Belle Vue Country House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 53 (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 have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice. Staff used a dual system when recording accidents and incidents, records were either completed on paper or on the electronic care management system (ECM). We saw examples where incidents had been responded to appropriately, however, due to the dual system, processes to analyse trends and patterns were not in place. The manager told us they had identified frequent incidents had taken place at mealtimes and had deployed staff to provide additional support in the ground floor dining area.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Prior to people moving into the service, information was gathered from relevant professionals and preadmission assessments were completed with people and/or their representatives. Assessments were conducted in person, usually by the manager who would discuss the person’s needs with the team to ensure they could be met. A relative told us, “Before [person] came in staff were prepared. Information came from the previous home and the hospital. They were happy to have my input.” A staff member commented, “Before coming to the home, the manager will conduct a short meeting and give brief feedback about the person. His or her name, age, health issues, care needs, wants, wishes, likes, and dislikes about personal care will be discussed. Also, we will read the care plans.” The ECM provided a ‘hospital passport’ which included an overview of people’s needs should they move to another service or require hospital admission.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. The provider previously had not always shared concerns quickly and appropriately. Systems were newly in place to ensure concerns were referred to the local authority, although these were yet to be embedded we reviewed a recent incident which had been appropriately escalated.

The provider’s safeguarding policy had not been updated since July 2013, it contained out of date information and did not include all types of abuse or the local authority’s contact details. The manager told us the provider was aware of outdated policies and had plans to review them all within 4 to 6 months. However, staff had received training on what constituted abuse and told us who they would report concerns to. A staff member said, “I would report to my line manager, if nothing was done we can approach the service provider, we can go to external agencies, the phone number for the agencies are in the nurses office and they are for CQC or the local authority.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that restrictions were in place including some locked doors to prevent people accessing unsafe areas. Although this was to promote people’s safety, mental capacity assessments had not been completed to ensure this was within their best interests. Where conditions to DoLS authorisations were imposed, they were being met. For example, people’s medicines were being reviewed in line with the conditions.

The provider did not always ensure risks were mitigated for people. We identified various instances where risks were not mitigated either due to assessments of risk not being in place or not being robust. For example, a person smoked cigarettes, a risk assessment had been completed, however, the risk assessment did not consider all potential hazards for the person. We fed this back to the manager who revised the risk assessment and put additional steps in place to support the person to smoke safely. Another person required occasional oral suctioning due to a build-up of secretions in their mouth, a risk assessment had not been completed for this. However, registered nurses were able to describe how they supported the person and had received appropriate training for the procedure. Other risk assessments were not in place to include the risk to people prescribed paraffin based topical skin creams and where a person was prescribed blood thinning medicines. We discussed our concerns with the manager who arranged for risk assessments to be conducted and shared with the staffing team. Risk assessments for other needs were clear, including where people lived with conditions such as epilepsy, diabetes or required a catheter.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. Belle Vue Country House is an older building; we identified some areas which required repair and upgrade. These included where walls had been damaged with the plaster exposed and where a person’s bedroom furniture was in an unusable state. Equipment to support people to move and position was 2 months overdue for servicing. We raised our concerns with the manager who purchased new furniture for the person and made immediate arrangements for the equipment servicing. The manager told us of ongoing improvement plans to maintain and upgrade the service.

The provider did not always make sure staff deployment was effective. We observed at mealtimes there were not always enough staff available to support people on the first floor, this included where people ate their meals in their bedrooms. Consideration had not been given to the number of people needing support and how routines could be adjusted to suit their needs, preferences and ensure a staff member was designated to assist them.

A person told us, “Belle Vue is lovely the staff are very caring, although they do seem very busy and could do with a few more to help them.” Relatives provided mixed feedback about staffing levels, comments included, “I get the impression that there aren’t enough staff given the complex needs that people have.” And, “Only just enough I would say but people here do have lots of problems, they do well with what they’ve got.”

Pre-employment checks were completed prior to staff commencing work. The manager had recently developed a training matrix to oversee which courses staff had completed and identify areas of additional learning requirements. Staff spoke of their supervisions and told us they were conducted regularly. A staff member said, “My supervisions are done with nurses, they are helpful. They tell us the day before so we can plan on what to speak about. The nurses let us know if we need to make changes in our work. They ask us about career development plans and training.”

The provider did not always assess or manage the risk of infection. Due to the age of the building and where repair was required, some surfaces were permeable which made them difficult for housekeeping staff to fully sanitise. This included where paint had flaked off the wall exposing plaster and where silicone had come away in bathrooms and toilets. Clinical waste bins were available around the service; however, we observed a wastepaper bin contained clinical waste although situated next to a clinical waste bin. Housekeeping staff were seen to be working hard. Staff mostly wore their personal protective equipment appropriately, we did however, observe a staff member cleaning a soiled area without changing their gloves or washing their hands, they used a mop without fresh water to clean bodily fluids.

Medicines were not always managed safely. We found instances where some medicines were not always safely stored, and were kept in shared boxes, this increased the potential risk of errors. The provider had systems in place to manage and monitor medicines and there was evidence of partnership working with external professionals to support safe practice through regular audits and reviews. People were supported to receive their medicines in a person-centred and respectful way. We observed staff administering medicines in line with people’s preferences, offering choice and respecting their right to refuse. People’s relatives told us they were involved and kept informed of changes to their family member’s needs. A relative commented, “[Person] was taking capsules and was very good at keeping them in their cheek. They (medicines) were found in tissues and in [person’s] cabinet. Staff now give [person] liquid medication. They did tell me what they were doing to sort it.”