The Belvedere

The Belvedere is a residential care home providing personal and nursing care for up to 41 people. At the time of the inspection 39 people were using the service. The home specialises in providing care to people living with dementia.

People’s experience of using this service and what we found

Overall people and their relatives were positive about the care and support they received at The Belvedere. People and their relatives indicated people felt safe and were supported by kind and caring staff.

There were enough staff to meet people’s care needs. However, the provider had identified the need for new or increased ancillary roles. For example, a new hospitality role at mealtimes. Recruitment was underway for several roles. Staff had been safely recruited.

Risks to people's safety were assessed and detailed information was recorded in their support plans to manage any identified risk. Some training needs had been identified and were being addressed by the provider in relation to nutritional risks. Some environmental safety checks were overdue, a new maintenance person was undertaking their induction, and these were in progress.

Medicines were managed safely. Part of the provider’s own improvement plan was to review the use of sedative type medicines, to ensure they were being used appropriately. Reviews with people’s GPs and mental health professionals were in progress.

Overall, staff followed Infection prevention and control (IPC) practices, which followed government guidance. The provider gave further assurance about the cleanliness of the premises, as they were recruiting and increasing domestic and laundry staff. Following our inspection, the manager reminded staff about the appropriate disposal of PPE. Improvements to aspects of the home’s environment and decoration were in progress.

There was no registered manager in post. The previous registered manager had left, and a peripatetic manager was providing support. A new manager had been recruited but had not yet applied to register.

The provider had identified areas for improvement in relation to good governance and had recently redesigned their auditing processes. A recent in-depth audit had been carried out and a detailed improvement plan was being actioned. The provider planned to improve outcomes for people in relation to lifestyle and to focus on meaningful activities

Most issues found during this inspection had already been identified by the provider’s audit. However, we further identified some issues around the accurate recording of checks of people in their bedrooms.

There had been some uncertainty due to changes in management. However, overall staff felt supported as a staff team and understood the expectations of their roles.

Feedback indicated that staff engaged regularly and involved people and their relatives in discussions about their care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection.

The last rating for this service was good (published 13 March 2020).

Why we inspected

The inspection was prompted in part due to concerns about medicines, staffing and management. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

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.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Belvedere on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service and what we found

People living at The Belvedere told us they felt safe. Safeguarding systems, policies and procedures ensured people were safe and protected from abuse. Risks to people’s health safety and welfare were identified and managed safely with the involvement of the person or their representatives. There were sufficient numbers of suitably trained and experienced staff on duty and safe recruitment procedures were followed. Medicines were safely managed, and systems were in place for reporting accidents and incidents and learning from them.

People’s care, treatment and support achieved good outcomes and promoted a good quality of life. People and their visiting relatives told us they were involved in discussions about their care and their outcomes were good. Comments included: “The home is excellent, (relatives) needs were assessed and we were involved in developing care plans, so staff know how to respond to (relative) and keep them safe” and, “I have seen (relatives) care plans they are very good. They reflect (relatives) needs.” People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were treated well, and their privacy, dignity and independence was promoted and respected. People and family members were given opportunities to openly express their views and opinions and they felt listened to. Their comments included: “The staff are fantastic. They work as a team, you can see them communicate to make sure people are safe,” and “We are very happy and confident (relative) is safe”.

The atmosphere in the home was warm and welcoming. A range of activities and opportunities for social interaction were on offered and we could see people had enough to do. Staff had developed good relationships with people. Care plans were personalised and reflected people’s individual needs, their history and preferences. People supported by their relatives told us staff knew them well and provided them with the right care and support.

The registered manager was clear about their role and responsibilities and they promoted a positive and person-centred culture. Staff worked well together as a team, and there was good partnership working with others to meet people's needs. Staff morale was good, and staff felt well supported. Effective systems were in place for checking on the quality and safety of the service and making improvements where needed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was good (published 28 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

The last inspection took place on 4 and 10 May 2016. At that inspection we identified breaches of the relevant regulations in respect of sufficient numbers of staff, the need for safe care and treatment of service users, person centred care and the need for good governance. At this inspection, we found that improvements had been made and the provider was no longer in breach of any of the regulations.

