Belle Vue Care Home

Belle Vue Care Home (Belle Vue hereafter) is a residential care home providing personal and nursing care to up to 52 people. The service provides support to people with a range of needs, including people living with dementia. At the time of our inspection there were 49 people using the service. Belle Vue is situated in a residential area not far from Paignton sea front. Accommodation is situated over two floors of the building, with the top floor providing accommodation designed for people living with dementia. People had access to a variety of communal spaces including a safe outdoor space.

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

Risks were assessed and regularly reviewed, and people’s care plans contained detailed and personalised information to support staff to manage people’s risks safely. People at risk of pressure damage were monitored closely. People’s relatives told us risks were well managed and they were routinely updated with any changes. Routine maintenance checks ensured the environment and equipment were safely maintained. People received their medicines safely. Systems were in place to record, monitor and review accidents and incidents and managers and senior staff routinely discussed areas of risk; action was taken to mitigate risks escalating.

People’s relatives told us they felt confident their relative was safe at Belle Vue. One relative said, “I am completely confident they are being truly looked after.” Staff knew how to recognise signs of abuse or neglect, understood how to report them, and had completed safeguarding training. There were enough staff to meet people’s needs and recruitment processes ensured staff were recruited safely.

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.

People’s care plans contained detailed and person-centred information. This meant staff had all the information they needed to support people in accordance with both their health needs and their personal preferences. One person told us, “It’s paradise. I have bacon and eggs every day.” A relative told us, “Their care plan is personalised, and they know their needs.” And a staff member said, “We take a very person centred approach at Belle Vue.” People were supported to remain active and maintain important relationships. People’s relatives told us activity provision was good. One relative said, “There are very good activity staff, they do a lot of activities, it is a very good programme.” Another relative told us, “There are activities and stimulation, [relative] is involved, it has kept them going to be honest, it has enriched their quality of life.”

People’s relatives told us they were comfortable raising concerns. One relative said, “We had an issue with their clothes one day, it was dealt with straight away.” Another relative told us, “They responded well. I’ve mentioned things a few times and they responded really well and apologised.”

Systems were in place to monitor quality performance, risks and regulatory requirements. Governance systems included monthly governance reports which identified when internal auditing had identified areas for improvement. The regional manager monitored governance, made independent checks and conducted routine support visits. The registered manager felt well supported. Staff gave positive feedback about managers. One staff member said, “I have worked in care for 11 years and I have never come across a manager as kind-hearted and hardworking. They’re simply amazing.”

The culture of the home was person-centred, and people were supported to achieve good outcomes. People told us they felt well supported by staff and managers. One person said, “I can’t praise the place enough.” Another person told us, “The management are second to none, if I’m not happy about something here, I can go and say something, I’m not scared to say.” People’s relatives felt people were experiencing positive outcomes and told us they were invited to be involved in their relatives’ care, where appropriate.

Staff told us there was an open, inclusive culture at Belle Vue. One staff member said, “Even in my first few conversations with managers I was made to feel welcome and like I could speak freely.” Another staff member said, “I love working here, the atmosphere is happy and it’s a great place to work.” A third staff member told us, “The culture is very transparent, and the aim is clear, we provide the best person centred care and we all work together as a family to ensure this.” Belle Vue supported continuous learning and sought opportunities to improve care and the outcomes people experienced.

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 good (13 June 2019).

Why we inspected

We received concerns in relation to pressure area care, weight loss and record keeping. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. We found no evidence during this inspection that people were at risk of harm from these concerns.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained Good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Belle Vue Care Home on our website at www.cqc.org.uk.

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.

There were policies and procedures in place which provided staff with clear guidance about good infection control practices, including the management of Covid-19 and visiting arrangements during the pandemic.

The provider was facilitating visits for people living in the home in accordance with the current guidance. People did not raise any concerns with us about the visiting arrangements at the service.

