This unannounced comprehensive inspection took place on 29 June and 12 July 2018.
Belmont Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
Belmont Grange is registered to provide accommodation with personal care for up to 25 people in one adapted building, with two of the bedrooms ‘shared’. Belmont Grange is a large Victorian building situated in Ilfracombe, North Devon within a residential area. Access to all floors is gained by a passenger lift. There were 22 people living at the service when we visited, with one vacant room and one person in hospital. The majority of people living at the service experienced some level of a dementia related illness.
We had previously carried out an unannounced comprehensive inspection of this service in March 2017. The safe, effective and well led sections were rated as requires improvement. The caring and responsive areas were rated as good. As a result, the overall service was rated as requires improvement. Two breaches of regulation were found. These related to people not having had assessments carried out relating to their mental capacity and people were not protected against the risk associated with the lack of systems to pick up on environmental issues. We also issued a recommendation in relation to the provider using a dependency tool to help them decide on the number of care staff required to meet people’s assessed needs.
Following the last inspection, the local authority Quality Assurance Improvement Team (QAIT) and North Devon Care Homes Team supported and worked with the service to address the breaches of regulation.
At the last inspection in March 2017, we asked the provider to make improvements and this action has been completed.
There was a registered manager in post. A registered manager is a person who has registered with the CQC 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, visitors and care professionals described the care as exceptional at Belmont Grange and this had an extremely positive impact on people’s care, support and wellbeing. Relatives described how staff went above and beyond what they should. There was a homely, vibrant and happy atmosphere in the home. Staff were compassionate, polite and respectful to people. They spent time with people, developed meaningful relationships and knew what mattered to them. They were familiar with their lives, past histories and their families. One person commented, “I said I’d never come here … but I couldn’t wish for anything better. The girls look after you, you’re not just their job. If I want anything they will do it for me even in their time off.” People’s relatives and friends could visit always and were very complimentary of the service and all the staff group. Regular feedback was sought from residents and their relatives.
The registered manager led by example and had made significant improvements in the care delivery, fabric of the building and the management of the home. This had been recognised by people, relatives and care professionals who were overwhelmingly positive about the changes. Comments included, “… feel that the atmosphere in the home is one that gives a positive feel when you visit, there is both a homely and vibrant atmosphere having known the home previously I feel that the environment and indeed the reputation of the home is now so much improved”, “Belmont Grange is a home which I have always been very grateful to have in our community” and “In my opinion, the manager has continually strived to make improvements.”
Recruitment checks were safely carried out and there were sufficient and suitable numbers of staff on duty to keep people safe and fully meet their needs. Staff received training and supervision to do their jobs properly. There were many positive comments from care professionals about the staff team and how well they did their jobs.
People were protected by staff who had been trained in safeguarding people from abuse. They had undertaken training, knew the right action to take and who to inform if abuse had been suspected.
People’s needs were assessed before they came to live at the service. People had care plans in place to guide staff. Risk assessments had been carried out in a way to ensure people were restricted as less as possible. People were involved in making decisions about their care. They were referred promptly to health care services when required and received on-going healthcare support. Staff acted on any advice given.
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. Improvements had been made in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed. Staff knew which people had a Power of Attorney (POA) in place to support the person in decision making. Best interest decisions had been made and involved the relevant parties.
People received their medicines in a safe way and effective systems were in place. The registered manager and staff were committed to ensuring people received end of life care at the service in an individualised way. An activities co-ordinator carried out a range of activities people could take part in.
Staff were very motivated, enthusiastic and proud of their jobs. They felt they were listened to, supported and valued by the registered manager. The registered manager ensured there was an open culture at the service and people, relatives and staff’s opinions mattered.
People were complimentary of the food and enjoyed the choice of home cooked meals. They were given choices and assisted by staff where necessary.
A quality monitoring system had been put into place which monitored and improved various aspects of the service. There was a complaints procedure in place and people knew how to make a complaint if necessary.
Ongoing maintenance of the building continued and further updates were planned.
We have made two recommendations about improving the environment and activities for people living with dementia.