Bell House Care Home Limited, Meltham, Huddersfield.Bell House Care Home Limited in Meltham, Huddersfield is a Residential home specialising in the provision of services relating to accommodation for persons who require nursing or personal care and caring for adults over 65 yrs. The last inspection date here was 15th March 2019 Contact Details:
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14th February 2019 - During a routine inspection
About the service: Bell House is a residential care home that was providing personal and nursing care to 24 people aged 65 and over. At the time of the inspection there were 15 people living at the home. People’s experience of using this service: At our last inspection we were concerned there were not enough staff to care for the needs of the people living there at the time. At this inspection we found there were enough staff and there was an improved system for assessing people’s needs before they came to live at the home. This ensured the provider could meet those needs within the staff complement. The provider advised they would keep staffing levels under review as the number of people living there increased. Staff understood how to manage any risks to people and knew the processes to follow to manage any allegations of abuse. People’s health care needs were well managed, and they received their medicines when they needed them. Staff had been recruited safely to ensure they were appropriate to work with people at the home. We found the service was clean and tidy which helps to protect people from the risk of infection. People were supported by staff who received appropriate training and support to carry out their roles and responsibilities. Staff felt supported by the management team. People received adequate food and drink which supported a healthy and balanced diet. Some aspects of the dining experience could be improved through better deployment of staff. People's likes and dislikes were accommodated within menu planning. The provider ensured that people were referred to healthcare professionals as required. 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 were able to make choices and were involved in decisions about their care. Staff asked people for consent before providing care. At our last inspection, we found care records lacked essential information to guide staff to care for people. We found improvements had been made and were ongoing. Care plans were person centred and reflected people's current needs and preferences. People and their relatives gave mixed feedback about the range of activities which took place in the home. This ranged from concern about the lack of activities throughout the day, to people being content with what was on offer. By our second day of inspection, the nominated individual confirmed they had appointed an activities coordinator to develop this area of care. A complaints procedure was displayed. People and relatives knew how to raise concerns and those we spoke with during our inspection were confident these would be dealt with appropriately. The provider had introduced the post of deputy manager at the home. This role freed up the registered manager’s time to undertake management tasks. The deputy manager supported staff to develop and had taken responsibility for the development of staff. The provider and managers were committed to continuing to make improvements at the service to improve the lives of the people who lived there. There had been an improvement in audits which meant they were now identifying where improvements were required. The provider was seeking advice and guidance to ensure they provided a service which followed current best practice to ensure they met the regulations. For more details, please see the full report which is on the CQC website at www.cqc.org.uk. Rating at last inspection: Requires improvement (report published 24 August 2018) Why we inspected: to check the service had made the improvements required following on from the last inspection 7 June 2018. Follow up: We will continue to monitor the service to ensure that people received safe, high quality care.
7th June 2018 - During a routine inspection
The inspection took place on 7 June 2018 and was or unannounced. The service had previously been inspected on 25 January 2017 and was in breach of the regulation in safe care and treatment. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the service to at least good. This inspection showed insufficient improvement had been made and this is the third consecutive time the service has been rated Requires Improvement. Bell House 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. The care home accommodates 24 people in one building. There were 15 people living there permanently at the time of the inspection and a further four were staying there on a temporary basis. There was no registered manager in place. The previous registered manager had left the service in June 2017 and a new manager had been appointed in November 2017 and had applied to register. 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. Medicines management was safe and we observed medicines were administered appropriately during our inspection. Risk assessment and risk management plans had been an issue at our last inspection. We found in some areas this had improved, but at this inspection, we found some areas of risk had not been considered. This put people at risk as it meant staff had not minimised harm to the person. People living at the home and some of their relatives told us there were times when staffing levels were insufficient. This meant people did not always get an immediate response when they asked for support. Staff told us certain times of the day were busy and they acknowledged a recent increase in new people at the home had affected the time they had to support people. We found all the areas of the home we inspected were clean which ensured the risk of infection was minimised. The registered provider continued to upgrade the environment internally, with new carpets, doors and decoration of the home. We found some decision specific capacity assessments had been carried out for people, which were compliant with the Mental Capacity Act 2005 (MCA). However, not everyone who needed a capacity assessment had this in place and not all best interest meetings had taken place to ensure the home was meeting the requirement of the MCA Code of Practice. People had been referred to other health professionals when the need arose and we saw this had positively affected people’s wellbeing. We received positive feedback about the service from a visiting health professional. However, we also found occasions when professional advice had not been sought promptly. We observed staff were very kind and caring when they were supporting people with care. People at the home and their relatives told us how kind and helpful some members of staff were and how they treated people with dignity and respect. However, following the inspection we were advised of a situation where people had not been supported with dignity. Some records contained person centred information detailing people’s life histories, preferences and choices. However, other records lacked detail and were incomplete in this area. We found care plans did not always evidence people’s current care needs. We found there had been a lack of strong leadership at the home. Not every area of care had been audited in enough detail to determine the quality of the service provided. Where audits had been completed and actions identified, it was not alway
25th January 2017 - During a routine inspection