At the time of the inspection due to a Covid-19 outbreak the provider had closed the home to non-essential visitors. Where people were receiving end of life care or required ongoing visiting to maintain their health and wellbeing, this was being supported in line with Government guidelines following the rules around essential care givers. Staff were supporting people to contact their relatives and friends through video calls, telephone calls and window visits.

Clear systems were in place for visitors to ensure they followed the current guidance on the use of personal protective equipment (PPE) and social distancing. Visitors to the service were asked to provide evidence of a negative Covid-19 test, wear PPE, have their temperature checked and complete a screening checklist.

Staff had received training in infection prevention and control and the use of PPE including undertaking aerosol generating procedures. There were sufficient stocks available, and staff were seen to be wearing PPE appropriately.

People and staff took place in regular Covid-19 testing in line with current government guidelines.

Vaccination records were monitored and stored by the registered manager for people, staff and regular visitors. Where visiting professionals attended the service, their vaccination status was checked.

Cleaning schedules and procedures had been enhanced to include more frequent cleaning of touch points such as handrails and light switches.

The management team had been open and transparent and worked closely with the Local Authority and infection prevention and control teams throughout Covid-19 outbreaks at the service.

All practice and procedures had been reviewed, updated and where necessary, changed in line with the latest guidance.

People’s experience of using this service: The managers and staff demonstrated a commitment to providing person centred, high-quality care. The management told us they aspired to deliver outstanding care and support to their residents and provide a specialised inclusive dementia community for the people of Torbay.

People and their relatives were complimentary about the care they received. People told us staff had an excellent understanding of their individual needs which resulted in them receiving personalised care. People said staff knew what their preferences were and how they liked to be supported. The dedication and team working at Belle Vue had a positive impact on people’s health, wellbeing and quality of life.

We observed staff were very gentle, caring and treated people with compassion and kindness. People's privacy and dignity was respected and promoted, and people were supported to maintain their independence. This provided them with a sense of purpose and wellbeing.

The managers and staff were passionate about ensuring people and their loved ones experienced positive end of life care that was delivered with tenderness, sensitivity and effective communication between staff, the person and their family.

People told us they felt safe living at Belle Vue. Staff had a good understanding of how to safeguard adults from abuse. Safeguarding training had been provided and refreshed in line with the providers policy to ensure knowledge remained up to date.

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 home supported this practice.

People's needs, and choices were assessed and their care and support delivered to achieve effective outcomes. Care plans provided staff with information and guidance about how to meet people's needs in the way they preferred. Risk assessments covered areas such as, moving and handling, falls, nutrition and hydration. Not all care plans and risk assessments were as detailed as they could be or contained information about how risks to people were being mitigated. We made recommendations to the provider about this.

There were sufficient staff to meet people's needs in a timely manner and ensure that care was person centred. The provider completed relevant pre-employment checks to ensure staff were safe to work with older people. The manager analysed staffing needs to ensure staff had the right mix of skills to meet people's needs safely.

Staff received training suitable to meet the needs of the people they were supporting and received regular supervision. Staff told us they felt supported in their roles.

People told us they knew what to do if they had any concerns or complaints about the home and the management team had resolved them. The home used learning from complaints to improve future practice.

People told us they thought the home was well led. People and their relatives were very complimentary about the management team and told us they knew them well. One person told us, “The managers know everything about me which makes me feel good.”

The provider had an effective system of governance in place to monitor and improve the quality and safety of the service. Feedback was regularly obtained from those who lived at the home and their relatives. Regular team meetings had been conducted and staff members felt able to approach the managers with any concerns, should they need to do so.

Rating at last inspection: On 20 March 2018 (report published 25 May 2018), the service was rated ‘Requires Improvement’ because the service was not always safe, responsive or well-led. At this inspection, we found these issues were addressed and the rating for the service has now improved to ‘Good’.

Why we inspected: This was a planned inspection based on the rating of the last inspection.

Follow up: We will continue to monitor the service to ensure it meets its regulatory requirements.

