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 requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

System supported the identification of incident trends and patterns, such as, where people expressed emotions, plans were implemented to reduce reoccurrence. Improvements since the last assessment included increased staff training, and implementation of processes to share learning.

A staff member told us, “We have a briefing every morning and discuss any incidents happened or safeguarding concerns raised, etc. For example, following a fall, we discuss the need for putting a sensor mat and crash mat at the bedside to prevent head injury.” Risk assessments and care records were updated in response to incidents alongside professional input to reduce potential risks of reoccurrence.
 

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.

Preadmission assessments were completed with people prior to them moving to the service, this information was shared with staff to support a smooth transition. When required, professional input was sought to build a clearer picture of people’s needs and to arrange support or equipment for the admission.

A staff member told us, “The manager will do the preassessment before admission, and we will discuss it in the morning briefing before the person arrives. Also, we collect information from their family. Once admitted, we get all the information from their care plan.”

Staff supported people to appointments or in the event of an emergency to promote consistency. A relative told us, “They (staff) called for help quickly when [person] fell and the carer went with her to hospital. [person] was alright.” Hospital passports were generated electronically to ensure current information was shared. Staff worked with external professionals to support safe transitions and continuity of care, including planned discharge arrangements and handovers.
 

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe, one said, “I think the staff are quite nice, they help me feel safe.” We observed people appeared comfortable in staff presence. Policies had been updated and included relevant contact information for partner agencies. Staff knew what signs they would watch for if someone was at risk of abuse and who to escalate concerns to. A staff member said, “If I suspect any signs of abuse, I will always report to my manager and immediate supervisor. If not corrected internally, we can inform the local authority, safeguarding team or CQC.” Referrals had been made to the local authority and actions were taken when concerns were identified. Safeguarding audits and a tracking system were used to review incidents, outcomes and any learning.

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. Staff and management worked within the MCA. DoLS authorisations were appropriately applied for and overseen.
 

The provider did not always complete assessments to promote safer risk taking. Although staff did provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People were involved in managing risks, but this was not always supported by robust documentation. People were involved in decisions about their care, for example agreeing the safe use of bed rails. Staff were observed supporting people to reduce risks, including monitoring safer smoking and promoting hydration. However, a risk assessment had not been conducted for a person who enjoyed walking around the service. We raised this with the registered manager who immediately completed a thorough risk assessment.

Risks in relation to people’s health had been appropriately assessed and care plans supported actions to mitigate risks. These included risks in relation to catheter care, diabetes and where people displayed emotions of anxiety. Staff worked in line with people’s care plans and updated them when needs changed.
 

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Environmental audits, including call bell checks and response time monitoring were undertaken. Where issues were identified, prompt action was taken to address them and strengthen oversight. Checks on moving and positioning equipment, were completed regularly. Environmental improvements had been made, including fire safety systems, redecorated areas and upgrades to facilities.
 

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were enough staff to meet people’s needs safely, staffing levels were monitored and staff were deployed to ensure people were supported throughout the day. People confirmed staff responded quickly when they used their call bells. A relative commented, “There seems to be lots of staff. I don’t know what the staff ratios should be, but staff are always available for [person]. The only time they had to wait was when there was a real emergency on.”

Recruitment processes were conducted safely; audits were completed to ensure staff files contained the necessary pre-employment checks. Staff received training opportunities, including a mix of face-to-face learning sessions and online training. The registered manager recently delegated some supervision responsibilities to senior staff; staff told us this approach worked well.
 

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The environment was clean, and ongoing maintenance and refurbishment plans were in place to support hygiene standards. A relative commented, “I can go in (to visit) anytime. They are very open. I think the cleanliness is pretty good. The doors and toilets in the lounge are clean. The rooms are clean. They regularly clean the carpets. They could do with some new furniture, but it is clean and wiped down if anyone has an accident. The carers wear gloves, aprons and sometimes masks.”

Infection prevention and control (IPC) audits were completed and identified areas for improvement, such as, laundry processes and environmental cleaning, actions had been swiftly taken.
 

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

We observed people were supported with their medicines in a safe, dignified and person-centred way. Improvements had been made to the storage of medicines, the new medicine room was clean, tidy and well organised. Records were completed well and reflected accurate stock balances. Staff arranged for medicine reviews when they noted ineffectiveness or unwanted side effects, we saw examples of reductions of medicines which provided better outcomes for people.

The use of covert medicines (medicines hidden in food or drink in people’s best interests) was used at the last resort. Decisions for covert administration were made with people’s legal representatives and medical professionals. Relatives commented on medicines, one said, “They explain to [person] what medicine they are giving and why they are getting it. [Person] gets (medical condition) and sometimes refuses the medicine for it. They explain to [person] but don’t force them.”