Belmont House Nursing Home

Belmont House Nursing Home is a care home providing personal and nursing care to up to 60 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 51 people using the service.

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

People were safe. Staff understood how to safeguard people from abuse and reported safeguarding concerns to the relevant people and agencies. Risks to people’s safety and wellbeing were managed well. There were enough staff to support people and meet their needs. Recruitment checks were undertaken on staff to make sure they were suitable to support people. The provider undertook regular checks and audits to make sure the premises and equipment were safe. The premises were clean, tidy and hygienic. Staff followed current infection control and hygiene practice to reduce the risk of infections.

People were involved in planning and making decisions and able to state their choices and preferences for how their care and support was provided. Staff knew people well and how to meet their needs. They received relevant training to help them do this. Staff were well supported and valued by managers and encouraged to learn and improve in their role. They were encouraged to put people’s needs and wishes at the heart of everything they did.

People were supported to stay healthy and well. Staff understood people’s healthcare needs and how these should be met. They made sure people could access support from healthcare professionals when this was needed. The service worked proactively with healthcare professionals and acted on their recommendations to deliver care and support that met people’s needs. People were encouraged to eat and drink enough to meet their needs and to take their prescribed medicines.

Staff were kind and caring. They treated people well and people were happy with the care and support they received. Staff supported people in a dignified, respectful way which maintained their privacy and independence. 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 could take part in a wide range of activities and events at the service based on their choices and preferences. Relatives and friends were free to visit the service without any unnecessary restrictions. The home had been designed and decorated to meet people’s needs. People had a choice of spaces to spend time in at the service, to build relationships and socialise with others.

The service was managed well. The registered manager had the skills and experience to perform their role and had a clear understanding of how people’s needs should be met. They undertook checks at regular intervals, to monitor, review and improve the quality and safety of the service. The service had a good track record in trialling and implementing new ways of working, to help improve the overall quality of care and support people received.

The service obtained people’s feedback about how the service could be improved and these were acted on. There were systems in place to ensure accidents, incidents and complaints were investigated and people were involved and informed of the outcome. Learning from these was shared with the staff team to help the service improve the quality and safety of the support provided.

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 the service was good (published on 1 March 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

Suitable arrangements were in place to help people maintain safe social contact with their family members and friends. Two ground floor rooms had been allocated with Perspex screening installed which allowed people living in the care home and their visitors to enter and leave separately whilst seeing each other safely. Prior to their scheduled visit time, all visitors were rapid tested for COVID-19 in external buildings and a designated member of staff co-ordinated all visits. A robust protocol was in place to support safe visiting including temperature and blood oxygen checks and the provision of personal protection equipment (PPE).

Staff and people at the home were engaged in the ‘whole-home’ testing programme. People living in the home were routinely tested for COVID-19 every four weeks and staff were currently being tested once weekly. Rapid testing was available for visitors and people using the service with staff about to start having two of these tests weekly in addition to the main laboratory test.

The service implemented isolation and zoning in line with good practice. Designated staff members across the care, food and housekeeping teams oversaw and audited practice around areas such as the correct use of personal protective equipment (PPE), handwashing and cleanliness.

The five bedded unit identified for use by the Local Authority as a designated care setting was located on the top floor, self-contained and physically separated from the other units. Access to this unit would be restricted to staff who needed to enter to perform their duties and they could do so via a stairway direct from a back entrance. People using the unit would enter via the front entrance and lift. These areas were already subject to a deep cleaning schedule and additional touch point cleaning would be implemented during any admission. Accommodation would be provided in single occupancy bedrooms, each with their own en-suite bathroom and toilet facilities.

Policies and procedures had been reviewed and updated since the pandemic started. The service regularly monitored and audited compliance with the infection prevention and control measures in place.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

At this inspection we found improvements had been made in all areas. Staff were confident with the equipment they used. Emergency pull cords were checked regularly to ensure they were within easy reach should someone need them. People’s PEEPS were up to date and relevant. Systems had been put into place to give people reassurance both before and after fire drills. Staffing levels had improved and we found adequate staffing in place to keep people safe. The quality assurance systems in place allowed the registered manager to identify when things went wrong so they were able to improve the quality of care.

