Archived: Belle Vue Lodge

Belle Vue Lodge is a nursing home and accommodates up to 59 people in one building. There are six individual living areas over three floors with an atrium on the ground floor available to all. People living at the service were older people, some of whom were living with dementia. At the time of our inspection, 35 people were living at the service.

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

People did not receive consistent care from staff who showed dignity and respect. Whilst some shortfalls were identified, positive feedback from people who used the service and visiting relatives were received about the caring approach of staff. This was confirmed by some positive staff engagement with people. People were involved as fully as possible in day to day decisions about their care. The registered manager was introducing formal procedures for people and their relative or representative, to participate in review meetings about the care and treatment provided. Advocacy information was available, and people were supported to access advocacy services when required.

People’s diverse needs, preferences and routines had been assessed and planned for. Improvements were required to the approach and opportunities of social inclusion, activities, stimulation and occupation. Action was being taken to make these improvements. There was an accessible complaints procedure available for people. Complaints were responded to in accordance with the provider’s policy and procedure. End of life care was planned with the person and others, to ensure care reflected people’s wishes that they were kept comfortable and received dignified care.

Recent improvements had been made to the leadership of the service. A new management team had been developed. They were taking action to identify the areas of improvement required and had an action plan, and the support from the operations manager to drive forward improvements. The registered manager had introduced management surgeries, as a method to improve communication and engagement with people and relatives. Systems and processes were in place that monitored the quality and safety of the service. Staff did not consistently feel positive about working at the service, improvements were required to address the staff culture and understanding roles, responsibilities and accountability.

People received safe care. Staff were aware of their role and responsibilities to protect people from risks and avoidable harm. Risks associated with people’s care needs had been assessed and were regularly reviewed and staff had guidance of how to mitigate and manage known risks. There were sufficient staff employed. Recruitment procedures supported the provider to make informed decisions about the suitability of staff employed. People received their prescribed medicines safely and national best practice guidance was followed in the management and storage of medicines. Infection prevention and control measures were used. Incidents were reviewed and lessons were learnt, and action taken to reduce reoccurrence.

People received effective care. The registered manager had recently introduced, and had pledged to use, new recognised assessment tools that reflected national best practice. Improvements to staff training in understanding care needs associated with dementia had been introduced. Additional action was planned, to further upskill staff’s awareness and competency. Staff supervision and appraisals had not been at the frequency the provider expected, but this had been addressed and action taken to make improvements. People received enough to eat and drink, and their health needs were assessed and monitored. Staff shared information and worked with external health care professionals to meet people’s ongoing health care needs. Improvements to decoration and furnishings were being made. 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.

We have made a recommendation about motivating staff and team building.

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 requires improvement (published 8 January 2019) and there were two breaches in regulation. The provider completed an action plan after the last inspection, to show what they would do and by when to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations. However, the service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Belle Vue Lodge accommodates up to 59 people in one building. At the time of our inspection there were 31 people living at the home. This is the service’s third inspection under its current registration. At the previous inspection on 2 and 3 May 2018 we rated the service as ‘Requires Improvement’. For the question, ‘Is the service Well-led?’ we rated this as ‘Inadequate’. We also identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Due to the seriousness of the issues we identified, we issued the provider with a warning notice and a deadline by which they needed to make changes to address the immediate risks to people’s health and safety.

During this inspection we found some improvements had been made, but further improvements were still needed. We identified two breaches of the Health and Social Care 2008 (Regulated Activities) 2014. These were continued breaches from the previous inspection. Overall the rating for this service will remain as ‘Requires Improvement’. The rating for the question, ‘Is the service well-led?’ has improved from ‘Inadequate’ to ‘Requires Improvement’.

A registered manager was not present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. The operations manager was currently managing the home alongside a newly appointed manager. 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.

Risks to people’s safety were not always appropriately assessed and acted on.

We have made a recommendation for the provider to take action to address to the assessment of the risks to people’s safety.

People were supported by staff who understood how to protect them from avoidable harm. There were enough staff in place to support people and to keep them safe, but there were delays in providing people with timely care. People’s medicines were administered safely, but storage and recording procedures were not always appropriately followed. The home was clean and tidy and staff understood how to reduce the risk of the spread of infection. However, cleaning products were not always stored safely. Accidents and incidents were reviewed, assessed and investigated.

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 support this practice. Improvements were needed in the way conditions placed on DoLS authorisations were recorded and checked to ensure they were carried out.

