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Archived: Belvoir Home Care Home Requires improvement

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Reports


Inspection carried out on 21 July 2016

During a routine inspection

This was an unannounced inspection carried out on 21 July 2016.

Belvoir Home Care Home can provide accommodation and personal care for 20 older people and people who live with dementia. There were 18 people living in the service at the time of our inspection.

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.

People were not suitably protected from the risk of acquiring avoidable infections. Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse including financial mistreatment. People had been helped to avoid the risk of accidents and medicines were managed safely. There were enough staff on duty to care for people and background checks had been completed before new staff were appointed.

Parts of the accommodation were not adapted and decorated to meet people’s needs. Staff had received training and guidance to support them to care for people in the right way. People had been assisted to eat and drink enough and they had been supported to receive all of the healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the Mental Capacity Act 2005 (MCA) and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. Two people living in the service were being deprived of their liberty and the registered manager had taken the necessary steps to ensure that their legal rights were protected.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had been consulted about the care they wanted to receive and they had been given all of the assistance they needed. This included people who lived with dementia and who could become distressed. People were supported to pursue their hobbies and interests and there was a system for resolving complaints.

Quality checks had been completed to ensure that people received the facilities and services they needed. Good team work was promoted and staff were supported to speak out if they had any concerns because the service was run in an open and inclusive way. People had benefited from staff acting upon good practice guidance.

Inspection carried out on 17 February 2016

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 5 January 2015 when we found that there were breaches of legal requirements. We found that medicines had not always been managed safely, people had not been consistently supported to eat and drink enough and there were not enough staff on duty. We also found that the registered provider had not completed robust quality checks. This latter shortfall had led to the persistence of the problems noted above and also had contributed to people not being consistently protected from the risk of accidents.

After our inspection of 5 January 2015 the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. As a result we undertook a further unannounced comprehensive inspection on 3 July 2015. We did this to check that the registered provider had followed and completed their plan and to confirm that they now met the legal requirements. During this inspection we found the registered provider had made improvements in the specific areas we had identified and had met the legal requirements in the breaches. However, we recommended that further developments should be made in relation to each of the shortfalls we had previously identified. We said that this was advisable to ensure that the improvements that had been made were sustained.

On 23 November 2015 we received information about concerns in relation to the service. As a result we undertook an unannounced focused inspection on 17 February 2016 to look into those concerns. The concerns related to an accident that had occurred when a person who lived in the service had opened a window that was located above ground floor level. They had then fallen out and been injured. We completed the inspection to check that suitable provision was in place to help reduce the risk of a similar event happening again.

This report only covers our findings in relation to the concerning information. You can read the report from our last comprehensive inspection and focused inspection, by selecting the 'all reports' link for Barnby Care Ltd on our website at www.cqc.org.uk

Belvoir Home Care Home is registered to provide accommodation and personal care for up to 24 older people most of whom live with dementia. The service is close to the centre of Grantham.

There was a manager who had been in post at the time of the accident. They had applied to be registered with us but at the time of the inspection visit we had not completed our consideration of the application. Since our inspection visit we have registered the 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 2008 and associated Regulations about how the service is run. Due to the manager not being registered with us at the time of our inspection, we only refer in our report to the ‘registered provider’. This is the company that owns and is registered with us to operate the service.

In this report we refer to windows that were located above ground floor level, had sections that opened and were accessible to people who lived in the service.

New safety latches had been fitted to all of these windows. This provision helped to ensure that people who lived in the service were protected from the risk of accidental injury when opening the windows.

The registered provider had completed suitable quality checks to ensure that the safety latches remained in good working order. This had enabled the registered provider to ensure that people who lived in the service were kept safe from the risk of accidents when opening the windows.

Inspection carried out on 3 July 2015

During a routine inspection

This was an unannounced inspection carried out on 3 July 2015.

The registered manager was not in post. They had been temporarily replaced by a senior manager employed by Barnby Gate Limited. However, this this arrangement had finished shortly before our inspection. As an interim measure the service was being managed on a day to day basis by both of the directors of Barnby Gate Limited. 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.

Belvoir Home Care Home provides accommodation for up to 24 people who need personal care. The service provides care for older people some of whom live with dementia.

There were 16 people living in the service at the time of our inspection.

We last inspected the service on 2 January 2015. At that inspection we found the registered persons were not meeting all the essential standards that we assessed. There were shortfalls in the arrangements to keep people safe. This was because people were not fully protected from the risks associated with the unsafe management of medicines and did not benefit from there always being enough staff on duty. In addition, people had not always experienced an effective service. This was because there were not robust arrangements to support people to eat and drink enough to promote their good health. We also found that the service was not well led. This was because the registered persons did not operate reliable systems to monitor and address shortfalls in the quality of the service provided.

