Background to this inspection
Updated
27 April 2021
The inspection
We carried out this focused inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act under the domains of safe and well-led, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
This inspection was undertaken by an inspector and an inspection manager.
Service and service type
Belvidere Nursing Home is a care home. People in care homes receive accommodation and personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We contacted both the Local Authority and the NHS infection Control Team to gain information on the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.
During the inspection
We spoke with four relatives of people living in the home. We spoke with the manager, the deputy manager, a nurse, and other staff. We reviewed a range of records. This included three people's care records, a sample of medication records, three staff recruitment files and records relating to the management of the service.
Updated
27 April 2021
About the service
Belvidere Nursing Home provides accommodation for up to 35 people who need help with their personal care. At the time of the inspection 23 people lived in the home. Some of the people living in the home, lived with dementia.
People's experience of using this service
Wirral NHS Infection Control Team raised concerns with CQC about infection control practices within the home. CQC visited to inspect infection control standards. We identified serious concerns with the management of infection control and COVID-19. Infection control standards and procedures did not comply with government guidelines. This meant people were not adequately protected from the risk of infection. We spoke with the manager immediately to ensure improvements were made.
We returned to the service three days later, to check on progress and saw that infection control improvements had been made. During this visit, concerns relating to medication management, record keeping, leadership and governance were also identified.
The management of medication was not always safe as it did not adhere to recognised standards of best practice. The competency of staff to administer medication safely had also not been properly assessed. This placed people at risk of harm.
People’s risks were assessed but information and guidance for staff to follow was not always up to date or sufficient. Other records relating to the care people received were repetitive and not always meaningful. This meant it was difficult to tell from people’s records what care they received. We asked the manager to ensure people’s care plans and daily records were updated without delay. A lack of accurate record keeping in places people at risk of inappropriate or unsafe care.
Accident and incidents were recorded but record keeping in relation to this and other aspects of service delivery also required improvement. For instance, audit records and safeguarding records did not provide sufficient information about what had been reviewed and what action had been taken to respond to or, drive up improvements.
The systems in place to monitor the quality and safety of the service were ineffective. This meant the concerns we identified had not been picked up and addressed. The manager’s knowledge of best practice guidance required improvement to ensure the service complied with relevant standards and legislation.
Staff recruitment was safe and there was enough staff on duty to meet people’s needs. People’s relatives told us staff were kind, caring and attentive and felt people were well looked after. Everyone was complimentary about the home and felt it was a good service. This provided some assurances that people were not at significant risk of harm whilst improvements to the service were being made.
Rating at last inspection and update
The last rating for this service was good (published 20 September 2018).
Why we inspected
The inspection was prompted in part due to concerns received about infection control from Wirral NHS Infection Control team. A decision was made for us to inspect and examine those risks. A targeted CQC inspection looking specifically at infection control standards took place on the 04 February 2021. We have found evidence that the provider needed to make urgent improvements with regards to infection control and COVID-19
As a result of these concerns, we widened our inspection and undertook a focused inspection on the 09 February 2021. This inspection included the key questions of safe and well-led. During this inspection we found that the provider needed to make improvements in respect of medication management, record keeping and the leadership and governance of the service.
We looked again at infection prevention and control measures under the Safe key question. We saw that progress on the provider’s infection control action plan was being made.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to Regulation 12 (safe care and treatment) and Regulation 17 (good governance) with regards to the service.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.