About the service:

Belmont View provides residential care for older people some of who are living with dementia. The home is registered to accommodate up to 85 people. The accommodation is arranged into separate units across the two floors of the home. At the time of the inspection there were 72 people living at the service.

People’s experience of using this service:

¿ Previous improvements identified had been put in place. The registered manager was able to demonstrate where these improvements were made immediately following the inspection. This meant people had consistently experienced a better quality of care that was safely and innovatively delivered.

¿ The providers ethos and values were delivered to people, relatives and staff. These values ensured everyone associated with Belmont View was treated as an individual, with dignity and provided opportunities to be independent and build resilience around their well-being.

¿ All staff went out of their way to respect people as individuals and provided exceptionally compassionate care to all. Staff had developed meaningful caring relationships with people and were committed to ensuring people lived fulfilling lives and were protected from social isolation.

¿ People were treated in a dignified way and staff took time to get to know what was important to them. People received care that was individually planned, promoting people's independence as well as their well-being. Staff were empowered to develop creative activities for all people regardless of their health needs. Care provided to people when they were coming to the end of their life was very caring and supportive. All staff spoke about people in a passionate and enthusiastic manner. It was clear that people living in Belmont View were central to the care provided, and that staff would go the extra mile to ensure they were well cared for.

¿ The registered manager, deputy manager and senior leadership team led by example. People, staff, relatives and health professionals felt their views were important to the leadership team and that their opinions were listened to. All staff were valued by the registered manager which encouraged staff look at partnership working that improved the quality of care people received. Leadership values were inclusive and set high professional standards for staff to adhere to. Staff spoken with were long standing and spoke with pride about working for Quantum Care, feeling valued by the processes in place to support them.

¿ Risk to people’s care was being managed well and was proactive in identifying risks to people’s health and well-being. People told us they were safe and staff were able to describe how they kept people safe and reported any concerns they had. There were appropriate numbers of staff that ensured people received care when they needed in a clean and well-maintained environment.

¿ People’s medicines were managed safely and given to people when they needed them.

¿ People received care from staff that were well trained and supported in their role and able to develop their skills further. Consent was sought from people prior to delivering care and legal requirements relating to consent were met. Care records were detailed and demonstrated clearly that people were involved in how they wanted their care to be provided.

Rating at last inspection:

¿ At the last inspection on 27 November 2017, the service was rated requires improvement (the report was published on the 12 January 2018).

Why we inspected:

¿ This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. Where services have been rated as requires improvement we follow up the rating with an inspection within one year.

Follow up:

¿ We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

This inspection was carried out on 28 November 2017 and was unannounced. At their last inspection on 3 December 2015, the service was found to be meeting the standards we inspected. At this inspection we found that they had continued to meet all the standards.

Belmont View 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. The service accommodates up to 85 people in one adapted building. At the time of the inspection there were 77 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

Most people received care in a person centred way but we observed some people who did not. This was addressed immediately by the management team following the inspection with some shortfalls addressed during the inspection.

Most people were supported in a safe way. People told us they felt safe. Staff knew how to recognise and report any risks to people’s safety. However, further development was needed in regards to unexplained bruises or skin tears being recorded, investigated and potentially reported.

Medicines were administered in accordance with the prescriber’s instructions. However, on one unit there were issues found but these were addressed during the inspection. There were sufficient staff who were recruited safely who received appropriate training and support.

People were supported in accordance with the principles of the Mental Capacity Act 2005 and their choices were respected. People enjoyed a variety of food and were supported to live healthy and balanced lives.

People were addressed by staff with respect and kindness. They supported in accordance with their preferences and wishes. Confidentiality, dignity and privacy was promoted.

People enjoyed the activities provided. They and their relatives where appropriate were involved in planning their care. There was a complaint’s process which people knew how to use and were confident they would be acted upon.

People and staff were positive about the running of the home. There were systems in place to monitor the quality of the home, listen to people and value staff. People’s views were sought and consulted in relation to the running of the home.

The inspection took place on 03 December 2015 and was unannounced.

Belmont View provides accommodation for up to 85 older people who require nursing care and may also live with dementia. At the time of our inspection 84 people were living at the home.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 carried out an unannounced comprehensive inspection of this service on 04 August 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Belmont View on our website at www.cqc.org.uk

The home was clean, bright and welcoming. There were no malodours present, people were well groomed and cared for, and the provider had addressed shortfalls on one unit that meant people were not living in sanitary conditions. Where people were prescribed medicines to be administered on an as needed basis, the manager ensured clear guidance was available.

People were provided with an array of food. Where people required assistance with eating or drinking, staff carried this out in a calm, relaxed and supportive manner. Where people were at risk of malnutrition or dehydration, staff responded accordingly and monitored people’s dietary intake regularly.

People who were at risk of harming themselves or others had a suite of care records developed and these had improved since our last inspection.

There was an open culture in the home and people, relatives and staff were comfortable to speak with the manager if they had a concern. The provider and manager had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

Belmont View provides accommodation and personal care for up to 85 older people. The service is not registered to provide nursing care. There were 83 people accommodated at the home at the time of this inspection.

The inspection took place on 04 August 2015 and was unannounced. We last inspected the service on 27 June 2014 and found the service was meeting the required standards at that time.

The home had a registered manager in post who had been registered since October 2010. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that applications had been made to the local authority in relation to people who lived at Belmont View and a number of these were pending an outcome.

People told us they felt safe living at Belmont View. Staff were aware of how to keep people safe and risks to people’s safety and well-being were identified.