People’s physical, mental health and social needs were mostly assessed and met in line with current legislation and best practice guidelines. Staff received regular training and their practice was assessed. Staff felt supported by the registered manager. People were supported to follow a healthy and balanced diet; however, people did not always receive their meal in a timely manner. People had access to external health and social care agencies. The home environment was generally well maintained and had been adapted to support people with a physical disability. However, the layout did not fully support people living with dementia.

People liked the staff and found them to be kind and caring. However, people did not always receive timely, person-centred care and support from staff. People were unable to recall if they had been involved with care planning and records showed limited examples of people’s involvement. People told us they felt staff treated them with dignity and respect. There was little space for people to speak with family and friends in private. People were encouraged to lead as independent a life as possible. People were provided with information about how they could access independent advocates. There were no restrictions on people’s friends or relatives visiting them. People’s records were handled appropriately and in line with data protection laws.

People did not always receive care that was appropriate, person centred or met their needs. Care records used on each unit at times did not reflect what had been recorded in people’s care records. People’s diverse needs were discussed with them when they commenced using the service. However, we found one person’s needs had not been acted on. People did not always have access to meaningful and engaging activities. Records showed formal complaints had been dealt with appropriately, however people and relatives did feel that more needed to be done to address less formal complaints. People were supported to make decisions about how they wished to be cared for at the end of their life.

The operations manager had made some improvements to the service since our last inspection. People were no longer at risk of serious harm, however more needed to be done to improve the quality of the care and support provided for all people. A new manager was is in place and they will work with the operations manager to make the required improvements. Quality assurance processes are in place to assist with this improvement; however, we are unable to assess the sustainability or effectiveness of them at this time. The operations manager responded to concerns raised during the inspection and acted to reduce the risks identified. Staff felt the home had improved since the last inspection.

You can see what action have taken in relation to the breaches at the end of this report.

Belle Vue Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the

premises and the care provided, and both were looked at during this inspection. Belle Vue Lodge is a nursing home and accommodates up to 59 people in one building. There are six individual units over three floors. On the first day of our inspection, 48 people were living at the service and on the second day, 49 people were present. People living at the service were older people, some of whom were living with dementia.

A registered manager was in place until 27 March 2018, when they left the service and de-registered. However, they returned to the service on the day of our inspection. The manager said they were taking up their previous position and would submit a registered manager application again. We will monitor this. 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.

Risks associated with people’s needs had not been effectively assessed, planned for or monitored. Information to guide staff of how to manage risks lacked detail and did not reflect people’s current needs. Where people experienced periods of heightened anxiety that affected their mood and behaviour, staff had limited information about the strategies to support people. Staff were aware of their responsibilities to protect people from abuse and avoidable harm. The provider was working with the local authority safeguarding team who were investigating safeguarding incidents and concerns.

Equipment used to reduce and manage some people’s risks, were found to not be used effectively to mitigate risks. The systems in place to record, monitor and analyse accidents and incidents people had experienced had not been fully completed. This impacted on the provider having clear oversight and the ability to consider if lessons could be learnt to make improvements.

The deployment of staff required reviewing to ensure people’s safety and individual needs were consistently met at all times. Safe staff recruitment procedures were in place and followed. Some shortfalls were identified in the management of medicines. Infection control and prevention measures were in place to reduce the risk of cross contamination.

The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had not been fully adhered to meaning people’s rights had not been fully protected. People’s communication needs had not been considered when assessing people’s mental capacity, and assessments lacked detail or had not been completed when required. Where people had conditions specified in their Deprivation of Liberty Safeguards authorisation, these had not been monitored.

The provider used recognised assessment tools when assessing people’s needs. People’s nutritional needs were assessed and referrals were made to external healthcare professionals, when concerns or changes occurred such as a change in a person’s weight.

Staff received an induction, ongoing training and support.

Systems were in place to work with other organisations. The staff worked with external healthcare providers to meet people’s health outcomes. Monitoring of wound care was found to not always be effectively managed. The design and layout of the building was not fully conductive to meeting the needs of all people that used the service.

Staff were inconsistent in their approach in providing people with dignified and respectful care. Additionally, there were inconsistencies in staff promoting choice. Relatives were positive that they were involved in their family member’s care and treatment. People had information about, and received support to access independent advocacy services.

People’s individual and diverse needs were not always met and respected. People were at risk of receiving inconsistent support, care plans did not provide an accurate or up to date

description of their needs. The provider’s complaint procedure had been made available for people that met their communication needs.

