Archived: Bellevue Court

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe living at the home. They told us that if they had concerns there were staff that they could speak to and they were confident their concerns would be dealt with.

The staff that we spoke to understood the procedures they needed to follow to ensure that people were safe. They were able to describe ways they provided care that ensured people were safe. We had seen that the manager took the correct steps if they were concerned that abuse had taken place.

We saw that the home was clean and well maintained. People we spoke with were happy with how their rooms and the environment was maintained.

We looked at audits the manager carried out and this showed us that checks were carried out on a regular basis to make sure the service was safe, for example equipment was well maintained and regularly serviced and all health and safety records were up to date. These checks meant that people were not placed at unnecessary risk.

We heard from people that there were enough staff on duty to meet people's needs throughout the day. People told us that this meant they received a level of support that kept them safe. One person told us that they became anxious at times and, 'I get a bit sharp, but staff don't respond back in this way, they help me calm down'. They told us that this kept them and other people safe.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We saw that some DoLS applications had been made and, staff were knowledgeable about what this meant and how it allowed them to promote people's safety with the minimum of restriction. The manager was well aware of when an application should be made and knew how to submit one.

Is the service effective?

People all had an individual care plan which set out their care needs. Some people recalled having been involved in the assessment of their health and care needs and had contributed to developing their care plan. We found there was sufficient information in people's records about risks to their health, for example people assessed at high risk of sore skin or with diabetes. Care plans also set out what equipment people needed and we saw this was made available for them. This meant that information was always available to staff to allow them to offer support consistently to meet people's needs.

People had access to a range of health care professionals some of which visited the home. People told us that staff contacted healthcare professionals for routine appointments or if they requested to them. People told us that their care and treatment was provided in a way they agreed with. This meant that people were sure that their individual care needs and wishes were known and planned for and that they had the appropriate support to ensure their individual needs were met.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people, and showed they were aware of people's preferences. People commented, saying staff 'Are pretty good' and 'They are approachable here, I have a keyworker as well'.

Staff were aware of people's preferences, interests, aspirations and diverse needs. Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

People were positive about food choices and the quality of the food they received. People told us, 'Foods good everything pretty high standard' and, 'The food is generally good'. We heard that there were a number of food options that catered for people with specific requirements, for example a vegetarian diet.

Is the service responsive?

We looked at how the service worked with other health care professionals to ensure people's health care needs were addressed. People told us that staff responded to their changing health needs to ensure appropriate health professionals were involved as and when needed. We spoke with a visiting health care professional and they told us that, 'Managers do as requested'. We found that care plans reflected advice from health professionals about people's changing needs. This meant that staff were aware of important information about people's changing needs.

We also heard from a social worker that the staff had responded quickly and appropriately when concerns were raised about a person's healthcare to improve the way this person's needs were met, thereby promoting their well-being.

Is the service well-led?

This report states that the registered manager is Mr Matthew Ronald Whitfield who was not managing regulatory activities at this location at the time of the inspection. Their name appears because they were still identified as a registered manager on our register at the time.

The provider had appointed a new manager who had recently commenced work at the home and was receiving support from another long standing manager who had worked with the provider for an extended period. This meant that the new manager had appropriate support and management was consistent during the changeover period.

The home had a system to assure the quality service they provided. The way the service was run had been regularly reviewed. Action had been taken to improve the service or put right any shortfalls they had found. For example the provider had strengthened the way it audited management of people's medication so that any errors were identified and put right.

Information from the analysis of key information about people's health care needs was reviewed on a regular basis so the manager was able to identify any particular risks to people. For example people were weighed on a regular basis and if there was any significant trends in respect of people's weight loss or gain this would be subject to closer scrutiny and monitoring, with health services involved as appropriate. Accidents and incidents were also monitored to identify changes and improvements to minimise the risk of them happening again.

People's personal care records, and other records kept in the home, were accurate and complete.

A pharmacist inspector from the Care Quality Commission visited the service. This was in order to look at medicine management to ensure it was safe following our inspection of October 2013. We spoke with people who use the service during the inspection but what they told us did not relate to issues related to medication management.

We spoke with the acting manager, the nurses on duty and looked at 10 people's medication records. We also looked at other records related to the safe administration and management of people's medication.

Despite some improvements with the homes management of medication we found that people were still not protected against the risks associated with medicines. This was because there were not appropriate arrangements in place to manage medicines.

A pharmacist inspector from the Care Quality Commission visited the service. This was in order to look at medicine management to ensure it was safe following our inspection of September 2013. We spoke with people but what they told us did not relate to this standard.

We were told by management that improvements had been made following our inspection in September 2013 to ensure medicines were managed safely. This included ensuring that the nursing team had undertaken further training in safe handling of medicines. We found that although there were some improvements particularly in relation to obtaining people's medicines we also found that some medicine records were incomplete and lacked information for staff to follow.

We found that specific areas of concern in the warning notice had been met; however there were still some areas of medicine management that required further improvement. We therefore informed the management team that appropriate arrangements were not always being undertaken in order to manage the risks associated with the unsafe use and management of medicines.

We spoke with eight people who lived at the home. We observed how care was provided to people, looked at seven people's care records and spoke with six staff and the manager.

Some people told us they were not asked for their consent in respect of medication and choices around daily routines. We saw that staff gained consent from people who did not verbally express their views through observation of their reactions.

People we spoke with expressed overall satisfaction with the care they received. One person said, 'The home is to be recommended, I would give it ten out of ten'. Staff we spoke with were aware of people's needs and we saw care provided in a way that promoted people's safety.

People told us they felt safe at the home. One person told us, 'I think the staff keep me safe'.

We inspected the home on 13 March 2013 and found that people were not protected against the risks associated with the unsafe management of medicines. We found that the required improvements had not been made at this inspection meaning that people were still at risk.

Staff training was monitored and staff reminded when updates were needed. Staff told us they felt they were well supported by the manager.

People's records did not always reflect what staff knew about their needs or the actual care that was provided to them.

People told us they felt able to express their views and felt involved in making decisions about their care. People we spoke with told us about choices that were able to make and we saw that staff offered people with dementia options at the point they were supporting them. One person said, 'I come and go as I please'.

People told us that they were satisfied with the support that they received. We saw that people had a good rapport with staff, and that they took time to sit and talk with people. We saw that staff responded promptly to people's needs. One person told us that, 'Staff look after us'.

We found that some electronic medicine administration records were not always accurate.

Electronic systems used had not always ensured that people had their medicines when needed.

We saw positive relationships between people and staff and one person told us, 'Staff are quite efficient'. Staff told us they were well supported by their managers so that they could deliver care safely and to an appropriate standard.

The provider had effective systems in place that identified, assessed, and managed risks to the health, safety and welfare of people who used the service and others.