Belford House

We found the following examples of good practice.

There were clear written measures to help prevent visitors from spreading infection. These included a visitor’s policy and code of conduct, health screening questionnaire and a visitor record as required by the government's test and trace scheme. Relatives booked a visit in advance and were provided with personal protective equipment (PPE). They then saw their relative in the nearby visiting room, which had a screen, this minimised contact with care home staff.

People also had contact with their families via both telephone and social media applications. The home had three iPads, a computer and mobile for people to use. Staff supported people, especially those living with dementia, to participate in family calls, to ensure their experience was positive and enjoyable. Staff also sent relatives a weekly update and photos of their loved one, to keep them informed of their well-being and welfare. The home used a social media page to show families pictures of group activities and enable relatives to maintain their links. The local church prepared a monthly video for people and local school children had also written to people.

People's welfare needs had been well met. There was a full range of activities for people, including walks. In addition to group activities, there were activities for those people in their bedrooms, which reflected the group activities, for example, flower arranging, making Valentines cards and planting seeds, to ensure people felt included. Staff also provided people with company during their meals, whilst they self-isolated, which made them feel welcome.

Staff had undertaken relevant infection control training and wore the PPE provided. The registered manager regularly audited infection control procedures in the home and staff’s hand hygiene practices. Procedures were in place in the event of a COVID-19 outbreak.

Some people living with dementia had been anxious initially when staff wore masks. To support people, staff’s photographs had been uploaded onto the iPads, so staff could show people what they looked like without their mask on, which had provided them with reassurance.

The service was clean, hygienic and well ventilated. Staff followed the cleaning schedules provided and used appropriate cleaning products. The communal areas had been appropriately designated for different activities and organised to ensure social distancing. For example, the tables in the two dining rooms, were each set for no more than two people. Staff breaks were staggered, to ensure social distancing was maintained.

The registered manager had risk assessed staff in vulnerable groups. Staff felt well supported both by the provider and the registered manager.

Rating at last inspection

At our last inspection we rated the service good overall and requires improvement in the key area of safe, due to issues in relation to water safety and a lack of sufficient information regards when to give medicines people took as required. At this inspection we found these issues had been addressed for people.

The evidence gathered at this inspection continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were kept safe from the risk of abuse. Staff understood their role and responsibility to keep people safe from the risk of harm. Risks to people had been identified, assessed and managed to ensure people’s safety. Learning took place following incidents to reduce the risk of repetition for people. There were sufficient numbers of suitable staff to provide people’s care in a timely manner. People received their medicines safely from trained staff. Processes were in place to identify any issues with people’s medicines and the registered manager took appropriate action where required. Processes were in place to protect people from the risk of acquiring an infection.

People’s needs were assessed, and the provision of their care was based on good practice guidance to ensure effective outcomes for them. Staff had the skills, knowledge and experience required to provide people with effective care. Staff had received relevant training to enable them to support people appropriately at the end of their life. Staff supported people to eat a range of nutritious and appetising foods and drinks. Staff ensured people’s healthcare needs were met in a timely manner. The environment was spacious and suitable for the needs of the people accommodated.

Staff treated people with kindness, respect and compassion, people felt they mattered. People were asked for their views about their care and were encouraged to involve their relatives in decisions about their care if they wished. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff ensured people’s privacy, dignity and independence were respected and promoted.

People received personalised care that was responsive to their needs. People were provided with a range of opportunities for social stimulation, both within the service and in the local community.

There was a positive culture, that was person centred and focused on the achievement of good outcomes for people. There was a strong focus on continuous improvement. The service enabled and encouraged open communication with people who used the service, their relatives and staff. People’s concerns and complaints were listened to and used to improve their experience of the care provided. The service worked in close partnership with other agencies.

Further information is in the detailed findings below

Belford House provides care without nursing to up to 32 older people who are frail or who suffer from dementia. One bed is set aside for people on short-term respite care.

A registered manager was in place as required in the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People felt well cared for and said staff were supportive, kind and respectful of their dignity. They told us staff sought their consent before providing care and gave them opportunities to make choices in their daily lives. They described the service having a calm, relaxed atmosphere. People’s opinion of the service had been sought through a survey which produced positive feedback.

People’s rights and freedom were protected in the way staff worked with them. Staff knew how to keep them safe and what to do if they had any concerns about people being abused. People’s complaints had been responded to and addressed.

We found some potential safety issues relating to the bathing facilities but these were put right during the inspection process. Some additional detail was also required in the guidelines for people who were prescribed medicines to be given only when required.

The staff rotas did not clearly identify the staffing levels and there were some shortfalls due to vacant posts which were being recruited to at the time of inspection. A programme was in place for staff induction and training and staff received ongoing support in their work.

Staff worked patiently and calmly with people, and knew them well, offering reassurance or assistance when required. People’s health and nutritional needs were well managed and they were encouraged to make decisions and choices about their daily lives. The level of activities was acknowledged by the registered manager as an area to be improved. To this end the service was trying to recruit a new activities coordinator.

The registered manager was praised by people and staff found her approachable and supportive. The registered manager and providers had systems in place to monitor the operation of the service and the registered manager directly observed care practice to monitor this.

We found that the service had systems in place to ensure that people were consulted about, and consented to, the care provided. People experienced effective, safe and appropriate care which met their needs. This was delivered by a staff team who were employed in sufficient numbers and who knew their needs well.

The systems for assessing and monitoring the quality of the service had developed further since our last inspection. Improvements had been made as a result of quality audits and as a result of people's comments and suggestions.

We looked at how people and their relatives were involved in making decisions regarding their care, and found evidence to suggest that this was taking place. We looked at the care planning process and found that proper records were being kept and regular reviews being carried out. We talked to people who used the service and their relatives and they told us they were happy with the home and felt safe within it.

We asked about safeguarding and were satisfied that staff would be able to identify and report any instances of abuse, although the process for reporting abuse could have been made clearer. We looked at medicines management and found that the provider was adhering to recognised policies and procedures which ensured that medication was safely stored and administered.

We looked at staffing support and found that staff received regular supervision and appraisal, and also had some opportunity for studying for more qualifications as well as undertaking regular training. Finally we looked at systems and processes for ensuring a good quality of service and were concerned that the provider had not been carrying out regular service reviews and audits, although this issue was now being addressed.