Archived: Belle Green Court Care Home

Belle Green Court is a residential care home that provides accommodation for older people who require personal care. The home can accommodate up to 40 people in one adapted building, over two floors. At the time of this inspection there were 38 people using the service.

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

Risks involved in the delivery of care to people were not adequately documented and there was not enough information in people’s care plans to support staff to manage risks effectively. The management of people’s medicines was not always safe. People said staff responded to them quickly when they needed support and people felt safe when receiving care at Belle Green Court. Staff knew how to safeguard people from the risk of abuse. The home was generally clean and tidy. People were protected from the spread of infection.

People were happy with the care they received. They said they were supported by staff who knew how to provide the care they needed. However, staff training was not up to date and some staff told us their supervision meetings were not effective. People were happy with the food they received, however, we found the kitchen staff did not have adequate information about people who required a special diet to reduce the risk of choking. This placed people at risk. People were supported to access community health professionals when necessary.

People were cared for by staff who knew them well. People had developed positive relationships with staff. Everyone we spoke with told us staff were kind and caring. People were treated with dignity and respect, and staff protected people’s privacy. 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.

A minimal number of activities were available to people. Improvements were required in this area to ensure activities were available more often and were person-centred and meaningful to people. We have made a recommendation about the development of activity provision in the home. People’s care plans required improvement to ensure they were person-centred and supported staff to provide personalised care. People knew how to complain or raise concerns about their care.

Improvements were needed to the quality assurance processes used by the registered manager and provider to assess the safety and the quality of the service being provided. The checks completed by the registered manager had not ensured the service complied with all legal obligations. People told us they did not have regular opportunities to provide feedback about the service. We found the provider had taken insufficient action to make necessary improvements to the service following feedback given by people in 2018.

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

Rating at last inspection

The last rating for this service was good (published 3 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the safety of the service, the recruitment of staff, the provision of staff training and supervision, the reporting of incidents and events to CQC and the governance and quality assurance systems used by the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection took place on 16 January 2017 and was unannounced which meant we did not notify anyone at the service that we would be attending.

Our last inspection at Belle Green Court took place on 29 February 2016. Following the inspection the service was rated as Requires Improvement. At that inspection we found breaches in three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in; Regulation 12, Management of medicines, Regulation 14, Meeting people’s nutritional and hydration needs and Regulation 18, Staffing ,training and appraisal. Requirement notices were given for these breaches in regulation and the registered provider was told to make improvements. On this inspection we checked improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of the regulations.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

People we spoke with told us they felt safe living at Belle Green Court and spoke very positively about the staff.

We found systems were in place and had improved to make sure people received their medicines safely.

There were sufficient staff to meet people’s needs safely and effectively.

Staff underwent an induction and shadowed experienced staff prior to commencing work, and had regular updates to their training to ensure they had the skills and knowledge to carry out their roles. The management of staff training records had improved so staff training could be better monitored. Staff received an annual appraisal and were well supported by the registered manager.

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.

People had access to a range of health care professionals to help maintain their health.

A varied diet was provided to people which took into account dietary needs and preferences so their health was promoted and choices could be respected. People’s fluid and diet intake was monitored by staff where a risk of dehydration or malnutrition had been identified.

Activities were provided both in and outside of the home which people said they enjoyed.

People living at the home, and their relatives said they could speak with staff if they had any worries or concerns and they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

Some people using the service and their relatives had been asked their opinion via questionnaires. The results of these had not been fully audited yet to identify any areas for improvement.

Staff told us they felt they had a very good team. Staff said the registered manager was approachable and communication was good within the service.

There were no formal meetings with the registered provider and people who used the service. The registered manager said the activities coordinator was planning to introduce these meetings. People and relatives said the registered manager had an ‘open door’ policy and was always available to talk to.

There was a manager at the service who was registered with CQC. 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.

Our last inspection at Belle Green Court took place on 19 December 2013. The home was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 29 February 2016 and was unannounced. This meant the staff who worked at Belle Green Court did not know we were coming. On the day of our inspection there were 38 people living at Belle Green Court.

We found some people’s medicines were not managed and administered in a safe and proper way, which meant there was a risk of people not receiving their medicines as required.

People told us they felt safe living in the home and relatives we spoke with told us they thought their family members were safe.

Healthcare professionals spoken with said they had no concerns about the care at Belle Green Court and said, “Overall I think the care here is very good.”

Staff told us they received training but some of this training was not up to date, could not all be evidenced by records kept at the home and did not cover the right areas to meet people’s needs.

One person was at risk of dehydration because staff had not sufficiently monitored or managed their fluid intake and output.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who lack capacity to make important decisions themselves.

People had access to a range of health care professionals to help maintain their health.

People living at the home, and their relatives said they could speak with staff or the registered manager if they had any worries or concerns and they would be listened to.

There were some systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken by the registered manager to make sure full and safe procedures were adhered to. People using the service and their relatives had been asked their opinion via some meetings and surveys.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People said, 'Nobody makes me do anything, I like to sit and watch, I do what I want' and 'They [staff] always ask me things first' and 'I can do what I want to do.'

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People said, 'I love it here. I wouldn't want to go home now. [Staff] are made of gold, can have a bit of fun with them. I've got a great carry on' and 'By and large, for comfort, food, cleanliness it's a lot better than other homes."

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. One person said, 'The building is first class, better than others. You can go in the small lounges for privacy, always plenty of room.'

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

There was an effective complaints system available.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We spoke with two relatives and they told us they were very satisfied with the quality of care at the service. Their comments included: "He gets on with them all (staff), they spoil him and they make him laugh." "Carers are great."

We observed staff giving care and assistance to people throughout the inspection and they were respectful and treated people in a friendly and supportive way.

People we spoke with made positive comments about their care and the staff. Their comments included: "Marvellous can't fault it." "I would recommend it to someone needing respite care." "Always a nurse available." "Get medication when I need it." "Staff are very good."

We found that staff were clear about what their roles and responsibilities were and what action they would take if they saw or suspected any abuse. People told us that they felt "safe" and that they had no worries or concerns. They all said that if they had any concerns or worries they would speak to staff.

People who used the service benefit from sufficient staff to meet their needs.

We saw that improvements had been made and the service had procedures in place for staff to follow to ensure that people's records were monitored and reviewed and that a personalised record was kept and maintained for each person who used the service.