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 requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

At our last assessment we identified concerns regarding consent and how the Mental Capacity Act 2005 (MCA) was applied. During this assessment, we found improvements had been made. MCA assessments were completed where people lacked capacity and best interest decisions were documented appropriately. Staff sought consent before providing care and people were supported to make their own decisions wherever possible. These improvements demonstrated the provider had addressed the concerns previously identified under Regulation 11.
 

This service scored 75 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs were assessed before and during their admission to the service. Most assessments were completed face to face, particularly for people living with dementia, to ensure their needs were fully understood. Preadmission assessment forms reflected people’s preferences, communication needs and backgrounds. One staff member said, “When someone is new, we read their care plan before they come and then we follow it, it has the things that they like in it.”

People’s relatives and where possible people visited the service prior making the choice to move in and were involved in initial assessments. A relative spoke of the admission process and told us, “A needs assessment was done with the home. Staff definitely understand [person’s] needs. They asked about past work, interests, hobbies, likes and dislikes.”

Improvements had been made to ongoing needs assessments, they were up to date, and audits were in place to ensure they were consistently completed. Work was ongoing to support people’s oral health; these included assessments and an ‘oral health champion’ to ensure people’s needs were being met. A ‘champion’ is a member of staff with a special interest and/or training in a specific care related subject, who works to promote good care.
 

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Nutritional needs were assessed using a nationally recognised tool for nutrition, with clear information about people’s assessed food consistency available to staff. We observed people were served their meals to their assessed need and enjoyed their food.

Specialist assessments had been completed to assess people’s risks of sustaining damage to their skin. Staff followed the guidance in people’s care records including ensuring people were repositioned if needed and had appropriate pressure relieving equipment. A relative told us, “The bed has an inflatable mattress kept to a constant pressure. [Person] is turned in bed every 2 to 4 hours. The equipment is in good condition and fairly new.”
 

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.

Handovers supported communication within the team which the registered manager attended to ensure oversight of people’s changing needs. A staff member said, “[Registered manager] joins the huddle in the morning and discusses changes with the group and gives updates around changes of practice and law. For example, the recent changes to DoLS. If a person has had any change to their support need, such as, a special diet [registered manager] updates us about this very quickly.”

We observed staff working together effectively during the assessment. For example, when a person became disorientated, staff responded promptly and consistently to support them.
Care records were maintained allowing incoming professionals a timely and accurate view of people’s needs. A healthcare professional commented on team working and said, “Staff highlight concerns, they involve relevant staff and I have supported with a best interest meeting for a resident who was unintentionally losing weight. This was an excellent example of the staff having concerns and being open to suggestions from various health care professionals, such as, independent mental capacity advocates, GPs, psychiatrist, care home matron, safeguarding lead and ensuring robust care plans are put in place and supported by a multi-disciplinary team.”
 

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were supported with their health needs, including nutrition, wound care and mental health. Staff monitored people and acted swiftly, resulting in improvements such as, healing wounds, healthy weight gain and emotional wellbeing. Activities were adapted so people could participate in ways that suited them. The activities promoted people’s dexterity, memory and movement. A hydration station had been placed in the communal lounge so people could help themselves to cold drinks.

Improvements had been made to people’s mealtime experience. A heated food cabinet had been purchased to keep meals warm for people who wished to eat later. Staff were assigned to support individuals to eat their meals if needed, we observed they did so in an unhurried way, seated next to them with good communication. Alternatives were offered if people declined their meals. We saw examples of referrals to dieticians and the salt and language therapy team where staff had noticed a decline in people’s food and fluid intake.
 

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.

Systems were in place for staff to monitor people’s needs and care records guided staff on how to minimise deterioration. For example, to promote wound healing or reduce the risk of deterioration, staff followed planned care including the use of pressure relieving mattresses, dressing regimes and supporting people to change their positions.

Improvements had been made to the recording of care interventions. We reviewed a person’s complex wound healing journey; staff worked well within their team and with external professionals such as tissue viability nurses (TVNs). A healthcare professional shared their views and said, “A highlight of excellent care has been a resident who had long standing leg ulcers, since being at Belle Vue these wounds have resolved and this showed excellent wound care management and Belle Vue staff liaised with the TVNs, taking their advice. Again, showing great team work.”
 

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Improvements had been made to staff’s understanding of the importance of consent. We observed staff requesting permission, offering choices and respecting people’s decisions. We observed a person decline their main meal, they asked for ‘4 bread,’ staff understood they wanted a plate of sandwiches which the person ate.

Staff explained how they requested consent from people. They told us how they watched for body language and reactions if a person could not communicate their agreement. A staff member said, “We talk to them and tell them what we are doing. Sometimes they say yes and other times they say no, and we do what they want.” A person told us, “They always ask, I don’t often say no. Yes they would respect my wishes if I did.” A relative commented, “They ask for [person’s] permission to give personal care. [Person] has never complained that staff do what they do not want.”

The management team had completed additional MCA training. Where people lacked mental capacity for some decisions, decision specific MCA assessments were completed. Best interest processes were followed and documented; however, people were also supported to make their own decisions wherever possible.