After the inspection the registered persons told us that all of these shortfalls had been addressed. During our present inspection we reviewed what steps the registered persons had taken to put things right. Although we noted that some further improvements still needed to be made, we found that significant progress had been made in addressing each of the problems.

The Care Quality Commission is required by law to monitor how a registered person applies the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. The safeguards are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to deprive them of their liberty. This is usually to protect themselves. At the time of our inspection none of the people who lived in the service were being deprived of their liberty.

Although people reliably received their medicines, some of the checks which the registered persons said needed to be made when medicines were dispensed had not been completed. The recruitment procedure had not always ensured that applicants could demonstrate their previous good conduct. Staff knew how to recognise and report any concerns so that people were kept safe from harm including the risk of financial abuse. People were helped to avoid having accidents and there were enough staff on duty.

Although people were supported to eat and drink enough, some of the arrangements were not robust. This increased the risk that people would not always receive all of the assistance they needed. People’s needs were not fully met by the adaptation, design and decoration of the service.

Staff had not received all of the training and guidance the registered persons said they needed in order to care for people. People had received all of the healthcare assistance they needed. Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. When this was not possible legal safeguards were followed to ensure that decisions were made in people’s best interests.

People were treated with kindness, compassion and respect. Staff recognised people’s right to privacy, promoted people’s dignity and respected confidential information.

People had not always been offered the opportunity to pursue their interests and to fulfil their spiritual needs. However, people had received all of the practical assistance they needed including people who had special communication needs and were at risk of becoming distressed. There was a system for resolving complaints.

Although quality checks had been completed they had not consistently addressed shortfalls in some of the care people received. People had been consulted about the development of the service. The service was run in an open and inclusive way and people had benefited from staff being involved in good practice initiatives.

Inspection carried out on 5 January 2015

During a routine inspection

Belvoir Home Care Home provides accommodation for up to 24 people who need personal care. The service provides care for older people some of whom live with dementia.

There were 17 people living in the service at the time of our inspection.

This was an unannounced inspection carried out on 5 January 2015. There was 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 2008 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor how a registered provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves or others. At the time of our inspection no people had had their freedom restricted.

We last inspected Belvoir Home Care Home in October 2014. At that inspection we found the service was meeting all the essential standards that we assessed.

Staff knew how to recognise and report any concerns in order to keep people safe from harm. However, people had not been fully protected from the risk of financial mistreatment. In addition, people had not been consistently helped to stay safe by managing risks to their wellbeing and avoiding accidents. Medicines were not safely managed. Background checks had been completed before new staff were employed.

Staff had not been fully supported to care for people in the right way. People were not reliably helped to eat and drink enough to stay well. People had received all the medical attention they needed. People’s rights were protected because the Mental Capacity Act 2005 Code of practice and the Deprivation of Liberty Safeguards were followed when decisions were made on their behalf.

Staff were kind and compassionate but some people had not been assisted to maintain their personal hygiene. Staff recognised people’s right to privacy and respected confidential information. However, parts of the accommodation did not provide a dignified setting within which to receive care.

People had not been fully consulted about their needs and wishes. People were supported to make choices about their lives but they had not been fully assisted to pursue their hobbies and interests. There was a good system to receive and handle complaints or concerns.

Quality checks had not been effective. People who lived in the service had been effectively consulted about the development of the service. There was a registered manager but staff were not well supported. The registered persons had not developed links with the local community and were not involved in any national good practice initiatives.

Inspection carried out on 5 September 2014

During an inspection to make sure that the improvements required had been made

This summary is based on information we obtained when we visited the service on 05 September 2014. We completed this inspection to check that the provider had made the improvements that we said must be made when we inspected the service on 03 April 2014. At our earlier inspection we found that improvements needed to be made to parts of the accommodation. In addition, we found that the way in which the provider consulted with people who used the service and checked on the quality of facilities and services needed to be strengthened. These changes were necessary so that people could reliably receive the care they needed in a safe and comfortable setting.

Our inspection dated 05 September 2014 observed specific features of the accommodation, examined the way in which the provider consulted with people who used the service and looked at the systems used to complete quality assurance checks. In addition, we spoke with five people who used the service, the manager and four staff.

We found that the provider had introduced most of the necessary improvements. The particular defects we identified relating to the accommodation had been put right. In addition, people who used the service had been asked their views and quality checks had been made more robust.

However, we noted that a considerable number of more minor defects in the accommodation still needed attention. In addition, we found that although the provider’s quality assurance system was able to identify problems this did not always result in clear plans being developed to quickly put them right.

We have said that the provider may find it useful to note that defects in the accommodation and shortfalls in some quality checks reduced its ability to ensure that people received safe care that responded to their needs and wishes.

Inspection carried out on 3 April 2014

During a routine inspection

We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

We observed how staff treated people in a respectful way. Staff were kind and attentive.

Is the service responsive?

