Bellsgrove Care Home

Bellsgrove Care Home is a residential care home providing personal care and accommodation for up to 15 older people including those who live with dementia. The service is set over three floors and has a communal lounge area and dining area on the ground floor. A lift connects all levels. At the time of the inspection 15 people were living at the home.

People’s experience of using this service and what we found

Risks associated with people's care were not always assessed in a safe way, particularly in relation to the use of bed rails and supporting people to eat. People and their relatives told us they felt safe and we checked that the provider had systems in place to ensure safe recruitment of staff. Staff followed good infection prevention and control practices. There were sufficient staff, however, we have made a recommendation that staff are efficiently deployed in order to engage with a people who remain in their rooms.

We found that the environment did not meet the needs of people who lived with dementia. Some people told us activities were not varied enough and the activities we observed did not always serve to engage those with more profound dementia, especially those who remained in their rooms for periods of time.

The provider did not always ensure that people accessed healthcare professionals in a timely manner. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

Quality assurance processes were not effective in identifying and delivering required improvements to the service which meant people were at risk of not receiving a consistent or safe service in line with their needs. There was a lack of robust management oversight of the service.

Staff told us there was good teamwork amongst the care staff but some said they did not always feel valued by the provider. Family members told us the registered manager was approachable and available to them and that there was a friendly and homely atmosphere at Bellsgrove.

People and their family members told us that staff were consistently respectful, kind and caring and we observed how staff engaged with people in a warm and friendly way. People’s needs were assessed prior to moving into Bellsgrove Care Home. Care plans were detailed and staff knew how to support people according to their wishes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

We carried out a focused inspection on 14 February 2021 when this service was rated requires improvement (published 21 January 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider had not made enough improvement and remained in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was carried out to check if the provider had followed their action plan and to confirm they now met legal requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to assessment of risk, medicines management, timely access to healthcare professionals, environmental design, lack of meaningful activities and governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Bellsgrove Care Home is a care home which provides personal care and accommodation. The service is set over three floors and has a communal lounge area and dining area on the ground floor. A lift connects all levels. Most people living at Bellsgrove are living with dementia. The service can accommodate up to 15 people. At the time of our inspection 15 people were living at the service.

People’s experience of using this service and what we found

People said they felt safe living at Bellsgrove and staff were kind to them. They told us there were sufficient staff at the service and we observed this to be the case.

We found the registered manager did not always check staff members’ eligibility to work in the UK as part of their recruitment process.

We identified shortfalls in staff practice in relation to infection control. Some of these related to the use of Personal Protective Equipment and cleaning of the service. Immediately following our inspection, the registered manager took action to start to address this.

People received the medicines they needed, but we identified some shortfalls in medicines records.

Although there was some good information relating to risks to people, we found people’s pressure mattress settings were not recorded. However, staff were knowledgeable in relation to people’s individual care needs.

People and professionals said staff were kind and both people and staff had the opportunity to be involved in the running of the service. We identified that some staff refresher training was overdue, however, this had been postponed due to the pandemic.

Where people had an incident or accident these were responded to and action taken to prevent further accidents. Staff knew how to recognise and report any safeguarding concerns.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (report published 21 December 2019).

Why we inspected

This focused inspection was prompted due to concerns we received about some aspects of the service. This included people’s safety, staffing levels, medicines management, recruitment, training and infection control practices. We found no evidence during this inspection that people were at risk of harm from these concerns. However, we did identify some shortfalls related to the concerns. The overall rating for the service has changed following this inspection and is now Requires Improvement.

CQC have introduced focused inspections to follow up on Warning Notices or to check specific concerns. They do not look at all key questions, only the key questions we are specifically concerned about.

At this inspection we reviewed the key questions of Safe and Well-Led only and this report covers our findings in relation to those.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bellsgrove Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme when we will carry out a fully comprehensive inspection looking at all key questions. If we receive any concerning information we may inspect sooner.

Bellsgrove is a care home providing personal care to up to 15 older people. At the time of our inspection there were 12 people living at the service. Accommodation is provided over two floors which are accessible using a lift.

People’s experience of using this service and what we found

People and their relatives described Bellsgrove as homely and a nice place to live. People were supported by staff who treated them with kindness and knew their needs and preferences well. People’s dignity, privacy and independence were maintained. People were offered choices and were involved in decisions about their care.

The registered manager provided strong leadership and was visible within the service. Quality assurance systems helped to identify and shortfalls in people’s care and prompt action was taken to respond to any concerns identified. There was a commitment to looking to improve the service and support and advice from other professionals was welcomed.

People lived in a safe environment and staff understood their responsibilities in managing risks to people’s safety and welfare. Sufficient staff were deployed and safeguarding procedures were in place. People received their medicines in line with their prescriptions.

