About the service:

Belmont House is a care home that provides accommodation and personal or nursing care for up to 52 people. At the time of this inspection there were 42 people using the service.

People’s experience of using this service:

• Belmont House had sustained compliance with the regulations since the last inspection but aspects of the service had deteriorated. A new manager had recently started working at the service. They were responsive to inspection feedback and understood further improvements to the service were required;

• People told us staff were kind and caring. They were positive about how they were treated by staff. People told us they were in control of their day to day routines and staff supported them to remain independent. Staff asked people for consent before providing care, however improvements were required in how the service recorded assessments of people’s capacity to make decisions and best interest decisions made on their behalf;

• People felt safe whilst residing at Belmont House. They had access to other community health professionals as required. Staff supported them safely with their medicines;

• Most staff could tell us about people’s likes and dislikes and knew information about people’s backgrounds. They used this knowledge to care for people in the way they wanted. However, information about people’s preferred priorities for care at the end stages of their lifer was not recorded in detail in people’s care records, which meant their wishes or preferences were at risk of not being followed or respected;

• Refurbishment and redecoration was ongoing at the service. Clear signage was available to orientate people to key places in the service. However, further improvements were required to make the service dementia friendly;

• Staff received a range of training and people thought staff had the right skills and experience to care for them effectively.;

• People were positive about the quality of the food. People were provided with a range of food options that met their nutritional requirements;

• Risks to people receiving care at Belmont House were assessed and kept under review. People’s needs were assessed and support plans were developed to guide staff in how to care for each person.

• People and their relatives gave mixed feedback about the range of activities which took place both in the home and in the community. We have made a recommendation about the provision of activities at the service;

• People who used the service and their relatives told us they had confidence in the management team and they could raise any concerns, which would be responded to. They also had the opportunity to attend regular meetings about the service to provide feedback and ideas for improvement. Relevant stakeholders were not always asked for feedback about the service in order to drive improvements;

• The service met the characteristics of good in all key questions, with the exception of responsive. The manager had plans in place to improve other areas of the service.

More information is in the full report.

Rating at last inspection:

At the last inspection the service was rated good (published 23 June 2016).

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 11 May 2016 and was unannounced. This means prior to the inspection people were not aware we were inspecting the service on that day.

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.

Following our last inspection the service was found to not be meeting the legal requirements for three regulations. These regulations related to staffing levels, obtaining consent for decisions and nutrition and hydration. We asked the provider to send us a report that said what actions they were going to take. At this inspection we found the provider had made the necessary improvements to these areas to meet the relevant regulations.

People we spoke with told us they felt “safe” living in the home and the staff were “kind” and “caring.”

On the day of the inspection the home was vibrant and active. We found staff were very busy attending to people’s needs though people did receive care and support when this was requested or required.

Information from staff files evidenced that appropriate checks were completed for all staff before they were allowed to work in the home, which helped to make sure staff were of good character.

We found where decisions had to be made for people on their behalf these were in their best interests under the Mental Capacity Act 2005 and had involved a multidisciplinary group of professionals.

People told us they enjoyed the meals provided and there was plenty of choice available. We saw staff taking time to ensure people were provided with a healthy and nutritious diet. Where concerns about people’s nutrition and hydration were identified accurate and up to date records were completed.

Each person had a care plan which gave details about what their day to day care and support needs were. Staff were familiar with people’s specific preferences in how they received care and support.

Staff we spoke with were confident the training they were provided with gave them the skills necessary to carry out their role well. They told us they had benefitted from the courses they attended.

The provider had carried out work to improve the aesthetics of the home and people we spoke with were pleased with this. There remained areas of the home that needed refurbishment work, particularly on the garden areas and on the nursing unit. The registered manager showed us the plan in place to make the outside areas more pleasant to sit in and told us about proposed work to make the nursing unit more dementia friendly.

The service had a full and varied activities programme available for everyone. A local community group were very active participants in organising and providing social activities both inside and outside the home. People who used the service were also offered one to one time with the activity worker where they could be read to or simply enjoy a private conversation.

There was an open and transparent relationship between people who used the service, their relatives and the registered manager. People said they were able to raise any issues or concerns they had and knew these would be dealt with in a responsible way by the registered manager.

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.

We were not able to verbally communicate with some people living at the home and so they could not voice their views and experiences to us. Due to this we used a formal way to observe people at this inspection to help us understand how their needs were supported. We call this the 'Short Observational Framework for Inspection (SOFI). During the observation we saw some examples of good communication skills by staff that utilised eye contact and touch to engage with people who used the service.

People who we could communicate with,told us that they were treated with dignity and respect. One person said, "they (staff) always knock on the door and tell me who it is. They are respectful, excellent and top class.”

People told us that the staff looked after them well and they were happy with the care they received. One person said, "I think its marvellous, ten out of ten.

People using the service said they felt 'safe' living in the home.

We found that staff were provided with appropriate training and supervision so that people’s health and welfare needs were met by competent staff.

The provider had an appropriate system in place for gathering, recording and evaluating information about the quality and safety of care the service provided. People who used the service and their representatives were asked for their views about their care and treatment.