding of the MCA and DoLS processes and the requirements of DoLS had not been followed. This meant people may not receive the care and treatment they need. The registered manager confirmed further training was planned for the following week which would help improve staff awareness of the procedures. You can see what action we told the provider to take at the back of the full version of the report.

During our visit we observed people being asked to give their consent to care and treatment by staff. However, people’s capacity to make safe decisions and choices about their lives was not always clearly recorded in the care plans; the registered manager gave assurances this would be reviewed.

At our last inspection we were concerned accurate records were not maintained in respect of people’s care. We found each person had a care plan that was personal to them. The care plans included information about the support people needed and arrangements were in place to monitor and respond to people’s health and well- being. However, we found records were not always clear or reflective of the care people were receiving. The registered manager advised this was currently being addressed with the introduction of the new care plan system and the auditing process. You can see what action we told the provider to take at the back of the full version of the report.

We did not observe anything to give us cause for concern about the way people were treated. People told us they were happy with the approach taken by staff. Comments included, “I think the care is good. People try to do their best” and “Staff are respectful, kind and considerate.” Visitors said, “The care is very good” and “Staff have a good attitude and give good care.” We observed staff responding to people in a kind and patient manner and being respectful of people's choices.

Prior to the inspection visit we were told there were, at times, insufficient staff to meet people’s needs and reliance on agency staff was high. We found there were sufficient numbers of nursing, care and ancillary staff to meet people's needs but noted levels of staff sickness were high. The registered manager was aware of this and was monitoring the situation. Staff told us any shortfalls, due to sickness or leave, were covered by existing staff or ‘regular’ agency staff. This helped to ensure people were looked after by staff who knew them. People had mixed views about the staffing levels but overall considered there were enough staff to attend to their needs. We noted people’s requests for assistance were responded to in a timely way and staff were available in all areas of the home.

Prior to the inspection we were told safe recruitment procedures were not being followed. We found a safe and fair recruitment process had been followed and the necessary checks had been completed. Staff received appropriate induction, training and support to help them look after people properly. Assessments of staff competency had not been done. The registered manager was aware she needed to check whether staff were safe and fit to practice.

At our last inspection we found the registered provider was not working well in co-operation with other health professionals which could impact on people’s health, safety and welfare. We found staff at the service were improving links with other health care professionals to help make sure people received prompt, co-ordinated and effective care.

People told us, “The food is okay; I have things I particularly like” and “We can choose; the choices are good enough for me.” We observed people being given the support and encouragement they needed and being offered choices of meals. The meals served looked appealing and plentiful. People’s dietary preferences and any risks associated with their nutritional needs were recorded.

There were opportunities for involvement in a number of activities. We saw a programme of activities which were arranged for small groups of people or mainly on a one to one basis. We were told activities would be changed to meet people’s daily requests and needs. Visitors told us they were able to visit at any time and were made to feel welcome.

People were able to discuss their concerns during day to day discussions with management and staff and also as part of the annual satisfaction survey. However, we found people’s concerns were not clearly recorded. The registered manager gave assurances she would review this. One person said, “I have nothing to complain about.” A visitor told us, “I don’t really know how to make a complaint but I have been given no reason to complain.”

There were systems in place to seek people’s views and opinions about the running of the home. We were shown two surveys that had been returned; we noted they reflected positive comments. Meetings were held for people living in the home and their families; although we were told the meetings were poorly attended. The registered manager was aware of the need for developing systems which would ensure people were kept up to date with any changes to the service and with their relatives care.