Staff felt supported and valued in their roles and received regular training and supervision. People had access to healthcare professionals and the staff team worked together to promote positive outcomes for people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Activities were available to people which were relevant to their interests and people had the opportunity to go out in the local area. People’s care was personalised and care plans reflected people’s preferences. People’s individual communication needs were known to staff.

Rating at last inspection

The last rating for this service was requires improvement (published 9 December 2018). One breach of regulations was identified. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last comprehensive inspection on 17 August 2017, we found that improvements were required in relation to mental capacity assessments, staff lack of understanding of safeguarding procedures, the environment required improvements and staff training and induction was not robust. We also identified that people’s records were not always kept up to date and there were insufficient audits taking place. At the latest inspection we found that this had improved although there were some areas that we asked the provider to address that related to some aspects of the environment. After the inspection the provider sent us evidence to show that these areas had now been addressed.

Staff understood what they needed to do to protect people from abuse. People told us that they felt safe with staff and we found that there were sufficient numbers of staff to support people. People’s medicines were managed in a safe way. Risks to people care was managed well by staff. Staff had a good understanding of infection control. The service was clean and well organised.

Staff understood and knew how to apply legislation that supported people to consent to treatment. Where restrictions were in place this was in line with appropriate guidelines.

There was detailed information in care plans for staff to follow. However, there was not always detailed information that related to end of life care planning. Although activities took place on the day of the inspection these needed to be more person-centred. More outings were needed for people. Staff did not always know what people’s interests and hobbies were. We have made recommendations around all of this.

There were systems in place to regularly assess and monitor the quality of the service the service provided however this was not always effective. We identified some shortfalls that were addressed soon after the inspection. We have made a recommendation around this.

Recruitment practices were safe and relevant checks had been completed before staff commenced work. Accidents and incidents were acted upon and measures were in place to reduce the risks. In an emergency such as a fire or a flood staff understood what they needed to do to ensure people were evacuated safely.

Staff were trained and supervised to ensure that appropriate care was delivered. People were supported to have access to healthcare services and healthcare professionals were involved in the regular monitoring of their health.

The environment suited the needs of people that lived at the service. Assessments of people’s needs were undertaken before they moved in to the service. Staff worked well across the service to ensure good delivery of care.

Staff were kind, caring and attentive to people’s needs. People were treated with respect and dignity by staff. People were encouraged to be involved in their care delivery. Staff supported people to live independent lives. People were supported to practice their faiths and visitors were always welcomed to the service.

People were encouraged to voice their concerns or complaints. Complaints were investigated and responded to. The provider actively sought, encouraged and supported people's involvement in the improvement of the home. Staff were encouraged to contribute to the improvement of the service and staff felt valued.

The management and leadership of the service were described as good and very supportive. Staff worked in partnership with external organisations.

Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The registered manager had informed the CQC of significant events including significant incidents and safeguarding concerns.

Bellsgrove Care Home provides residential care for a maximum of 15 people. Some people receiving the service were living with dementia. On the day of the inspection there were 15 people living at the service.

There was a registered manager in post. 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 was also the provider. Throughout this report we refer to them as the registered provider. The registered manager was on holiday during the inspection and the trainee manager, who is a relative of the registered manager, was in day to day charge.

Everyone who lived at Bellsgrove, their relatives and healthcare professionals all commented very positively about the care at this home. However, although we found that people were cared for by dedicated staff improvements were needed in the running of the service.

People were not protected against the risks of potential abuse because staff were not aware of their responsibilities in how to safeguard people and did not receive safeguarding training in their induction.

People did not have PRN protocols in place for their ‘as required’ medication. This meant that staff might not have the information about when someone might require a medicine or what the maximum dose was. Medicines audits were not being carried out regularly to ensure good practices were being followed.

Staff did not work in accordance with the Mental Capacity Act 2005 (MCA). MCA assessments had not been completed for specific decisions and staff were unaware of the principles of the MCA. This was the same as at the previous inspection.

People were receiving care from staff who had not been provided with induction training which ensured staff were prepared for their role. Staff were also not provided with on-going training to ensure there competence was maintained

People and their relatives were concerned that the provider’s plans to refurbish the whole of the ground floor had not happened. The living room carpet and chairs were dirty and aged and there were torn blinds in the conservatory.

Contemporaneous records of peoples care, and decisions being made in relation to their care were not being kept. There were no audit systems in place to monitor and improve the quality of care being provided at the service. This meant the registered provider was unable identify shortfalls and make improvements.

People felt safe and their care records contained up to date risk assessments to guide staff in how to protect people from risks whilst enabling them to remain independent. The provider followed safe recruitment practices. People were supported by sufficient staff to meet their individual needs and medicines were administered safely.

People’s nutrition and hydration needs and preferences were met. People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP, district nurse, tissue viability nurse, community mental health team, or other health care professionals.