Belmont House Nursing Home is a three storey purpose built residential nursing home in Sutton that provides nursing, support and personal care for up to 60 people. At the time of our inspection the second floor was not in use and 32 people were using the service using the ground and first floor accommodation. The service had dining and lounge areas on each floor with a hairdressing salon, a coffee area, cinema room and a dedicated activities room on the ground floor. There were secure well maintained gardens with planting and seating areas. The laundry, catering, staff room and training area were located in the basement. The environment appeared light, clean and well maintained.

People told us they felt safe at Belmont House Nursing Home. There were appropriate safeguarding policies and procedures in place and staff were all trained in safeguarding adults and had a good knowledge and understanding of how to identify if people were at risk of abuse and knew what to do in these circumstances. Risks were identified and plans were in place to monitor and reduce risks to help keep people safe.

There were systems in place for the safe storage, administration and recording of medicines. Each person’s medicine was stored securely and only senior competent staff were authorised to administer medicines. During the inspection all medicine records we observed had been filled out correctly and medicine audits were completed to ensure medicine procedures were robust.

Staff had been recruited safely with appropriate checks on their backgrounds completed. We saw all the staff had completed an induction programme and on-going training was provided to ensure skills and knowledge were kept up to date.

We observed positive and appropriate interactions between the staff and people who used the service. Staff were caring and treated people with kindness, dignity and respect. People who used the service and their relatives were complimentary about the permanent staff and the quality and standard of care received. There were nominated dignity champions within the staff team.

The home employed two activity coordinators and this had a positive impact on the quality of life people experienced. People we spoke with enjoyed the variety of activities available, the activity schedule catered for all interests. The provider was looking at ways to further encourage engagement for those people living with dementia.

There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People were encouraged and supported to eat and drink well. When people were at risk of poor nutrition or dehydration, staff involved other professionals such as the GP or dietician.

People and their relatives were encouraged to express their views and opinions. They knew how to complain and make suggestions, and were confident their views would be acted upon. The provider had a complaints procedure to support this.

The breaches of regulations we found at the inspection on the 29 September and 4 October 2016 were in relation to person centred care, dignity and respect, need for consent, safe care and treatment, good governance, staffing and fit and proper persons employed. This was because the provider did not have effective systems to assess, review and manage risks to ensure the safety of people and they did not have suitable arrangements to protect people against the risks that can arise from the unsafe management of medicines. We also found that staff’s recruitment processes were not carried out safely, staff did not receive appropriate training and support and the provider had not followed processes to ensure that any restrictions on people's liberty were kept to a minimum. In addition, people were not supported by caring staff, who respected their privacy and dignity and the provider had not ensured that people always receive care from staff of a gender of their choosing. Our findings also showed that care plans had not been updated to take into account people’s changing needs and the provider did not have adequate quality assurance systems and we found care records including food charts; fluid balance charts and turning charts were not completed properly to monitor people's health.

Following our inspection in September 2016 and as part of our decision making process for urgent enforcement action against the provider, we wrote to them requesting a plan outlining what actions they had taken since our inspection and what further action they planned to take in order to meet the breaches of regulations summarised above. We received an action plan within the timescale requested which provided some assurance that the provider had addressed or was in the process of addressing our most urgent concerns and that they would make all the necessary improvements by the end of December 2016.

We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Belmont House Nursing Home on our website at www.cqc.org.uk”

Belmont House Nursing Home provides accommodation, personal and nursing care for up to 60 older people. There were 23 people using the service when we visited. The home is divided into three units, one on each of the three floors of the home. The ground floor is for people with nursing needs and the first floor accommodates people with dementia. The third floor was not being used at the time of our inspection.

The home had a registered manager but they were no longer in post at the time of the inspection and had not yet deregistered. There was a peripatetic manager in place on the day of 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'. 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.

At this inspection we found that whilst there had been some improvements in the quality of the service, there were still some areas that needed to be further improved. For example some staff were still not sure how to operate the movement sensors and sensory mats in people’s bedrooms. These devices alert staff when a person gets out of bed or from their chair and who may be at risk of falling, so they could support the person. We found that staff did not always remember to turn these devices back on when they were leaving a person’s room

Pull cords to the alarm system in bathrooms and toilets had been shorten so they hung about a foot above the floor, which meant they might not be accessible to a person should they fall on the floor.

Personal emergency evacuation plans (PEEP) in people’s care plans were up to date but we found that PEEP’s kept in a ‘Fire Box’ near to the main entrance and used should the home need to be evacuated were not up to date. The inaccuracy of information about people may cause confusion and delays should the building need to be evacuated in an emergency.

