Archived: Belmont Care Home

Updated 18 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was an unannounced comprehensive inspection which took place on the 10, 11 and 12 October 2017. On the 10 October the inspection was undertaken by three adult social care inspectors, a specialist advisor who was a pharmacist and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. This person had experience of services for older people and people living with dementia. On the 11 and 12 October the inspection was undertaken by two adult social care inspectors.

Before the inspection we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. The provider did not return the information we requested. We have addressed this in the well-led section of this report.

Prior to the inspection we had received information of concern relating to medicines administration which is subject to an ongoing investigation. We did not look at the specifics of that case but did look at some of the issues raised.

We reviewed information we held about the service and provider, including notifications the provider had sent us. A notification is information about important events which the provider is required to send us by law. We also asked the local authority and Healthwatch Stockport for their views on the service. Prior to our inspection Stockport Metropolitan Borough council (SMBC) shared an action plan they had implemented with Belmont Care Home in response to their identified concerns. We used this information to help us plan our inspection.

As some people living at Belmont Care Home were not able to tell us about their experiences, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

During our inspection we spoke with eight people who used the service, one visitor, the provider, the deputy manager, six care staff, the laundry assistant and the chef.

We carried out observations in public areas of the service. We looked at nine care records, a range of records relating to how the service was managed including medication records, five staff personnel files, staff training records, staff duty rotas, policies and procedures and quality assurance audits

Updated 18 November 2017

This was an unannounced inspection which took place on the 10,11 and 12 October 2017.

Belmont Care Home provides residential care for up to 40 people. Since our last inspection in March 2017, the service has not accepted any new admissions to the home. During this inspection there were 19 people living at the home.

At our inspection in January 2017. We identified breaches of five of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which were in relation to good governance, safe care and treatment, premises, training and person centred care. We also identified two breaches of the Care Quality Commission (Registration) Regulations 2009 in relation to the provider not submitting statutory notifications as required. We rated the home 'Inadequate' and placed the service into special measures. We then completed a focussed inspection in March 2017 due to concerns we had received. We looked at areas in the safe and well-led sections. The service was again found to be inadequate in safe and well-led, with continued breaches in relation to the safe management of medicines, assessing and taking action to reduce risks to people's health and wellbeing, good governance and staff training and supervision.

Requirement notices were issued for all the breaches of regulations. In March 2017 a warning notice was issued for the breach of regulation 17 Good Governance. The provider sent us an action plan telling us how they would become compliant with the regulations.

During this inspection we checked if the required improvements had been made. We found the provider was still in breach of the regulations identified in our last two inspections of the service and we also found a further two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service remains 'Inadequate' and the service remains in special measures. We are currently considering our options in relation to enforcement in response to the breaches of regulations identified. We will update the section at the back of the inspection report once any enforcement work has concluded.

We also made one recommendation, that the service ensures toilet facilities have appropriate locks on them to ensure that people’s privacy and dignity is maintained.

We found that not all windows were fitted with appropriate restrictors. This did not follow the Health and Safety Executive (HSE) published guidance on the use of window restrictors in care homes. Appropriate window restrictors prevent the windows in care homes from being opened too widely and people falling from the windows.

Health and safety checks and equipment maintenance checks were not completed. Areas of the building were not adequately maintained or secure. Records of fire safety checks were either not available or were incomplete and did not show regular checks or testing had been carried out. Areas of concern identified in the last fire risk assessment had not been addressed.

Medicines were not managed safely. Staff were not provided with sufficient information about medicines that were to be given ‘when required’. Records indicated that medicines storage temperatures were not being monitored and recorded to ensure medicines remained effective and no action had been taken to rectify this. There was little evidence to demonstrate that staffs continued competency to administer medicines had been checked and records of stocks of medicines could not be found.

Systems for the recruitment of staff were not sufficiently robust and did not ensure all required pre-employment checks had been made. Staff had not received the training, induction or supervision they needed to support them to carry out their roles effectively.

Some care records had been updated since our last inspection. We found the new care records to be person centred and gave detail about peoples likes and dislikes and the way they wanted to be supported. However we found that care records had not been reviewed regularly. Care records including risk assessments were not always accurate or had not been updated when people needs had changed. Records of support provided were not always complete.

The provider was not meeting the requirements of the Mental Capacity Act (MCA) 2005. People were potentially being unlawfully deprived of their liberty.

People we spoke with told us staff treated them with respect. However, we found that people’s privacy and dignity was being compromised. We found that two toilet doors that opened onto public areas of the home did not have privacy locks on them. One of these toilets was directly opposite the front door. Had the toilet door been left open people using the toilet area would have been visible from the front door.

We observed staff interactions that were gentle, friendly and caring. Staff took their time when supporting people and no one was rushed. Staff knew people well.

There was a lack of planned activities for people to take part in. People told us they didn’t go outside the home very often.

There was a lack of systems to monitor and improve the quality of the service. We found checks and audits that were carried out by staff within the home were incomplete and not sufficiently robust to ensure best practice was followed and compliance with regulations was being maintained.

The Care Quality Commission (CQC) asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. The completion of a PIR is a legal requirement of a provider’s registration with the CQC. The provider did not return the information we requested.

The service is required to have a registered manager in place. 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. The service did not have a registered manager.

The service are required to notify CQC of events such as accidents, serious incidents and safeguarding allegations. The service had not notified CQC of all events they are required to.

Staff were positive about working for the service and the improvements that had been made since our last inspection.

The provider was displaying the rating of the last CQC inspection as they are required to do.

The overall rating for this service is 'Inadequate' and the service is in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.