Belle Rose Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Belle Rose Nursing Home was registered for 12 people. There were 10 people living in the home at the time of our inspection. People had a variety of care and support needs related to their physical and mental health.

This unannounced inspection took place on 24 February 2018. At our last inspection in October 2016 we identified a breach of regulation. This breach was in respect of the governance of the home. At this inspection we checked to see if the provider had made the improvements necessary to meet the requirements of the regulation. We found that they had made improvements to the quality of care people received in line with the findings of the CQC and quality monitoring carried out by the statutory agencies.

There was a registered manager for the service. 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 were happy with their care and they were confident in the registered manager and staff team. They told us the staff were kind and we saw staff were cheerful and treated people and visitors with respect and kindness throughout our inspection. People also told us they saw health care professionals when necessary and were supported to maintain their health by staff. People’s needs related to on going healthcare and health emergencies were met and recorded. People received their medicines as they were prescribed.

Staff were consistent in their knowledge of people’s care needs and spoke with confidence about the personalised support people needed to meet these needs. They were committed to supporting people to live their life the way they chose to within a homely environment. They told us they felt supported in their roles and had taken training that provided them with the necessary knowledge and skills. There was a plan in place to provide staff with refresher training. They told us there were enough staff and we saw that people received care and support when they needed it.

People felt safe. They were protected from harm because staff understood the risks people faced and how to reduce these risks. Measures to reduce risk reflected the person’s preferences. Staff knew how to identify and respond to abuse.

Where people had received end of life care in the home feedback from relatives was consistent in its acknowledgement of the kindness and compassion of the staff team in ensuring people’s wishes and needs were met.

People described the food as very good and there were systems in place to ensure people had enough to eat and drink. Where people changed their mind about what they wanted to eat they were offered alternatives.

People were engaged with activities that reflected their preferences, including individual and group activities both in the home and the local area.

Staff understood how people consented to the care they provided and encouraged people to make decisions about their lives. Care plans reflected that care was being delivered within the framework of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had been applied for when necessary.

There were systems in place to monitor and improve the oversight of the home. We found that recording around staff recruitment and training and support was not robust and we have made recommendations about this.

This inspection took place on 16 and 17 August 2016 and was unannounced. It was carried out by a single inspector.

Belle Rose Nursing Home provides accommodation, nursing care and support for up to 11 people with severe and enduring mental health conditions. Most people at the service had physical health needs alongside their mental health needs. The service is located in the centre of Dorchester and provides accommodation over two floors with a life to access the bedrooms on the first floor. People have access to communal living and dining areas and there is a garden to the rear of the property. Three of the rooms are en-suite and there are both bathing and wet room facilities available to people.

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 were supported to receive their medicines by staff who had received appropriate training, however pain medicine for one person was given later than prescribed and although medicines were stored securely, temperatures were not recorded to ensure these were within safe storage limits.

Staff, relatives and professionals told us that the environment at the home could be improved and we saw that décor was dated and in need of improvement. We did not see that this had a direct impact on people, but the environment could have been improved and would have provided people with more pleasant surroundings

People did not have access to sufficient opportunities for social interaction or occupation. Staff on shift took people out on an as and when basis, this was dependent on the number of staff on each shift and how people were feeling. Relatives and staff also felt that people needed increased opportunities for social stimulation and to be able to go out more often.

At the previous inspection, we had made recommendations that the service consider opportunities for people to be involved in activities and interactions which reduced isolation and promoted health and mental wellbeing. We also recommended the service consider how all members of staff could be enabled to work as a team and have appropriate opportunities to share best practice. At this inspection, neither of these recommended improvements had been made.

People and staff felt that the registered manager was approachable. Staff told us that they were not listened to and they were not encouraged or empowered to help to develop the service.

There were no clear methods of gathering or using feedback from people, staff, relatives and stakeholders and therefore none of these people had any regular input into the development or improvement of the service.

Quality assurance audits were completed regularly by the registered manager in a number of areas. However these audits were not providing a clear picture of trends or gaps in practice and did not reflect the evidence we saw.

People were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of how to whistleblow if they needed to and reported that they would be confident to do so.

People had individual risk assessments which identified risks to themselves and others and had clear actions to manage these risks. Some people had complex risks and staff were aware of what approach to use and their role in supporting people to manage risks.

There were enough staff available to support people and call bells were responded to quickly when people needed assistance. If people needed equipment, this was available and staff had received training and were confident in how to use this.

People were supported by staff who had the necessary training and skills to support them. Training was provided in

We used a number of different methods to help us understand the experiences of people. People who used the service had complex needs which meant they were not able to tell us their experiences in detail. We observed staff and how they interacted with people, reviewed care records and spoke with the provider and staff.

People’s views and experiences were taken into account. However we found the provider did not have suitable arrangements to ensure that people’s privacy and dignity was respected.

We saw that people’s needs were assessed and that care and treatment was delivered to meet their needs.

People were not cared for in a clean, hygienic environment and there were no effective systems in place to monitor and control the risk of health care associated infections.

The provider had effective systems to monitor pre-employment checks and recruitment procedures for staff.

The service had some systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others. However, the absence of an effective system to monitor infection control measures and home cleanliness had not ensured the home was clean.

