Belmont House is a care home which is registered to provide accommodation and personal care for up to 52 people, who may have nursing needs or be living with dementia. On the day of our inspection there were 46 people living in the home.
There was a manager at the service who was registered with CQC. 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.
We last inspected Belmont House on 21 May 2013 and found that the service was meeting the requirements of the regulations we reviewed at that time.
The registered manager understood Deprivation of Liberty Safeguards (DoLS) and applied for authorisations as needed which we saw evidence of. The registered manager was in the process of making further applications. However, we found that the arrangements in place for obtaining consent for decisions did not always follow the principles of the Mental Capacity Act 2005 (MCA). For example, one
person was administered medicines covertly. Although the person’s GP had been consulted and deemed this to be safe, there was no evidence that a best interest meeting had taken place to demonstrate that decisions were being made in line with their best interests.
During our inspection we observed the number of staff on duty relative to people’s needs and looked at how quickly people were able to summon assistance. We saw that there were enough staff to keep people safe but that staff often did not have time to spend talking with or comforting people because they were so busy. For instance, a person who was anxious and shouting out was attended to by kind and understanding care staff but they could not spend time sitting with the person because there were too few of them to do this alongside their other duties. One person who used the service told us, “They could really do with more staff. Sometimes they are short staffed and it makes it really hard for staff. They can’t be everywhere.” Another person said, “The staff are excellent. I feel very safe here.”
The home was clean and tidy, however there was an unpleasant odour along the corridors in both the residential and nursing units. At times there was an overwhelming smell of air freshener or something similar which was intended to mask the odours but in fact made it worse. There had been some refurbishment in areas of the home but a number of areas were looking very tired.
Some people who used the service had been identified as being at risk from low nutrition. Their care plans stated that they must have their food and fluid intake recorded. We saw that on some days the food and fluid charts had not been fully completed. This meant people who used the service were not protected from the risk of inadequate nutrition and hydration. During the inspection we did not see any snacks and fresh fruit available. When the tea trolley was brought round in the morning and afternoon there was no offer of anything other than a drink. One member of staff told us people could have snacks whenever they wanted and we asked how people would know this but they were unable to tell us.
Prior to the inspection we contacted 11 healthcare professionals to ask them their opinions of the service. They all gave us positive feedback about the service. They told us people who used the service were well cared for by staff that were well trained and professional. Healthcare professionals told us they did not have any concerns regarding the care and support provided to people. One healthcare professional told us, “The staff are friendly and we have a good working relationship with them.”
From discussions with staff we found they were fully aware of how to raise any safeguarding issues and were confident the senior staff in the service would listen. One person said, “'The staff are excellent. I feel very safe here.”
We found the service had appropriate arrangements in place to manage medicines so people were protected from the risks associated with medicines.
The service employed an activities co-ordinator and we saw some activities take place. However, there were periods of time where there was a lack of stimulation for people.
Staff said the training they completed provided them with the skills and knowledge they needed to do their jobs. Care staff understood their role and what was expected of them. They were happy in their work, motivated and confident in the way the service was managed.
Staff said that communication in the home was good and they always felt able to make suggestions. There were meetings held for all staff every two months and additional meetings for groups of staff, for example, senior care workers and ancillary staff. Minutes of these meetings showed this was an opportunity to share ideas and make suggestions as well as being a forum to give information.
The service had a complaints policy and procedure. People and relatives told us they could talk with staff and managers if they had any complaints or concerns. One person said, “If I wasn’t happy about anything, I would tell the senior and if she didn’t sort it out, I would tell [the manager]. She [the manager] is very approachable and looks after everybody here.”
During our inspection, we found three breaches 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.