Belle Vue Country House

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to the governance at the service.

This service scored 57 (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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities. Meetings were not held for people and their relatives to provide opinions and feedback. The manager told us that meetings used to take place but due to the low uptake they did not continue. Surveys and feedback questionnaires were not routinely sent out by the provider; there was no formal process in place to review the quality of the service and gain views. Some relatives commented on this and said, “No feedback is asked for, no meetings for residents and relatives that I know of.” And, “I’ve not been asked for any feedback or filled in anything.” Although there was a lack of formal processes people and their relatives told us they could speak with staff or management and had confidence they would be listened to.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge and experience to lead effectively. The manager had worked at the service for a number of years; however, they were new to management. Throughout our inspection we highlighted areas where improvements and changes were required, the manager and provider took our feedback seriously and evidenced plans to improve and the immediate action taken where needed. Managers were transparent throughout the inspection process and showed a will to make improvements where concerns were identified. There were gaps in knowledge about when to submit statutory notifications to CQC and when it was appropriate to complete mental capacity assessments, however, this was an area the manager was working on.

People, their relatives, staff and professionals all spoke highly of the manager and provider and told us of their caring and compassionate approach. Comments included, “[Manager] is a new manager but very knowledgeable, they tried to implement ideas with bite sized sessions which were interactive, taking suggestions from the team.” And, “I know the manager and If I need to, I can always find them and catch up for a chat and a pot of tea. I prefer to see [manager] in [person’s] room, face to face.” And, “[Manager] was recently promoted and its early days they are catching up with things. I have a feeling from the early stages [manager] wants to improve the home on a different level and they are doing well in a span of 3 months. [Manager] has good knowledge and skills and bringing up things to practice, I have a feeling things will change, it’s for the good for everyone we prioritise the residents.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard, however, systems and processes were not in place to support this. Staff told us they could approach the manager or provider if they were concerned about people or their working situations, concerns could also be discussed during supervisions. A staff member spoke about their supervisions and said, “My supervisions are done by [staff name], sometimes [manager] does them too. I like supervisions, they are very helpful we can discuss any concerns and what changes we can apply in the home. They will tell me about how we are working and where we need to improve, we can ask for any training.” Although staff told us they were comfortable speaking up, the provider’s policy had not been updated since 2017 and did not contain details of who else to contact externally besides ‘the local CQC inspector.’

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff attended regular meetings, were included and felt listened to, they gave examples of where they had put forward ideas to improve their work lives and people’s experience. A staff member told us, “We regularly attend staff meetings. We discuss things related to our job, we address various issues regarding providing care, safety or infection control. We give feedback, for example, regarding changes in residents' behaviour or special needs, environmental improvements, etc.” Some staff were recruited from overseas, the provider supported them to adjust to the culture and held workshops to provide guidance and answer questions. Staff told us their shift patterns were adjusted to suit their needs, a staff member told us, “I have a family and most of my shifts work round this, [manager] thinks about our needs and does a rota accordingly.”

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. Systems to check the accuracy and completeness of people’s care records were not effective, they did not identify inconsistencies or where risk assessments had not been completed. Systems did not highlight that care records lacked person-centred information. We fedback our concerns to the manager who evidenced staff were working on improvements and produced a comprehensive quality check list for future use. Quality checks were not in place to review the support people received was accurately documented, we reviewed people’s activity records which showed multiple people had only 1 record of social engagement within a month. We spoke with the manager about our concerns; they told us this was a recording issue.

There were other audits and quality assurance processes in place, these included for infection prevention and control and the environment. The audit templates were not robust and did not prompt the auditor to review the areas which raised concerns. Although people, their relatives and staff spoke about the visibility and availability of the manager, they had not identified concerns relating to the mealtime experience for those people supported on the first floor.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. The manager and provider had worked with partners in care to make improvements within the service, they had listened to advice and had plans to meet targets. Visiting health and social care professionals spoke of the management at the service, some comments included, “I feel there is positive changes with the new manager in post, the new manager is approachable and works well as part of the multi-disciplinary team and is always considering the resident’s wellbeing. Will always advocate and seek advice from myself, where applicable.” And, “They are well led but all of the staff I communicate with seem to be well trained and know the system. I have been working with them for around [number] years and we have a very good professional relationship.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They actively contributed to safe, effective practice and research. The manager provided examples where they had made suggestions to the electronic care planning system provider to improve templates which would also benefit other care providers. The manager showed us a study which the service had participated in, this was called NightCAP (Improving night-time care and reducing hypnotic drug use in people living with dementia in care homes). The principles and practices learned from NightCAP were integrated into routine care, resulting in improvements in people’s sleep quality, reduced night-time anxiety, and fewer incidents of falls or confusion due to over-sedation. The manager told us staff reported increased confidence, empathy, and collaboration, with improved handovers and continuity of care between day and night teams. The manager said, “We are genuinely pleased to have taken part in such a meaningful, evidence-based project and continue to apply its principles in our daily work.”