Opportunities for social activities and participation in meaningful occupation and stimulation were limited. End of life plans were not routinely completed but were in place for people who were at the end stage of their life. Some staff had received end of life training and plans were in place for all staff to receive this.

The systems and processes in place to check on quality and safety were found to be ineffective. The provider had failed to identify the shortfalls in the fundamental standards that were identified during this inspection. There was a lack of oversight, accountability and consistent leadership. Recent management changes had not been managed effectively or were communicated with people, relatives, representatives and staff.

During this inspection we found four breaches of the 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 the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Belle Vue Lodge is a care home registered to provide personal and nursing care. Accommodation is provided over two floors, arranged into separate units. It is situated in Nottingham and accommodates up to 59 older people, many of whom are living with dementia. At the time of our inspection there were 56 people using the service.

The service had a registered manager in post. 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.

Belle Vue Lodge had a calm atmosphere and people told us they felt safe. Staff had been trained in safeguarding (protecting adults from abuse) and understood the importance of protecting the well-being of people who might not be able to say if something was wrong.

The risks to people's safety and well-being had been assessed and minimised. Staff knew what action they needed to take to keep people safe. Staff followed risk assessment guidance in order to keep people safe.

There were enough staff on duty to keep people safe and meet their needs. Staff had time to interact and socialise with people as well as providing personal and nursing care. Staffing levels were responsive to the needs of people. The registered manager followed the provider's staff recruitment policy to help ensure the staff employed were suitable to work with people who use care services.

People were supported to take their medicines when they needed them and as prescribed. Staff undertook training to help ensure people's medicines were administered safely.

Staff had completed training to support people effectively. However, we found that staff would benefit from further specific training in dementia and managing complex behaviours. This would enable staff to respond consistently when people were distressed, agitated or confused.

The registered manager had reduced the number of agency staff working within the service to ensure people received effective care from staff who were known to them.

Staff told us they felt supported in their roles and the registered manager and senior staff provided staff with clear guidance and leadership.

People's capacity to make decisions and choices had been assessed. Staff understood the importance of offering people choices. They followed the principles of the Mental Capacity Act when supporting people to make decisions and providing people with care.

People had their health needs assessed and care plans were put in place to meet their needs. Where appropriate, people were referred to external health professionals for support and guidance to ensure they remained as healthy as possible. Care records did not always reflect that people were receiving care and support in line with professional guidance.

Staff were caring, compassionate and attentive in their approach to meeting people's needs. Staff used different ways of enhancing communication and used their knowledge of people to develop positive relationships. People and relatives were involved in making decisions about their care.

Experienced staff knew people well and used the knowledge they had to tailor their care and support. Care plans did not always include the information staff who were new to the service needed to provide personalised care that reflected people's preferences.

People had opportunity to be involved in a range of one-to-one and group activities. People were supported to go out into the wider community through day trips and events.

People and their relatives were confident to raise concerns and complaints about their care. The registered manager supported people to raise concerns and complaints in a number of ways and used information to bring about improvements in the service.

There were arrangements in place to regularly assess and monitor the quality of the service. The registered manager and staff were working to an action plan and a number of improvements had been made. These included an increase in staffing levels and reduction in the use of agency staff. Staff were clear about the roles and responsibilities. People, relatives and staff were supported to share their views about the service. The registered manager had used this information to improve care. This showed that the service was well-led.

We found that there were processes in place to ensure that people were able to give informed consent to their treatment and care. However, we also found that people's care and treatment was not fully planned and delivered in a way that ensured people's safety and welfare.

We found that people were supported to be able to eat and drink sufficient amounts to meet their needs. However, we also found that appropriate checks were not always undertaken before staff began work.

We found that there were sufficient staffing to meet people's needs and the provider assessed the quality of the service provided.

We spoke with four people who use the service. The feedback we received from people who used the service indicated they were pleased with the quality of the accommodation and had no concerns about maintenance issues. One person said, 'I love my room,' which was highly personalised. Another person said, 'There's no problem with the building as far as I'm aware.'

People using the service were not happy with the temperature of one part of the home on the day of our inspection. We received confirmation from the service the following day that the heating issue had been resolved.

We found that people, staff and visitors were protected against the risks of unsafe and unsuitable premises. We also found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We spoke with three people who use the service. They were happy with the care provided by the service and raised no issues of concern regarding any of the outcomes inspected.

We found people were treated with dignity and respect and received care that met their needs. We found that there were sufficient staff to meet people's needs and that records were kept securely and were fit for purpose.