The Belmont

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 remained good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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.
Systems were in place to enable learning and improvements. Leaders investigated and reported safety incidents and complaints and shared what had been learnt with the team and wider company. Accidents and incidents were reported, reviewed and analysed to identify patterns and trends.
 

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. Staff carried out preadmission assessments either at the service, in the person’s home, or in hospital. Information gathered was used to create care plans and risk assessments. Hospital passports were developed to enable a smooth transfer between services; the passport contained a summary of people’s needs and other key information. New admissions into the service were communicated to staff through daily meetings. Where needed the provider and registered manager made referrals to and worked alongside other health professionals to ensure people’s needs continued to be met.

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, relatives confirmed this. Comments included, “The staff are lovely, kind and genuine, they give you a hug, and there is always somebody around” and “Staff help me to get ready for bed, they know I don’t like the dark, so they always make sure I have a light on, I feel safe because of this”. A relative told us, “I feel happy that [person’s name] is in a place of safety with 24/7 care”. Staff were trained in safeguarding and knew what signs may indicate potential abuse and how to report concerns. They were confident their concerns would be listened to. Safeguarding and whistleblowing policies were in place and were regularly reviewed and updated. Information was displayed in staff areas guiding them how to speak up if they had concerns.
We reviewed whether the service was operating in line with the principles of the Mental Capacity Act 2005 (MCA), including the use of appropriate legal authorisations for any deprivation of liberty Safeguards (DoLS), and whether conditions were being adhered to. DoLS are legal proceedings to protect people who lack capacity to consent to their care and treatment; Conditions are sometimes attached to ensure the person’s best interests are protected. For example, issues relevant to the person’s culture or maintaining social contacts. Overall, we found compliance with these requirements. However, some staff lacked knowledge regarding who had a DoLS in place and why and 1 person had a condition attached to their (DoLS), and staff had not been recording evidence to demonstrate that this condition was being met. The registered manager assured us they would raise this with staff to ensure evidence was recorded.
 

Staff assessed risks to people’s health, safety, and welfare, including those related to falls, medication, and choking. However, they did not consistently implement the actions identified to reduce these risks and overlooked contributing factors. We reviewed falls and found, although staff had identified the need for monitoring devices to detect movement of people at risk of falls, they did not consistently use these. We observed some people wearing unsuitable footwear, which could increase their risk of falling. Staff did not always carry out safety checks as described in people’s care plans. We shared our observations with the registered manager, who assured us they would review the concerns with staff, and arrange additional training for falls awareness. Staff did not use behaviour charts for 1 person and failed to create a care plan to guide support, which meant they did not monitor interventions or outcomes. We raised this with the registered manager. Shortly after our visit they sent us a copy of a new care plan and confirmed they had developed a support plan and discussed it with staff.
Some people and relatives told us they were involved in decisions about risks and safety. Staff supported people to take positive risks, such as self-administering medicines and accessing the local community independently. Staff completed risk assessments and outlined how they would monitor these risks. For example, by conducting daily stock count checks for people who managed their own medicines.
 

The provider did not consistently detect or control potential risks in the care environment. Although they had systems in place to maintain the building and equipment, we identified some shortfalls. For example, the provider failed to follow their own policy regarding the testing of portable electrical appliances. The policy stated: “An Annual Visual Inspection is to be carried out internally by the maintenance staff. A Runwood Visual Inspection Sticker will be applied to each item once visually inspected by the maintenance operative, clearly dated so this can be seen by all.” However, we found some items had not been tested within the last 12 months. Additionally, the provider did not carry out fire drills every 3 months as required by their ‘Local Fire Plan’. Some staff told us they would not feel confident if the fire alarm were to activate. The registered manager assured us they would schedule regular fire drills and ensure they are conducted in line with the fire plan going forward.Despite these concerns, we also found areas of good practice. Staff had assessed and maintained equipment to ensure people’s safety, and they kept records of all checks, audits, and external visits. The environment was spacious, clean, and well maintained. People had up-to-date Personal Emergency Evacuation Plans (PEEPs) to guide staff on the support required during a fire, and grab bags were prepared with essential items for evacuation. Directional signage was appropriately placed on the reminiscence floor to help people with dementia navigate to key areas such as toilets and lounges.

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. Staffing numbers were calculated based on people’s dependency levels and reviewed regularly. Most staff felt staffing levels were adequate but felt mornings were busy and rushed. We received mixed reviews from people regarding staffing levels. One person told us there was not enough staff at mealtimes and they could be waiting a while for their meal. During our visit we observed there were enough staff to meet people’s needs and calls bells were answered promptly. Records showed and staff told us they received training relevant to people’s needs and had regular support by way of team meetings and one-to-one meetings with their line manager. Leaders supported staff in the event of last-minute unplanned staff absence to ensure consistency of care for people. The registered manager told us they over recruited and employed bank staff to reduce the need for agency staff and to maintain consistency. Staff told us they received induction and training when they started working for the service, as well as ongoing refresher training for mandatory areas such as safeguarding and moving and handling. Training records reflected this. Staff were supported through regular one-to-one meetings; appraisals and they operated an open-door policy.

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. They carried out
regular audits to ensure areas of the home were maintained to a high standard. Policies were in place in line with current guidance for staff to follow. Guidance on good hand washing techniques was displayed in toilets and bathrooms. Staff also received training to support with infection prevention and control (IPC). We saw there was adequate supplies of personal protective equipment, and we saw this being used appropriately. People told us the environment always looked nice and clean. We did find some minor shortfalls in the kitchen regarding stock control; however, this was promptly addressed when we raised it with the registered manager.
 

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Guidance was not consistently in place for people who required ‘as and when’ (PRN) medicines and there were not routinely monitored to assess their effectiveness. This meant people may not receive their medicines correctly or to good effect. Staff did not consistently record the number of tablets given where variable dosages were prescribed, this meant the registered manager could not be assured stock balances were accurate. Creams were not always labelled or stored safely, which meant these may be ineffective if used past the recommended timeframe and could pose a risk to people who may accidently ingest these. We discussed our findings with the registered manager, who updated people’s PRN guidance and shared with staff the concerns raised to enable more effective recording. The providers own checks and audits had not identified the concerns we found. Despite our findings we found no harm to people and found other areas of medicines were well managed. For example, controlled drugs (CDs) were stored safely, and the stock balance matched the entries in the register. Fridge and room temperatures were consistently recorded to ensure medicines were stored at a safe temperature. People were supported to self-administer their own medicines following an assessment, and staff had received relevant training with competency checks in place to ensure safe administration.