We saw that people's individual needs for care were assessed and met. This also included people's individual choices and preferences about how they wanted to spend their day.

Is the service safe?

Staff had understood their roles and responsibilities to ensure that people were protected from the risk of abuse. People were protected against the use of unlawful or excessive control or restraint because the provider had made suitable arrangements. Parts of the accommodation were not well maintained. This had reduced people’s ability to be comfortable, relaxed and safe in their home.

Is the service effective?

We found that staff knew people's individual personal and healthcare needs. We saw that people valued the care they received from staff members.

Is the service well led?

The quality assurance system was not robust. Stakeholders had not been fully consulted about the services and facilities provided. Quality audits had not effectively identified problems with the accommodation, health and safety checks and important recording systems. These oversights had reduced the provider’s ability to reliably care for people in a safe setting.

Inspection carried out on 25 June 2013

During a routine inspection

Prior to our inspection we reviewed all the information we had received from the provider. As part of the inspection we spoke with three people who used the service and four visiting relatives or friends about their views. We also spoke with the acting manager and four members of staff. We looked at service information, care plan files for three people and did a tour of the building.

People we spoke with told us they felt staff listened and respected their views and wishes. One person said, “They (staff) are all marvellous and treat me well, I feel I’m listen to and respected.” Another person said, “I’ve lived here many years, if anyone isn’t happy it’s their own fault. I’m happy here and the staff are all very good.”

We observed people being served their lunch and drinks throughout the day. We saw people were offered choices and the menu provided nutritional and well balanced meals. The people we spoke with described the food as “marvellous.”

People who used the service described staff as knowledgeable and competent in their work. One person we spoke with told us, “I get well looked after, they (staff) are all friendly and helpful.”

We looked at the internal audit systems in place. We saw people who used the service and their representatives were asked for their views and opinions. One person told us, “We have meetings and are asked what we like or would like and what we think about the service.”

Inspection carried out on 5 February 2013

During a routine inspection

Prior to our visit we reviewed all the information we had received from the provider. As part of the inspection we spoke with four people who used the service, three relatives, a friend of a person who used the service and a visiting professional. We also spoke with the manager and five members of staff. We looked at service information, support records and documentation for four people. On the day of our inspection there were 16 people living at the home and an additional three people on respite.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People we spoke with told us they were well cared for and they were happy with the care and treatment provided. One person who used the service told us, “It’s a very nice place and I’m very satisfied.”

The people we spoke with could not recall if they had a care plan or if they had been involved in review meetings about the care and treatment provided.

Visitors to the home told us they were aware their relatives had care plans, however, relative’s experiences about how involved they had been in the development and review of care plans were variable.

We observed staff were providing positive support and engaged with people who lived at the home. People appeared relaxed and comfortable in the presence of staff.

Inspection carried out on 26 March 2012

During an inspection to make sure that the improvements required had been made

People told us they felt they were able to make choices for themselves. One person said, “I get up and go to bed when I want to.” Another said, “I’ve been watching television (in another lounge) then thought I would come and see what’s happening up here.” We asked one person if they had seen any changes in the home recently, and they said, “Yes, things seem better organised.”

We asked three people if they felt their privacy and dignity was respected and they said they did. People told us they were happy with the care they received. We asked four people if they felt safe in the home and they all said that they did.

We saw staff sat spending time with people at various times during our visit. One person told us, “It’s good when they (staff) have time to do things with us, I enjoy that.”

Inspection carried out on 7 February 2012

During a routine inspection

The inspection of Belvoir Home care home took place on 19 and 20 January 2012. The new acting manager took up post on 16 January 2012 and made contact with us on 18 January 2012 to raise concerns she had found in the home. Since she had started working as the manager she had demonstrated an understanding of what was required to ensure people’s needs were met and had already begun to make positive changes.

On the second day of our visit one person told us lots of the people had slept in that morning. They went on to say a member of staff brought them a cup of tea that morning. They told us, “I like my tea hot, but normally it is cold. This morning it was hot. It was the best cup of tea I have had since I came here.”

A person told us, “I was told I had to get up at 6am I didn’t want to get up then as I was going out later.”

We spoke with some people whilst they were having their breakfast. One person said, “It would be nice to have a cooked breakfast. I like bacon and eggs.”

We asked people what activities they were able to take part in. One person told us “We do not do anything.” They told us they watch the TV as there is nothing else to do.

We asked the person what they would like to do. They told us they would like to play whist or dominoes, but there was no one to play with. We asked have you ever been asked what you would like to do. They replied no.

One person told us about a staff member they did not like. They said,” They are a bit rough and sharp. Sometimes they shout at me.”

We asked one person what it was like living at the home, they said, “Its alright, it could be better.” Other people told us they thought the staff were good.

Reports under our old system of regulation (including those from before CQC was created)