Belle Vue Country House

On this page

• 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 good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to obtaining consent and following the principles of the Mental Capacity Act 2025.

This service scored 54 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. People’s care records were not always accurate as assessments were conducted on different dates and were recorded either on paper or the ECM. For example, people’s weights were taken to inform staff if there had been a loss or gain. Weights contributed to the completion of the malnutrition universal screening tool (MUST) and the Waterlow assessment tool (a tool designed to establish people’s risk of sustaining damage to their pressure areas). We identified several instances where people’s risk score was inaccurate as their weights were not current. Inaccurate assessments posed a risk pathways to prevent malnutrition of pressure damage would not be followed. Oral health assessments were not completed, on the first day of our inspection we noted there was a lack of toothbrushes made available to people. As staff did not document when oral hygiene had been completed the manager could not be assured people were being supported to clean their teeth. This was addressed by the second day of our inspection.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. People’s care records did not always contain current information about them and assessments were not always consistent. Where people were assessed to receive meals prepared to a specified consistency, their care records and the catering list did not always align with the advice from the speech and language therapy (SaLT) team. Despite the records not being clear, we observed people did receive the consistency of food as advised by SaLT. We discussed our concerns with the manager who reviewed people’s care records and risk assessments immediately.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. Visiting healthcare professionals provided positive feedback about how staff contacted them in a timely manner and followed their advice. Some comments included, “I find them to be an excellent team. They always flag up acute and routine queries appropriately. They are efficient in discussing queries over the phone and in person. They follow through with plans. They are courteous with patients and their families.” And, “I was really impressed with the nursing care provided towards a resident with complex needs who was declining personal care, a best interest multi-disciplinary meeting was arranged due to concerns with self-neglect, due to resident’s complexities. The resident has been showered and admitted to being well cared for, despite some resistance to care, I feel Belle Vue really do manage these situations well.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. People were not always supported well during mealtimes. We observed on the first floor, kitchen staff delivered hot meals and staff helped people to eat their food, however, throughout the support other people required assistance which took the staff member away from the person they were supporting. When staff left the person they did not continue to eat and their food had gone cold. We observed this happened multiple times on both days of our inspection. People who were in their bedrooms were supported with meals after the service in the lounge/dining area, their food was situated on a tray and was also going cold. We fed this back to the manager who has since developed a mealtime dignity audit to oversee mealtimes and where needed adjust staff deployment and routines to ensure people receive meals to their preferences and needs in a timely way.

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. We saw various examples where staff had noticed changes in people’s needs, health and presentation and acted to improve their outcomes. This included where a person did not respond well to a medicine, staff identified side effects and requested a review by the prescriber. Some people experienced epileptic seizures, we reviewed records which showed they were appropriately supported during and following seizures and relevant professionals were contacted for advice when needed.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. Mental capacity assessments were not always conducted for people to establish their ability to make decisions in line with the Mental Capacity Act 2005 (MCA). MCAs were not routinely completed including where people required bedrails in their best interests. The manager showed us a completed MCA; the assessment was not decision specific, covered all aspects of the person’s life and did not demonstrate the person was involved in the assessment.

The provider did not seek formal consent; consent forms had not been completed by people or their representatives for various decisions. Relatives told us that staff were respectful and obtained consent before supporting them. We mostly observed staff respectfully gaining permission before supporting people. We observed a person who was declining to eat their meal, a staff member spent a long period of time encouraging them and was so persistent the person eventually agreed, despite their body language and facial expressions indicating they did not want to eat it. The staff member demonstrated kindness but did not respect the person’s right to decline.