Belmont Care Home

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.

This is the first assessment for this service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of the legal regulation in relation to safe care and treatment.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Theproviderdid not always have a proactive and positive culture of safety based on openness and honesty.Staffdid not always report safety events. Lessons were not always learnt to continually identify and embed good practice.

Although there was an incident recording policy, staff had not completed incident forms when medicines ran out and people missed their doses. This meant there were missed opportunities for timely action to be taken and reduce the risk of this being repeated. However, for issues such as accidents and falls, staff recorded information on the electronic care planning system. These were reviewed by the manager and discussed at governance meetings with the wider provider, and any changes required were communicated to staff during staff meetings and handovers.

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.

There were processes to make sure new admissions into Belmont Care Home were well managed and consistent. The manager conducted pre-admission assessments and involved relevant people to gain important information about needs and personal preferences. Relatives said they were fully involved in the process, 1 relative said, “We have had a lot of time with the staff getting [my relative] settled in. We have been able to tell the staff about him, and this helped them support him in the best way.”

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.

The manager worked alongside the local authority well and made safeguarding referrals when required. There was a system to collate and monitor safeguarding investigations and outcomes to make sure any recommendations were implemented. Staff completed safeguarding training and knew how to raise concerns.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. Incare homes, thiscan be donethrough a procedurecalled the Deprivation of Liberty Safeguards (DoLS),whichispart of the Mental Capacity Act 2005(MCA).We checked whether the service was working within the principles of the MCAand how they managed DoLS within the service. The manager made applications to the local authority when someone was at risk of being deprived of their liberty and monitored these to make sure renewals were made on time. Staff understood and adhered to the care plans and restrictions that were listed.

The provider did not work well with people to understand and manage risks.

There were discrepancies in written guidance relating to people’s health and wellbeing, and care was not always delivered to manage or minimise risks.

For 2 people with an identified choking risk, there was limited, contradictory and out of date guidance detailed in their care plans. Additionally for 1 person we observed their meal had not been prepared to a level that reduced their choking risk, and staff did not supervise them during mealtimes as per the care plan. Daily notes about food were not clear and showed meals had not been prepared to a consistent standard. Some staff had limited understanding about safe food preparation. Although we did not identify harm occurred, it meant there was an increased risk of choking and harm to people’s health. For other people who were prescribed oxygen including 1 person that smoked (increasing the risk to fire safety), there were no fire risk assessments or care plans to guide staff about safe care provision. We fed all this back to the provider who put actions in place immediately to address. This included reviewing all written information to make sure guidance was clear and up to date and arranging refresher training sessions for staff.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Health and safety checks were made and external companies carried out compliance checks and servicing. These were in date, for example around gas, electrical and water safety testing. There was a fire risk assessment in place with regards to the building and premises, and actions had been taken to address any areas this identified. People had individualised plans about what support they would need in the event of a fire. There was a maintenance management system, and the maintenance manager conducted environmental audits on a regular basis and made sure the building and items within it were maintained or replaced in a timely manner.

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.

We checked employment and recruitment records and found people were recruited using safe processes, including checking references and right to work documents. The provider used a staff dependency tool to make sure the right numbers of staff were on shift to meet people’s needs, and reliance on agency staff was kept to a minimum. Some staff said specific points of the day could be challenging and it was difficult to spend time with people during these periods. Staff completed inductions and training relevant to their role, and training compliance rates were high.

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.

The home appeared clean, tidy and free of hazards. We saw regular cleaning schedules in place to make sure people’s rooms and communal areas were well maintained. Staff observed bare below the elbow protocols (where no items of clothing or jewellery is worn below the elbow, to reduce the risk of infection). Staff washed their hands and wore protective clothing such as aprons and gloves at the required times.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Processes relating to thesafe administration of medicines needed improvement.We saw4 examples where people missed their doses of medicines as there was none left in the home to administer. This could pose a risk to people’s health and wellbeing. Staff had not completed incident forms to enable actions to be taken and reduce the risk of this being repeated. On occasion medicine records (MARs) were not clear; for example, the date and reason for missed doses was not recorded. This meant we were not assured medicines were administered according to people’s prescriptions. Guidance for staff about ‘as and when required’ medicines was missing or not individualised, meaning people may not receive medicines as intended. Although staff knew when time sensitive medicines (for example for Parkinson’s Disease) should be taken, they did not always record the time they were given, so we could not be sure medicines administered would be effective and not cause harm.

Although the provider’s medicine audits identified concerns, measures taken to address had not been embedded enough to reduce the risk of medicines running out. Additionally, staff did not take action to follow up with the pharmacy in a timely way. We did not find any evidence that people had been harmed, and we fed back our findings to the manager. The manager acted straight away, including reviewing processes, increasing oversight and audits, refresher training and checking staff competency.

However, care home staff worked with other professionals to review people’s medicines needs.Checks were carried out to confirm people’s current medicines on admission to the home.Staff provided patient support when administering medicines and appropriate safeguards were in place should the covert (hidden) administration of medicines be used.