This inspection took place on 25 January 2017. The service had been inspected in June 2016 and had been in breach of several of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At our previous inspection we had concerns about how risks to people living at the home were managed and the lack of robust governance arrangements. Staff had not received appropriate induction, supervision and training and they had not had their competence checked to demonstrate they could put this learning into practice. At this inspection we checked to see whether improvements had been made and sustained. Bell House is registered to provide personal care and accommodation for up to 24 older people. The accommodation is single storey and all bedrooms are single rooms some with en-suite toilet facilities. There were 22 people living at the service at the time of our inspection. There was a registered manager in post who had been in post since 2014. 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 found the registered provider had initiated many improvements at the service. This included the regular supervision of staff, and an improvement in training and competency checks particularly around moving and handling and medication administration. The environment had been further enhanced and a programme of refurbishment was on-going. The registered manager and registered provider undertook regular audits at the home, and these had improved from our last inspection, although we still found some of these audits lacked robustness as they had not picked up isolated issues we found when reviewing care plans, which had the potential to cause harm, such as one fall had not been analysed to ensure risk reduction measures could be implemented, and one person had not been assessed for suitable shower equipment. Record keeping and the detail in people’s care plan on the whole had improved and reflected people’s care needs. Staff were more accurately recording when care had been provided. Staff had received training in how to keep people safe. All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any safeguarding incidents. The home had a training programme in place to ensure staff had the knowledge and skills to perform in their role and this included specific areas of learning such as oral health. Staff had received practical moving and handling training and had their competencies checked. There had been occasions when staffing numbers were not in line with the registered provider’s assessment of staffing levels derived from the dependency tool in use. The home was actively trying to recruit more staff but was struggling to recruit staff with the required values and behaviours. Standardised risk assessments had been undertaken for those people at risk of malnutrition and pressure sores. The home completed risk assessments when other risks such as choking, medication, fire and falls had been identified. Moving and handling risk assessments and care plans had improved from the previous inspection although further improvements were needed in the amount of detail required to guide staff. We reviewed accidents and incidents at the home and noted the analysis of accidents and incidents had improved since the last inspection and there had been management overview to determine the root cause of accidents and some measures put in place to prevent further accidents. However, we found one accident where staff had completed the form but not passed it to the manager to ensure all preventative measures had been considered or recorded. Medicines were
31st May 2016 - During a routine inspection
This inspection took place on 31 May 2016 and 2 June 2016. The service had been inspected on 11 May 2015 and met the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. The Care Quality Commission is notified when there has been a death at a service. We had been notified there had been two unexpected deaths at Bell House and as a result we undertook this inspection to ensure the people who lived at Bell House were safe and received a service that met their health and social care needs. Bell House is registered to provide personal care and accommodation for up to 24 older people. The accommodation is single storey and all bedrooms are single rooms some with en-suite toilet facilities. There were 22 people living at the service at the time of our inspection. There was a registered manager in post who had been in post since 2014. 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. Staff had received training in how to keep people safe. All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any safeguarding incidents. The service was using risk assessments for nutrition and pressure care management and had put risk reduction plans in place for these risks, but we could not find evidence in the files we looked at that all risks had been identified and reduced. The assessment of risk in the home’s risk index did not correlate with the associated care plan to ensure risks were well managed. The moving and handling risk assessment and care plans lacked detail and the falls risk assessment did not accurately identify a person’s risks and measures were not put in place to reduce the likelihood of falls in line with national good practice. We found the analysis of accidents and incidents was poor as the information collated lacked description and the management overview to determine the root cause of accidents and their analysis was minimal and inaccurate. The lack of detailed analysis of accidents and the lack of detailed risk assessment to manage all the risks for the people who lived there demonstrated a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found medicines were stored and administered safely and we observed medicines being administered safely and professionally at the home. We found the environment was in the process of refurbishment and to a high standard in most areas. However, the corridors leading to the bedrooms were narrow and not ideal for wheelchair users and the communal lounge lacked space to manoeuvre. The home was extremely clean with good infection control practices in place. They had recently been inspected by the Infection Control Team and had attained a high score. Staff had received training to ensure they had the knowledge and skills to perform in their role in some areas, and the service encouraged staff to enrol in national care qualifications. However, the service could not evidence staff had received practical moving and handling training or had their competencies checked. Staff supervision was not up to date and the service was not meeting its own policies in relation to the frequency of supervision. This breached Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as there was a lack of evidence to demonstrate staff had the training, competency and supervision to provide safe care and treatment. The service was meeting its legal requirements under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards. Staff had received on line training in this area, but we found they lacked under
11th May 2015 - During a routine inspection
We inspected the service on 11 May 2015. The visit was unannounced. Our last inspection took place on 17 October 2014 and we found the service was not meeting the regulations relating to consent to care and treatment, care and welfare of people who used services, safeguarding people who used services from abuse and assessing and monitoring the quality of service provision and records. We asked them to make improvements. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations. On this visit we checked and found improvements had been made in all of the required areas.