The provider and staff were not following their own fire safety policy to help ensure that people were reassured and kept safe when the fire alarm was activated.

There were at times insufficient staff to ensure people received the care and treatment they needed in a safe and timely manner. At our last inspection in September/October 2016 we were told the number of care workers would increase to four at night, we found this increase in staff had not happened. Prior to our inspection CQC received numerous complaints, many of the complaints included concerns about the lack of staff, especially at night and at weekends. At this inspection where there were 23 people living in the home, the payroll submission for two weeks in February 2017 showed that on some occasions there were insufficient staff to adequately support and care for people and to keep the home clean.

The provider's governance and quality assurance systems and processes were not always effective to identify and address the concerns we had found during our inspection. Audits of the premises were not conducted on a regular basis. A monthly risk assessment of the environment to help in the prevention of falls was last conducted on 2 November 2016. Although no audits were being conducted of people’s food charts, fluid balance charts and turning charts, the ones we looked at were up to date and completed correctly, except where the fluid balance charts were not always totalled at the end of the day.

Appropriate equipment for testing blood sugar levels for people with diabetes were now available. Suction equipment to help clear a person’s airway in an emergency were also set up and ready to use. Staff understood how to use them which could help to ensure suitable assistance was given to a person who became unwell. The administration of medicines was safe and the National Institute for Health and Care Excellence [NICE] guidelines were being followed. Records showed the nurses had received medicines management training including a competency test.

The provider had taken the necessary steps before staff were employed. This included making sure a completed application form was received, requesting employment, references and criminal record checks. These checks helped to ensure that people were cared for by staff suitable for the role.

Staff were knowledgeable of the different types of abuse and how to report any concerns to the management team. We saw that the service had contracts in place for the maintenance of equipment used in the home to ensure these were safe to use.

Not all the staff we spoke with were receiving regular one to one supervision with their manager. Staff we spoke with felt they had good access to training. Of the 44 staff, 12 were not fully up to date with all the training considered mandatory by the provider.

The provider had taken steps to ensure that any restrictions on people's liberty were kept to a minimum. We saw that people's capacity to consent to their care had been assessed and where appropriate an application to the local authority had been made for authorisations to deprive a person of their liberty.

People's preferences and likes and dislikes in relation to food was recorded in their care plans. We saw that alternative meals were available for people if they changed their mind on what they wanted to eat. People were supported to maintain good health and have appropriate access to healthcare services.

The provider had made improvements to ensure people’s comfort, privacy and dignity was met. People were asked if they would like net curtains at their bedroom windows and the bedding on people’s beds was of a better quality and additional bed coverings were available to help promote people’s comfort and warmth. We saw that when bedroom doors were closed and personal care being given a privacy notice was hung on the door handle to advise other staff not to enter the room while personal care was being given.

Records showed that people who requested personal care from staff of the same gender was now being met. We looked at the current staff rotas and saw an appropriate mix of staff was available during the day and at night.

We observed staff delivering care in a calm and relaxed manner. They knocked on people’s doors and asked permission before going in. People were well presented, men were freshly shaven and women had their make up on. They were dressed appropriately for the weather.

The care plans we looked at showed involvement from the relatives and people. Each person was allocated a named nurse and a key worker and these staff endeavoured to build a relationship with the person and their relatives. Records showed that care plans were reviewed monthly; however, there was no record of regular involvement of the relatives and the people at these reviews.

The home had started a scheme for one person to be 'Resident of the day'. However we found this new scheme could not always be put into practice on the day because of the lack of staff. The care plans we looked at included people’s preferred activities and hobbies. Records showed people being involved in both group and individual activities but feedb

Belmont House Nursing Home provides accommodation, personal and nursing care for up to 60 older people. There were 19 people using the service when we visited. The home is divided into three units, one on each of the three floors of the home. The ground floor is for people with nursing needs and the first floor accommodates people with dementia. The third floor was not being used at the time of our inspection.

The home had a registered manager but they were no longer in post at the time of the inspection and had not yet deregistered. There was a newly appointed manager who was registered with CQC at another home within the Caring Homes Health Care Group. They had submitted an application to CQC to register as the manager of Belmont House.

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’. 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.

We found the provider did not have effective systems to assess, review and manage risks to ensure the safety of people. For example staff were not using the right lancing device to test for blood sugar levels increasing the risks of cross infection. Suction machines were not prepared and set so these could be used in an emergency, to clear a person’s airway if they choked. These issues were addressed when we pointed them out but the provider’s own systems had not identified those issues.