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

Belle Vue 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 accommodates 49 people in one adapted building, over two floors and is split in to a ground floor nursing unit and first floor dementia care unit. At the time of our inspection there were 32 people living at the home. The home supported older people, some with physical disabilities and long term medical conditions. Some people at the home were living with dementia.

There was no registered manager in post at the time of the inspection. We were supported on the first two days of the inspection by the interim manager and the newly recruited manager on the last two days of the inspection. 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.

People told us they felt safe living at Belle Vue. One person said, “I certainly feel as though I am safe here.” However, we did not find that all of the provider’s processes ensured people’s safety.

The provider's recruitment processes were not fully effective and some pre-employment checks were incomplete.

Some risks to people's safety and well-being were assessed and care plans guided staff on how to meet people's care needs and manage risks. However, risk assessments were not always in place to support staff to understand and support people with their health. Where risks had been identified, records did not always show that care had been delivered as it should. Records did not always demonstrate staff were maintaining effective oversight of some people's fluid intake to manage their risk of dehydration. People were not always being protected from the risk of malnutrition.

Since the provider took over the home in November 2017 they had been working hard to improve standards of care quality for people living at Belle Vue. They recognised they were still in the early stages of improving the quality of care were implementing improved care planning, monitoring and auditing processes. There were systems in place to monitor the quality of the service but these were not effective in identifying all areas where improvements were needed.

We received mixed views from people, relatives and staff about whether there were sufficient numbers of staff deployed at Belle Vue. Some people told us they had to wait for care as staff were busy with other people. Staff told us they felt that some days were busier than others and an extra member of staff would be beneficial. They were aware people were having to wait for support, especially at mealtimes. We observed there were enough staff on the ground floor to meet people's needs. However, on the first floor dementia unit, we observed that some people had to wait for staff to help them. We made a recommendation that the provider reviews staffing levels within the home to ensure they meet the needs of the people.

People told us they would benefit from more activities at the home. One person commented, “There’s not much to do here.” Another said, “In some ways it’s absolutely wonderful, all of the attention we get, but there is nothing going on in the afternoons. You need something to stimulate you.” the home had a programme of activities and the management were looking at how they could enhance the provision of activities available to people.

People's medicines were managed and administered safely. There were suitable arrangements for ordering, receiving, storing and disposal of medicines. Where people had been prescribed medicines covertly (without their knowledge), staff had followed the correct procedures and consulted the pharmacy about the safest way to give the medicines. However, this had not always been documented. We made a recommendation about recording advice and discussions with regards to medicines in people’s care records.

People told us they had enough to eat and drink. People were given choices of what to eat and staff checked with people if they had had enough to eat and drink. People's healthcare was monitored and health professionals involved where necessary.

People and their representatives were involved in the assessment and development of their care plans. Care plans identified people’s needs and outlined how these needs would be met. However, care plans did not always include sufficient information about people's preferences to ensure they received person centred care at all times.

People were protected because staff understood their roles in safeguarding people from abuse. Staff had received training in safeguarding adults and information on how to raise safeguarding concerns was available. Staff received training specific to the needs of the people they supported. They told us they felt well supported in their role. Staff received regular one to one supervisions and appraisals with their manager where they could discuss their performance and their skills development.

People were treated with kindness and compassion and staff talked with them in a courteous and respectful manner. People knew the staff that supported them and it was clear from our observations that people, staff and relatives had formed positive relationships, resulting in a friendly and happy atmosphere within the home. People's rights to privacy and dignity were respected and they were supported to maintain relationships with people that were important to them.

People's legal rights were protected because staff followed the guidance of the MCA. Mental capacity assessments were used to assess people's ability to make specific decisions. Where people were unable to make decisions, best interest decisions were documented.

The provider ensured the safety of the premises. Regular checks were carried out on the health and safety of the building and maintenance works were actioned where improvements were identified. The environment at the home was clean and well maintained. People were protected from the spread of infection. The provider had plans in place for in the event of a fire and equipment in place to support staff. Staff were trained in fire safety and regular drills were conducted.