The Bell House is registered to provide personal care and accommodation for up to 24 older people. The accommodation is single storey and all bedrooms are single rooms.
There was a manager in post; however, this person was not registered. 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 received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines. Medicines were administered to people by trained staff.
People received sufficient amounts to eat and drink. We found the dining experience for people who used the service was pleasant.
Robust recruitment processes were in place which ensured staff were suitable to work with vulnerable adults. Staff received regular supervision and annual appraisals. This gave staff the opportunity to discuss their training needs and requirements.
During our visit we saw people looked well cared for. We observed staff speaking in a caring and respectful manner to people who lived in the home. We observed interactions between staff and people living in the home and staff were respectful to people when they were supporting them. Staff knew how to respect people’s privacy and dignity. Staff demonstrated they knew people’s individual characters, likes and dislikes and had good relationships with the people living at the home and the atmosphere was happy and relaxed. Care plans were person centred and individually tailored to meet people’s needs.
We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS). Staff were clear when people had the mental capacity to make their own decisions, this would be respected. Staff told us they had received Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA) training.
Staff demonstrated a good understanding of how to protect vulnerable adults. They told us they had attended safeguarding training and were aware of the policies in place regarding reporting concerns.
People who used the service and their relatives had opportunity to give their views and opinions on the service provision. There were regular resident and relative meetings and satisfaction surveys were also distributed to people who used the service on an annual basis.
People’s health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made.
The management team investigated and responded to people’s complaints, according to the provider’s complaints procedure. People we spoke with did not raise any complaints or concerns about living at the home. There were effective systems in place to monitor and improve the quality of the service provided.
26th September 2013 - During an inspection to make sure that the improvements required had been made
As part of this inspection we also received information that staff had not attended movement and handling training on the use of hoists and hoisting equipment. These issues were included as part of this review. We spoke with two staff, including the manager and one person who used the service. We observed and heard the staff speaking with people in a respectful manner. Staff had received up to date movement and handling training on the use of hoists and hoisting equipment.
Arrangements were in place to ensure that repairs and the maintenance of the premises were carried out in a timely manner. We found the care records were up to date and people were receiving their care as planned. We also saw the care records were kept securely and could be located promptly when needed in line with the Data Protection Act 1998.
26th June 2013 - During a routine inspection
At the time of our visit there were 11 people living in the home; we talked with four people who used the service, one relative and four staff, including the provider of the service. People told us that they enjoyed living at the home and we saw evidence in the documentation we looked at that people were involved in making choices and decisions about their care. We saw information in the care records that people had access to health care professionals and this included doctors, district nurses and chiropodists. This shows that people’s health care needs were being met. Most of the staff were observed to speak with people in a respectful manner however; some staff did not. A compliance action has been made and the provider has been asked for evidence as to how they intend to address this. There were enough qualified, skilled and experienced staff to meet people’s needs. Arrangements were not in place to ensure the decorative condition and maintenance of the home were carried out in a timely manner.
We found the records were kept securely and could be located promptly when needed in line with the Data Protection Act 1998. However, we also found that one of the four care plans inspected was not up-to-date. A compliance action has been made.
24th October 2012 - During an inspection to make sure that the improvements required had been made
We carried out this inspection to check on the progress of the compliance actions we made on the 6th July 2012. However, we also received an anonymous concern in relation to staffing levels and this included not having sufficient staff on duty at the evening meal time. Therefore we included a review of the staffing as part of this visit. On the day of our inspection we spoke with five people who used the service and a visitor. People told us they were happy living at the home and they were looked after by staff. One person told us that staff were always available if they needed support. A visitor told us staff were usually available if they needed to speak to anyone; the staffing levels had improved and this included the use of more experienced staff.