The Belvedere is a purpose built care home located close to Alderley Edge. It offers permanent or respite nursing and dementia care for up 41 older people. All bedrooms have ensuite facilities. Lounges and dining rooms are accessible to all residents and there is a garden which they can also use. The home is divided into three units; Silk unit which caters for older people with nursing needs, Mulberry unit which is for people living with dementia with additional nursing needs and Weaver unit for people living with dementia and with complex needs. On the day of our inspection there were 41 people living in the home.

The home has a registered manager who had been in post since September 2016. 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.

We found through our observations that there were sufficient numbers of suitably qualified, competent, skilled and experienced persons deployed within the service to meet the needs of the people living there.

We found that the arrangements for the administration, storage and disposal of medication were safe.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

We asked staff members about training and supervision. They all confirmed that they received regular training and supervision throughout the year.

We observed caring relationships between staff members and the people living in the home.

There was a flexible menu in place which provided a good variety of food to the people using the service.

We found that that there had been improvements in the care plans and these were being updated regularly and the provider was now consistently keeping contemporaneous records in respect of fluid intake, however there was scope for further improvement.

The provider had a quality assurance system in place and regular audits were being completed, and issues identified were addressed in a timely manner. This system included audits on medication, weight losses, accidents and incidents. In addition to the above, there were also a number of maintenance checks being carried out weekly and monthly. These included checks on fire alarms and emergency lighting and equipment such as hoists and electric profiling beds, as well as checks on water temperatures.

Staff members and relatives we spoke with were very positive about how the home was being managed. Everyone spoke of the improvements observed since the current registered manager had been in post.

The last inspection took place on 13 October 2014. At that time the service was not in breach of any of the regulations, however some recommendations were made regarding record keeping in relation to Deprivation of Liberty Safeguards (DoLS) applications and adaptation of the physical environment for people living with dementia. We saw that the service now had a system in place for recording DoLS applications and whether they had been granted and when they needed updating. Improvements had been made to the physical environment and these were ongoing as the building was undergoing a refurbishment during the days of our inspection.

The Belvedere is a purpose built care home located close to Alderley Edge. It offers permanent or respite nursing and dementia care for up 41 older people. All bedrooms have ensuite facilities. Lounges and dining rooms are accessible to all residents and there is a garden which they can also use. The home is divided into three units; Silk unit which caters for older people with nursing needs, Mulberry unit which is for people living with dementia with additional nursing needs and Weaver unit for people living with dementia and with complex needs. On the day of our inspection there were 38 people living in the home.

The home has a registered manager who had been in post since September 2015. 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.

At this inspection we identified breaches of the relevant regulations in respect of sufficient numbers of staff, the need for safe care and treatment of service users, person centred care and the need for good governance. You can see what action we told the provider to take at the back of the full version of the report.

We found through our observations that there were insufficient numbers of suitably qualified, competent, skilled and experienced persons deployed within the service.

We found that whilst the administration, storage and disposal of medication were safe, the provider did not have the correct protocols in place for the administration of covert medication and PRN (when required) medication.

We found that the provider was not consistently keeping contemporaneous records in respect of fluid intake and some of the care plans were not being kept up to date. Records were not kept securely to ensure people’s confidentiality was maintained.

Although the provider had a quality assurance system in place and regular audits were being completed, some of the issues that we identified during the inspection had not been identified by these systems. This system included audits on medication, weight losses, accidents and incidents. In addition to the above, there were also a number of maintenance checks being carried out weekly and monthly. These included checks on fire alarms and emergency lighting, the proper operation of window restrictors and equipment such as hoists and mattresses, as well as checks on water temperatures.

Staff members we spoke with were not always positive about how the home was being managed. All of the staff members that we spoke with voiced concerns about the numbers of staff employed to provide support to the people within the service.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

We asked staff members about training and supervision. They all confirmed that they received regular training and supervision throughout the year.

We observed caring relationships between staff members and the people living in the home.

There was a flexible menu in place which provided a good variety of food to the people using the service.

We talked to the staff and found that they had a good understanding of issues around consent in a home where some people might not be able to express this very easily. We observed staff caring for people and found that they did so with respect. We looked at the arrangements for meals and found that people's nutritional requirements were taken into account.

We checked that the provider took steps to make sure that the people they employed to provide care were suitable to do so and that there were adequate arrangements for people to make complaints.