We previously visited the home on 28 March 2012, when we found the home was not complying with regulations. We asked the provider to send us an action plan to show how they would become compliant, which we received on 7 June 2012. We undertook this visit to check how their actions had addressed these shortfalls identified in the last inspection report. We visited the home unannounced on 26 July 2012. We used a number of different methods to help us understand the experiences of people using the service. This was because the people that used the service had complex needs which meant they were not all able to tell us their experiences. One person who lived in the home told us that they were happy there and the staff were friendly. We observed staff were friendly and people responded well.

We visited the home unannounced on 28 March 2012. We used a number of different methods to help us understand the experiences of people using the service. This was because the people using the service had complex needs which meant they were not able to tell us their experiences.

We spoke with two people visiting relatives. Both considered Belle Rose provided a safe place for their relatives to live. One of the visitors said this was because staff knew people well and responded to events competently and calmly.

People moved freely around the home and garden, making use of personal and communal spaces as they chose. Staff accompanied some people individually into town and one person went out unaccompanied whenever they wished. People chose where they took meals and drinks.

We saw that staff preserved dignity and privacy when they helped a person with a care need that could have been distressing. A regular professional visitor to the home told us they saw people’s privacy and dignity upheld and had seen a person’s room reconfigured for that purpose.

We saw that the chef talked with people in the home, at meal times and over drinks. The chef told us it was important to know at first hand about people’s likes and dislikes, and to adjust the menu in response to their feedback.

Visitors told us they were kept informed of the wellbeing of their relatives. One person said their relative was supported to do “all sorts of things, in and outside the home”.

We saw that some people spent long periods with little staff engagement. All the staff we spoke with considered there was a need for people to be offered more opportunities for engagement or achievement during the day.

A person that visited the home frequently told us the manager was readily available within the home and was open to ideas and observations. The person told us the manager and other staff appeared to want to know if they were satisfied with the care they provided to their relative, and to address any observations they made.

We undertook an unannounced inspection of the service on 31 July with a second visit on 3 August 2015. At our last inspection of 7 August 2013, the service was not meeting all the regulations inspected. We found shortfalls in standards of respecting and involving people, cleanliness and infection control and in the assessment and monitoring of quality. We asked the provider to send us an action plan setting out how these would be addressed. At this inspection we found improvements had been made in these areas and standards were now being met. At this inspection we made recommendations for improvement in areas related to activities for people and the involvement of staff in how the service was run.

The service provides accommodation, nursing care and support for up to 12 people with severe and enduring mental health conditions. The home is not registered to accommodate people detained under the provisions of the Mental Health Act. People using the service experienced age related changes and most had physical health needs alongside their mental health needs.

Accommodation was over two floors with a lift, and an office area on the third floor. The home is situated within the town providing close access to community shops and facilities. Ten people lived in the home at the time of inspection aged from 60 upwards.

The service had a registered manager who was also the owner of the service. 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.

At the last inspection we found people’s dignity was not respected due to the lack of storage available for incontinence products. This had been addressed and we found people’s dignity was respected. Since the last inspection, improvements had been made to the premises to benefit people, such as refurbishment of rooms, storage arrangements, and through the appointment of a housekeeper which helped improve safety and cleanliness.

People were supported as appropriate to maintain their physical and mental health. The service enabled people to maintain their safety through the use of risk assessments which balanced keeping people safe with promoting their independence. These assessments identified any risks to a person’s safety and management plans were in place to address these risks. Staff were aware of signs and symptoms that a person’s mental health may be deteriorating and how this impacted on the risks associated with the person’s behaviour. Staff expressed a wish for greater team working, for example, to have opportunities to make suggestions or raise concerns. We made a recommendation about this. Safe medicines management processes were in place and people received their medicines as prescribed.

People had care plans outlining their care needs, including guidance about maintaining their health to enable staff to support them as they wished. Staff worked in combination with the community mental health teams and with other relevant health care professionals to ensure people received adequate support in relation to their physical and mental health. Any concerns about a person’s health were shared with the person’s care coordinator so they could receive additional support and treatment when required.

Individual support was provided through a key worker system. Staff spent time engaging people in conversations, and spoke to them politely and respectfully. Staff showed empathy for people and treated them with dignity and respect. People appeared calm and relaxed. Staff attended regular training courses which helped them to develop the skills and knowledge to meet people’s needs. Staff received supervision and had opportunities to obtain relevant qualifications.

Some people told us about their experience of the service and these comments were positive. People told us they felt settled in the home and that they felt safe. One person told us that the service was ‘unique’. Another person told us, ‘I feel very happy here.”

Two external professionals involved with people living in the home described how the service supported people with complex needs to participate in community life. Some people visited the town regularly and enjoyed trips out occasionally. There were sufficient staff to meet people’s needs however we recommended the service consider best practice in engaging older people with mental health needs in activities or therapies to promote wellbeing. This was particularly for people who chose not to go out or who could not go out unaccompanied.

People’s choices were respected, the service understood and protected people’s rights and the relevant safeguards had been put in place.

The registered manager undertook checks on the quality of service delivery and had developed an audit which described indicators for quality and safety relevant to this type of service. A range of policies and procedures had been developed to govern the way the service ran and to ensure people received the support they required.