6th July 2012 - During an inspection in response to concerns
We carried out this review because we received information form the local authority safeguarding team of an alert they had received. The information included, concerns in relation to the care people receive and their care plans not being up to date, insufficient food, the management of medicines, and the cleanliness of the environment. All of these issues were included for review as part of this visit. Many of the people who use this service were living with dementia which meant they were not all able to tell us their views and experiences. Therefore to help us to further understand people’s experiences, we looked at care documentation, observed practice and spoke with a visiting relative who told us they were happy with the care provided by the home. People told us they liked living at the home, the staff were kind and they were looked after. People told us that they were always offered a choice of what to eat, the food was nice and there was always plenty to eat. No-one raised any concerns with us during our visit. The people we spoke with said if they were not happy they would tell the staff.
23rd April 2012 - During an inspection to make sure that the improvements required had been made
A relative told us that the staff were very good and always showed a lot of respect for their relative. People told us they were happy living at the home. One person said, “The staff are all lovely, we are well looked after”. A relative told us that they visit the home several times a week and were complimentary about the care their relative was receiving. They said that the staff were lovely. The person also said that the food was good, and that the activities had improved. One relative said that their relative initially came to the home for respite care and as their relative had settled in so well, they decided to make the stay permanent. Relatives spoken with said that the staff were friendly, and the activities were improving. People said, “It’s free and easy, nice really. You can do what you like. I choose to read or go for a walk as this is what I like doing “. A relative said that their relatives’ room was, “Really pretty”. They said they were, “Really happy with the home and it is always clean”. Another person said that the environment was improving. We spoke with relatives who told us they visited the service regularly, and there was always plenty of staff about. People who use the service also told us that staff were always about to look after them and they felt safe. The provider confirmed that the manager, who recently joined the company, is in the process of completing her probationary period before she applies to be registered with the CQC. However, we would expect to receive her application to be the registered manager within the next three months. Where the service provider is not a partnership the manager needs to be registered with the Commission to comply with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, Regulation 5.
28th February 2012 - During an inspection to make sure that the improvements required had been made
Staff were observed to be providing support to people in a relaxed and unhurried way. They spent time talking to people and were available if they needed assistance. Visitors said that the situation with regards to staffing had improved and especially now the provider was working in the home. They said they visit regularly throughout the week and had seen some positive changes. People said they were well cared for and that since the provider had come to work at the home, “She made sure of that”.
6th February 2012 - During an inspection in response to concerns
We inspected this service because we received information form the local safeguarding team of an alert they had received. The concerns raised were that the service was without a manager, that there were insufficient numbers of staff on duty and as a result people were not being bathed and looked after properly. We were also told that the provider had removed people’s personal monies which had been given to the home for safe keeping, from the premises We spoke to people about the care they receive, particularly about when they last had a bath. Most people said they couldn't remember. We were unable to determine from speaking to people whether they had had a bath because of memory problems People we spoke with said staff were kind and helpful. One person said the home could do with more staff. We visited the service on 3 occasions to check that the home was being managed properly and that there were enough staff on duty. We carried out these visits on 30 January 2012; and the 1 and 6 February 2012.
18th January 2012 - During an inspection to make sure that the improvements required had been made
People we spoke to said that staff were kind and thoughtful. They said they were happy living at The bell House.
26th September 2011 - During an inspection to make sure that the improvements required had been made
We spoke with people who live at Bell House about staffing levels particularly during the afternoon and evening. Most people told us that although there were fewer staff available during this time, they didn’t have to wait to long to be attended to. One person said that they thought there should be more staff on duty and they sometimes had to wait for a bath or have it postponed if staff were too busy.
6th July 2011 - During a routine inspection
We talked to people who live at The Bell House about the care and support they receive. They told us that staff were kind and courteous towards them although some people said that there was sometimes a shortage of staff particularly during the afternoon. One person said that staff had talked to them about the care they needed; about what time they wanted to get up and where they wanted to eat their meals. Another person told us that they had been involved in their care plan and they could spend their day as they choose to. People said that the meals provided were good and they felt if they had any concerns they could talk to staff about them. One person said ‘I feel listened to when we raise concerns’.
