Belvoir House

Belvoir House is a residential care home providing personal care to up to 39 people. The service provides support to older people and younger adults, some of whom live with dementia. At the time of our inspection there were 29 people using the service. The home is a converted period building with a large garden. People are accommodated over 2 floors in 2 wings known as Nightingale and Kingfisher, each of which have their own communal areas

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

Improvements had been made in the management of risks to people individually and from the environment. People were supported by enough staff who had been recruited safely. The cleanliness of the service had improved and risks relating to COVID-19, and other infections were assessed and managed. Any safeguarding concerns were identified and responded to appropriately. People received their medicines 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 practice. People's needs were considered holistically and nationally recognised tools to assess these were used. Improvements had been made to the training and support provided to staff. This meant people were supported by competent staff. People's meal time experience was improved, people were provided with enough food and drink that met their needs and preferences. People's health care needs were assessed and staff worked with external health professionals to help ensure these were met. The provider had started to undertake a refurbishment programme and improvements had been made to the physical environment.

People and relatives told us the care and support had improved significantly. People were supported by kind attentive staff, who encouraged their independence. People's privacy and dignity was respected and promoted. New systems were in place to ensure people and their relatives were able to express their views on the support they received.

People received person-centred care from staff who knew them well, including their individual needs, social histories, and interests. Care plans contained person-centred information about each person, including people's communication needs. Staff ensured people had the tools and equipment they needed to help them communicate effectively. People and relatives praised the activities now on offer, they were consulted on the activities being offered and this had helped ensure they met people's individual needs and interests. No complaints had been made since the previous inspection, the management team had been open, honest, and reflective in response to the concerns identified at the last inspection.

Changes had been made to the management of the service since the previous inspection. The new management team were responsive, effective, and committed to ensuring improvements to the quality of the service were made. People were supported by staff who understand their responsibilities. Everyone we spoke with told us the service had significantly improved. Relatives praised the homeliness of the service. The culture of the service had changed, staff morale was improved, and the atmosphere was pleasant and welcoming. People and their relatives benefited from a person-centred culture in which staff engaged and listened to them. The management team were open, approachable and supportive. Relationships with the local community had begun to be formed for the benefit of the people using the service. The management team had engaged effectively with other stakeholders who were supporting them to make improvements in the service

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

Rating at last inspection and update

The last rating for this service was inadequate (published 24 August 2022).

We imposed conditions on the providers registration after the last inspection. This meant the provider had to submit governance documents and assurances every month to CQC.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 25 July 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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.

Belvoir House is a residential care home providing personal care to up to 39 people. The service provides support to older people and younger adults, some of whom live with dementia. At the time of our inspection there were 39 people using the service.

The home is a converted period building with a large garden. It is separated into two areas entitled Nightingale and Kingfisher, each of which have their own communal areas.

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

The provider’s governance system had failed to promptly identify serious and widespread concerns at the service that had negatively impacted on the people who used it. Whilst at the time of the inspection, actions had been taken to start to address the concerns, they were still evident.

We saw that some people received care and support that was undignified and disrespectful. Care was often task orientated and not person-centred and we saw people becoming distressed whilst waiting for staff assistance.

The lack of robust recruitment processes, induction, probation, supervision and support had contributed to the poor culture within the service. Whilst staff told us this was improving, the impact had already been felt by the service.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the systems in the service did not support this practice and the service was failing to adhere to the Mental Capacity Act 2005.

Risks had not always been identified and promptly managed and there were sometimes delays in referrals being made to health professionals and the local authority safeguarding teams. People received their medicines as prescribed however improvements needed to be made to ensure medicines management fully met good practice.

People’s nutritional needs were met, and they were offered choice and enough to eat and drink however associated assessments had not always been completed in a timely manner. People had not been involved in care plan reviews and evaluations of care plans had not consistently and regularly taken place.

People told us the service had deteriorated under the previous manager who left the service in early June 2022. A new manager was in place who people told us they had confidence in to make the improvements required. Throughout this inspection, the provider demonstrated a commitment to make the changes needed and acknowledged the concerns found. They took prompt and robust action in response to the concerns identified.

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

Rating at last inspection and update

The last rating for this service was requires improvement (report published 02 October 2019). 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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, risk management, quality of care, infection prevention and control practices and staff training. A decision was made for us to inspect and examine those risks.

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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staff recruitment, person-centred care, consent, dignity and respect, safe care and treatment and governance at this inspection.

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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Brundall Care Home is a residential care home providing accommodation and personal care for up to 39 people. At the time of the inspection visit there were 37 people living in the home, the majority of whom were living with dementia. Accommodation is over two floors and the home has been divided into two areas called Nightingale and Kingfisher.

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

Risks to people’s safety had not always been assessed or managed appropriately which placed them at risk of avoidable harm, and the systems in place to protect people from the risk of abuse had not always been effective at doing this.

People’s consent had not always been sought in line with the relevant legislation and therefore, people had not been fully supported to have maximum choice and control over their lives.

The governance systems and leadership in place had not been fully effective at monitoring the quality of care people received and therefore, reducing risks to their safety. CQC had not been notified of important incidents as is required by law.

People received enough food and drink to meet their needs although the dining experience required improvement to ensure it was a pleasant experience for all. People received their oral medicines when they needed them but some improvements were required to the recording of prescribed creams.

Staff had received training in various subjects and received regular supervision however, this needed improving as we found a number of issues with staff practice during this inspection.

The staff were kind and caring when they interacted with people although the provider had not ensured the service had a consistently caring approach and this needed improving. There were enough staff to meet people’s needs but some of the required checks to ensure they were of good character before they started working at the service had not occurred.

People and relatives were happy with the care they received and told us this had improved under the new provider’s leadership and people had access to regular activities to provide them with stimulation.

The service had ensured that people and relatives were involved in the planning of care and had taken steps to ensure care was delivered to meet people’s individual needs and preferences. Some improvements are required with regards to the planning of people’s oral healthcare and we have made a recommendation in this area.

The home and equipment people used was clean and the environment had been adapted to meet the needs of the people living in the home. Any concerns or complaints raised had been listened to and acted on and people and relatives had been actively engaged in the running of the service and their opinion valued.

Staff ensured people were supported with their health needs and worked well with other professionals when required, this included when people reached the end of their life.

Rating at last inspection

Brundall Care Home was purchased by a new provider in 2018. Under the old provider, the home had been rated as Inadequate. This was the first inspection under the new provider’s ownership.

Why we inspected

This was a planned inspection based on the date the provider registered with us.

Enforcement

We identified five breaches of regulation at this inspection. This was in relation to the assessment and management of risks to people’s safety, the systems in place to protect people from the risk of abuse, obtaining consent in line with legislation, governance systems for monitoring and improving quality of care and notification of incidents to CQC.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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