Staff were caring and knew people well. People were encouraged to be independent. Staff promoted people’s privacy and dignity, and people were able to have a say in the running of their home.

Care plans were detailed and contained information on people’s lifestyles and preferences. They included details on people’s routines and what support people liked to receive. People’s needs were assessed and their care was regularly reviewed.

People had access to a range of activities and were able to choose what activities they took part in. People and their relatives knew how to make a complaint and raise concerns. Relatives and friends were able to visit the home and were made welcome.

Staff and people were involved in the running of the home. People and those important to them had opportunities to feedback their views about the home and quality of the service they received.

Health and safety audits were taking place and actions had been identified to deal with risks relating to the homes water system. Accidents and incident records were maintained and appropriate action had been taken following accidents and incidents. The service had a business continuity plan in place.

During the inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made four recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.

This was an unannounced inspection that took place on 7 September 2016.

The home had a registered manager. 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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

In the event of an emergency where the home would have to close, the registered manager had not considered how people’s care would be provided. There was no contingency or emergency planning process in place so staff may not be able to provide effective care in such a situation.

Staff had not always completed decision specific assessments in relation to the Mental Capacity Act 2005, although applications where people’s liberty was being restricted had been made. Staff were heard to obtain people’s consent before they supported them.

There was a good atmosphere in the home where people and staff interacted in an easy-going manner. People and relatives were extremely happy with the care provided and they were made to feel welcome when they visited. Staff supported people to take part in various activities and staff were attentive to people to ensure they were involved with anything that was going on.

Staff followed correct and appropriate procedures in administering medicines and medicines were stored safely.

Care was provided to people by staff who were trained and received relevant support from their manager. This included regular supervisions and appraisals. Staff told us they felt valued by the registered manager and enjoyed working in the home.

Care plans contained information to guide staff on how someone wished to be cared for. Information included detail around people’s mobility, food and personal care needs. Where people had risks identified guidance was in place for staff to help reduce these risks.

Quality assurance checks were carried out by staff to help ensure the environment was a safe place for people to live and they received a good quality of care. Staff were involved in the running of the home as regular staff meetings were held. People were asked for their views about all aspects of their care and could make their own decisions. We received some good feedback about the home.

There were a sufficient number of staff to care for people. Safe recruitment practices were followed, which meant the provider endeavoured to employ staff who were suitable to work in the home. Staff were able to evidence to us they knew the procedures to follow should they have any concerns about abuse or someone being harmed.

People had care responsive to their needs and staff knew people extremely well. People were provided with a choice of meals each day and those who had dietary requirements received appropriate food.

Staff maintained people’s health and ensured good access to healthcare professionals when needed. For example, the doctor, occupational therapist or district nurse.

People knew how to make a complaint if they felt the need to. They told us any concerns they raised were dealt with immediately by the registered manager.

There was an open positive culture within the home and it was evident the registered manager was respected by staff. The registered manager had a good management oversight and was keen to improve the quality of care provided. We raised some issues we found with the registered manager during the inspection. These related to the environment, cleanliness, contingency plan and medicines storage. Before we left the inspection we found the registered manager had taken action to address these.

During the inspection we found one breach 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 the report.

We found that staff interacted with people during our inspection. We saw that people were involved in separate activities and staff engaged with them individually.

We spoke with one relative of a person who used the service. They told us that they felt staff engaged with their family member regularly. They told us that the service held events that were popular with people. They told us that this included a choir coming to the service.

We found that the records were up to date with daily care information on each person who used the service. We also found that each person's file had been updated with any visits from Health Care professionals.

We found that people who used the service and their relatives were involved in the planning of their care. We saw that staff treated people with respect and dignity. However the service did not have meetings with all of the residents and their family members to discuss how the home should be run.

We could not speak with most people as they had complex needs. The relatives told us that the care that was provided to people was good. We looked at two care plans and saw that people's needs had been identified and risks assessments had been completed.

All the staff we spoke with were able to tell us about how to safeguard vulnerable adults and the types of abuse to look out for. They were also able to tell us who the local safeguarding team were and how to contact them if necessary.

We found that there were suitable amounts of qualified staff that met the needs of people who used the service. Staff told us that there were always enough staff on duty and that staff sickness was always suitably covered.

The provider was able to show us that all of the staff had received up to date training in all of the mandatory courses required by the service. Staff told us that they felt supported and that they could speak to their manager if they had any concerns.

We spoke to two people who were using the service and two relatives during our inspection. One person told us that they didn't go out much. They told us that they felt the place was like their own home and felt very comfortable. Another person told us that activities did not happen much but they enjoyed going out when they could.

One relative told us that they staff provided 'Brilliant care' and they were very happy with the care that they received. They said that nothing was too much for the staff when it came to the care for their relative. Another person told us that they knew that their relative was well looked after and had never had any concerns about their treatment at the service.