1st January 1970 - During an inspection to make sure that the improvements required had been made
The inspection was carried out over two days by two adult social care inspectors. During the inspection we followed up on two warning notices for outcomes 4 (care and welfare) and 16 (assessing and monitoring the quality of service provision) and four compliance actions for outcomes 8 (cleanliness and infection control), 9 (management of medicines), 13 (staffing) and 14 (supporting workers) which were given following our last inspection in June 2014 . The provider had sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked and found some improvements had been made. We spoke to the home manager who told us they had been in post since 1 September 2014. We were introduced to the 'head of care' who said it was their first day of employment at the home. During the inspection we spoke with four people who lived at the home. Not all of the people we spoke with were able, due to complex care needs, to tell us about their experience of living at the home. The inspectors also looked around the premises, observed staff interactions with people and looked at records. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five key questions we always ask; • Is the service safe? • Is the service effective? • Is the service caring? • Is the service responsive? • Is the service well led? This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report. Is the service safe? The service is not safe. On the previous inspection we raised concerns with the provider about some of the windows in both communal areas of the home and peoples bedrooms not having restrictors in place. On this inspection we saw the provider had put some restrictors in place however, some windows still did not have restrictors in place. This meant people were not safe. We received an action plan telling us actions would be taken to ensure safe management of medicines within the home. For example, the provider told us they would be carrying out weekly and monthly audits of 'as required' medicines. We found weekly audits were being carried out. The manager showed us evidence of both weekly and monthly audits being carried out and also 'spot checks' they had conducted on a weekly basis. This meant the home had safe systems in place regarding medicines. We saw people living at the home were unsupervised by staff for periods of time. This was despite most people sitting in the main lounge of the home. We also saw there were people sitting in the lounge area of the home who did not have a call bell to use to summon assistance. Is the service effective? The service was not effective. The home did not promote a good quality of life for the people that lived there. We saw audits had been carried out but we were unable to see evidence of how the required actions identified had been followed up. We also saw one of the quality audits completed by the manager did not include evidence to show how their findings had been reached. For example, we saw ‘Respect client’s right to privacy’ was ticked as met. We had discussed the full length glass panelled doors on people’s bedrooms with the manager and how this impacted on people’s privacy. The manager agreed that these needed replacing. We saw this had not been reflected in the audit. This showed that quality audits in place at the home were not effective. We looked at two people’s care records and saw there were gaps in assessments which impacted on how care was delivered to the person concerned. For example, in one person’s dependency assessment we saw it did not identify how many staff were required to support the person. We also saw some care plans lacked detail which meant people were at risk of receiving care that was not personalised. For example, in one person’s care plan for hygiene we saw there was no detail regarding the person’s preference of a bath or shower, or the toiletries they liked to use. We saw the home had not obtained consent from a person who had bed rails in place. We also saw an assessment of the person's mental capacity had not been carried out. This showed the home did not follow guidance under the Mental Capacity Act 2005. Is the service caring? The service was not caring. We looked at the care records of a person who had received palliative care at the home. We saw documentation in the person’s daily records, handover sheets and the communication book in place at the home which identified the person was, at times, in a lot of pain. We looked at the person’s medication administration record (MAR) and saw the person had not received appropriate pain relief as prescribed by their GP. The provider and the manager told us they were not aware of the person being in pain. We also saw another person had continued to lose weight and the home had not taken action to prevent further weight loss. Is the service responsive? The service was not responsive. People who needed additional support with their healthcare needs from external professionals did not always receive their support in a timely manner. For example, we saw a member of staff who was new to the home had reviewed the care records of one person. They told us they did not know the person and had not been involved in the persons care. We saw the person had lost weight in the last two weeks and in their care plan the new staff member had written “No changes at present, review monthly”. This meant the issue of weight loss had not been identified and therefore the person was at risk of further weight loss. Is the service well-led? The service was not well led. People were not protected against the risks of inappropriate or unsafe care because the provider did not have effective systems to assess and monitor the quality of the service people received. The leadership and management at the home did not assure the delivery of high quality, person centred care. We have asked the provider to make improvements. The provider had told us through their action plan that they would be reviewing and updating all of their policies. However, we saw this had not been done. We found photocopied policies from another service owned by the provider had been put into the policy file. This showed the provider had failed to review and update the policies. This meant the policies in place at the home were not appropriate to the service. We spoke with staff following our inspection and they told us they did not feel supported by the provider. They also told us that following our last inspection the provider had not put system in place to ensure staff were able to access support and discuss their concerns without being worried about losing their job. Staff told us the provider often said “If you don’t like the way things are you know where the door is”. They also told us their views were not always taken into consideration. This suggested the home did not promote an open and fair culture.
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