People’s risk assessments and management plans were not always updated when their needs changed. Risk assessment for falls had not been updated after people had had falls. This meant people were not being adequately protected against further risks of falls. The provider had a strategy to manage falls but this was not disseminated within the home so staff were aware of this strategy to reduce the risks of falls. Staff did not fully understand how to operate the sensor mat that was linked to the call bell system so these could be used effectively, to help prevent falls.

The provider did not have suitable arrangements to protect people against the risks that can arise from the unsafe management of medicines. Among the concerns we found, we noted that the quantity of medicines were not always recorded when received into the home or carried forward to provide an audit trail about how medicines were managed. On a few occasions we could not correlate the amount of medicines in stock with what had been received and given; therefore we could not confirm people had received their medicines as prescribed. On at least three occasions on one day staff had signed the MAR sheet that medicines had been given to people but we found the medicines were still in their blister packs.

People had personal emergency evacuation plans (PEEP) in their care records but we found that these had not been reviewed when their needs had changed.

Staff recruitment procedures were not safe. Records did not show a current photograph of the staff member and none of the records we looked at had a current criminal record check. There was no evidence of any assessment of their suitability to work with people who used the service.

People were not supported as well as they could have been by staff who were knowledgeable in understanding their needs because they did not receive appropriate training and support. Records and feedback from staff showed that staff were not receiving regular supervision, particularly when they had all newly started working at the home.

The provider had not followed processes to ensure that any restrictions on people’s liberty were kept to a minimum and to demonstrate that where these restrictions needed to be in place that appropriate risk assessments were undertaken and best interests decisions were made. For example all the doors and lifts to other floors were locked and opened via a key pad system. The number to use to open the doors or lift were not displayed. All the doors to the garden and patio areas were alarmed. This meant that people who were able to could not move around the home freely.

People were not supported by caring staff, who respected their privacy and dignity. For example we heard of two incidents where staff did not respond to call bells at night in a timely manner and people were unable to receive the help they needed. We saw a person being assisted to the toilet in the main corridor and the actions of the staff did not help to maintain the person privacy and dignity.

The bedding we looked at in people’s rooms was of a poor quality and several people told us they were cold in bed. None of the bedrooms we looked at had secondary window coverings, i.e. net curtains or similar, even though the rooms overlooked private housing and other bedroom windows. This lack of secondary window coverings did not help to maintain a person’s privacy and dignity.

The provider had not ensured that people always receive care from staff of a gender of their choosing, even though this information had been recorded in their records.

Care plans had not been updated to take into account peoples changing needs. Staff said they had not received training on reviewing people’s care plans. There was no proper care planning and monitoring around pain management to help alleviate people’s pain.

The programme of activities the home hoped to offer had not started fully during our inspection. In the ground floor lounge the television was on for the majority of both days, the volume was not very loud which may have meant that people could see the screen but not hear the programme. We did not see any activities taking place on the first floor which is mainly for people with dementia. We however saw a party that staff had arranged to celebrate a special occasion for two people at the home.

The provider had a complaints policy and a procedure to respond to people's concerns and complaints. A number of complaints and concerns had been raised about the quality of the service since it opened in July 2016. We saw these had been acknowledged and were still being investigated by senior staff so they could respond appropriately to the complainants.

The provider did not have adequate quality assurance systems. They had expanded the home’s occupancy and did not have systems to check if people’s needs were being met and they were not effectively monitoring and taking action where areas for improvements were identified, to ensure the quality of the service was being sustained.

Food charts, fluid balance charts and turning charts were not completed properly to monitor people’s health. The provider was therefore not maintaining adequate records to show that people were being cared for appropriately. People were therefore not protected against the risks that can arise if appropriate records about their care are not maintained.

The provider had appropriate processes to manage abuse and staff were aware of the action to take if they see or hear about alleged abuse to safeguard people.

The provider had arrangements to support people with their healthcare needs. There was a GP who visited the home weekly and links to health care professionals within the community that staff contacted if they needed advice about how to care and treat people.

During the inspection we saw that people appeared well cared for. They presented well, with clean and appropriate clothes for the weather.

We found seven of breaches of the Health and Social Care act 2008 (Regulated Activities) Regulations 2014. These were in relation to person centred care, dignity and respect, need for consent, safe care and treatment, good governance, staffing and fit and proper persons employed.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.