Belvedere House

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.
 

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by involving people in care planning and reviews.

People and relatives told us they were involved in reviewing care and had access to care planning information. One relative told us, “Mum and I go to his care reviews together. They send me something every month to let me know how dad is getting on.” Another said, “Dad has his care reviewed annually. We do have the ability to contact staff if we want to make any changes.”

Staff told us nurses worked with people and their relatives to develop care plans. Staff understood that their role was not to create the care plans but to follow the information recorded within them.

The registered manager said during pre-assessment, relatives were invited to be involved where a person had limited capacity. People and relatives met with the nurse to discuss their likes, dislikes and care needs. Care plans were then shared with people and their relatives.

Regular care plan reviews and communication with relatives supported care plans to remain responsive to people’s changing needs, preferences and circumstances.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them.

Staff used nationally recognised assessment processes to assess people and monitor them on an ongoing basis. This included assessments such as Waterlow (checking a person’s skin integrity) or MUST (review a persons risk of malnutrition).

We reviewed care records and saw evidence about people's nutritional and dietary needs. This included any special diets, dietary preferences and guidance from external professionals, such as speech and language therapy (SaLT) being completed. A relative told us, “Mum gets additional support for her diabetes. They check her blood sugar levels and then they need to decide whether they can let her have something with sugar in it.”

The registered manager told us they kept up to date with current good practice by attending registered managers’ forums and community hubs and reviewing CQC updates and inspection reports from other care services.
 

The provider worked well across teams and services to support people. They made sure information was shared, care plans were updated, and relatives and relevant professionals were kept informed when people moved between different services.

Arrangements were in place to support communication and continuity of care when people accessed hospital services. A staff member told us, “If a resident goes into hospital, the nurse will call the hospital and get any updates and will update the care plans and will also contact the next of kin.”

Relatives were happy with how the service worked with external professionals. One said, “Dad sees the GP regularly. He’s been referred to the dietician and occupational therapist. He sees the chiropodist and has dentist visits. The hairdresser does his hair for him.”

The registered manager said they promoted teamwork at staff meetings and regularly reminded staff, “We are all here for the same goal.” All staff had a responsibility to contribute to people’s wellbeing regardless of their role. They also said, “I ensure people take responsibility and are accountable and are able to raise any mistakes they have made as we all need to work as a team.” This supported an open approach to communication and shared responsibility across the staff team.
 

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control.

People were supported to maintain their mobility and independence while receiving appropriate assistance. Staff said they supported people who wanted to remain independent. One staff member told us, “We help residents who like to be independent. For example, if a resident needs a frame to walk to the toilet, we will assist them by going with them but will not take over and will not rush them.”

Relatives confirmed this and said, “She’s encouraged to be independent. Everyone is treated as an individual here and she likes to be independent. She can bring herself downstairs in the lift.”

Management oversight demonstrated consideration of how changes could improve people’s wellbeing, participation and experience of living at the service. The registered manager said, “I am aiming to change the downstairs lounge so that it is more dementia friendly. Right now the curtains are quite dark and furniture is very bulky so difficult to move when coordinating joint activities with upstairs and downstairs.”

The provider introduced dementia-friendly red crockery and pictorial menus to support people living with dementia to recognise food and encourage eating. Aids and equipment to promote independence were identified before admission and made available when people moved into the service.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People experienced positive changes in their health and wellbeing with relatives able to recognise improvements in their condition.

A relative told us, “The staff are very friendly, professional and attentive. When he first came here, he looked sallow. He’s put weight on and he looks a lot better.” Another said, “He has been here about 4 months. He is looking so much better and we all think he’s put on weight.” This indicated that the person’s nutritional status and overall appearance had improved since receiving care at the service.

A person’s care plan recorded they were bedbound on admission. Staff subsequently supported the person to mobilise using a medical wheelchair and access communal areas, including the lounge and dining room. This enabled the person to spend more time out of bed and participate in communal activities and mealtimes.
 

The provider did not consistently apply the principles of the Mental Capacity Act (MCA) and did not always respect people’s rights when delivering care and treatment.

Records showed inconsistent application of the principles of the Mental Capacity Act (MCA) 2005. One person’s care records indicated capacity assessments and best interests’ decisions had been completed despite information demonstrating the person had capacity to make the relevant decisions themselves.

For other people, there was an absence of capacity assessments and best interests decision records relating to restrictive practices in use. Two people were subject to restrictions associated with locked doors; however, there was no evidence that capacity had been assessed or that best interests’ decisions had been completed to demonstrate the restrictions were necessary and proportionate. In addition, 1 person was subject to monitoring through the use of a sensor mat, with care records stating staff had to be aware of the person's whereabouts at all times. There was no evidence of a capacity assessment or best interests’ decision to support this restriction.

Where best interests’ decisions had been completed, records did not demonstrate who had been involved in the decision-making process, the rationale for decisions reached, or whether less restrictive alternatives had been considered. This limited assurance that decisions were made in accordance with the MCA.

We raised these concerns with the registered manager, who was responsive to the issues identified and confirmed that they would investigate the findings further and take appropriate action to address any gaps identified.