We found that the home was staffed sufficiently and was calm throughout our inspection.

There were suitable arrangements for the safe storage, management and disposal of people’s medicines, including controlled drugs.

Staff had the skills and knowledge skills necessary to provide people with safe and effective care and support. Staff received regular support from management which made them feel supported and valued.

People were supported to make their own decisions as much as possible.

People did not always receive appropriate support or encouragement to eat and drink sufficient quantities.

People had access to a range of healthcare professionals when they needed them.

The views from people about receiving the right care and support and being involved in developing their care plans was mixed.

There were activities in place and visitors were encouraged to visit at any time of the day. We observed throughout that people’s privacy was promoted.

There were arrangements in place to obtain feedback from people who used the service, their relatives, and staff members about the services provided. People told us they felt confident to raise anything that concerned them with staff or management.

People’s care records did not always contain sufficient detail to provide a comprehensive account of a person’s needs and care.

There was an open culture in the home and relatives and staff were comfortable to speak with the manager if they had a concern.

The provider had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

We used the information we had gathered to answer the five 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?

We had received information of concerns about various aspects of care and support for people who used the service. We carried out a responsive inspection to find out whether people were receiving safe and appropriate care.

This is a summary of what we found:

Is the service safe?

The people we spoke with said that they were well looked after and cared for. People had their needs assessed and were met appropriately. One person said “Staff are very good. I get good care and I feel safe here.” A relative said “Generally speaking the care is really good, staff are good too. I have no complaints.”

People were protected against the risk of abuse and staff had received training in safeguarding people who used the service. The staff were aware of their responsibilities to report any allegation of abuse.

We noted that the general environment within the home was clean, fresh, bright and odour free.

There were systems in place for safe management and administration of medicines. This meant that people received their medicines regularly and on time.

Staff had received relevant training to complement the work they did. People received care from staff who were knowledgeable and competent in their roles.

Information about people who used the service had been maintained so that they were protected against the risk of unsafe or inappropriate care and support. Confidential records were kept safely and securely and retained for the required length of time.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. 36 applications had been submitted under this system. We saw evidence that staff had received training in Mental Capacity Act and DoLS and there were appropriate policies in place.

Is the service effective?

People received care and support that met their needs. People and their relatives were involved in the decision making process about their care. Regular care plan reviews had taken place to ensure that people and their relatives were aware of the changes in their health and wellbeing. Where appropriate the support and advice of other health care professionals had been sought to ensure that people’s health care needs were met.

People using the service were protected from the risks of inadequate nutrition and dehydration. A choice of suitable nutritious food and drink and a well-balanced diet was provided for people to meet their needs.

Staff were aware of people’s needs and had received training to ensure that people received care and support appropriate to their needs. The staff members we spoke with said that they reported any unusual behaviour or condition of people so that appropriate help and advice was sought.

Is the service caring?

People told us that they were well looked after and cared for. One person said “Staff are very good. I get good care and I feel safe here.” A relative said, “Mum’s been here for three years, more than happy with the care mum receives. Staff are really friendly, the place is always clean. I am involved with the care plan. They’ve not only looked after my mum, they have looked after me.”

Is the service responsive?

The care plans we looked at showed that people's needs had been assessed and met appropriately. People had been involved in the decisions about their care and any changes in their care needs had been discussed with them.

We saw that the home had a complaints procedure in place and there was evidence of complaints that had been dealt with in line with the home’s policy. One person who used the service told us about a complaint they had made and that they were happy about the outcome. We checked the complaints log which confirmed that the complaint had been entered and dealt with according to what the complainant had told us.

Is the service well-led?

People’s care and support had been planned and delivered in accordance with their identified needs. The provider had carried out an annual questionnaire survey of people who used the service, their relatives and other stake holders. The feedback from the surveys had been positive with some ‘not so positive comments’. An action plan had been put in place to address the ‘not so positive comments.’ We noted from the action plan that the issues raised had been addressed. People told us that their views were listened to and acted on.

During our inspection in April 2013 we found that some records about people’s care were not complete, up to date or securely stored.

During our inspection on 12 September 2013 we found the provider had made improvements in record keeping. Records relating to the people who received a service at Belmont View were accurate and fit for purpose. Records were stored securely and were located promptly when requested.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. The relatives of two people told us they were satisfied with the care provided to their relatives and that staff understood and met their relative’s needs. One relative told us the staff provided, “... excellent care.” They said “Staff are very flexible. I’m very pleased with the care my [relative] gets.”

There were sufficient staff to meet the needs of the people living at the home. In the main staff were respectful and caring in their approach. We saw a number of activities taking place throughout the home.

The staff we spoke with were knowledgeable about people’s needs and consistent in their responses to our questions about people’s needs and how they were met. However, we found that people’s care plans and assessments had not been updated. This meant that people were at risk of not receiving the care that they needed because records had not been updated to reflect people’s current needs. Some records were not stored securely and did not protect the privacy and dignity of people living at the home.

We found people’s nutritional and hydration needs were met and people living at the home were protected from the risk of abuse. There was an effective complaints system in place and comments and complaints were responded to appropriately.

We used a number of different methods to help us understand the experiences of people using the service, because many of the people using the service had complex needs which meant they were not able to tell us their experiences.

People living with dementia who we observed and spoke with were alert and sociable. We observed staff speaking to people and supporting them with practical tasks, but with limited social interaction. We found that people were not supported to engage in meaningful occupation and stimulation. One person told us, “There are activities in the day room, but if we don’t want to join in, there is nothing to do on the unit.”

A visiting relative said, “The care workers are generally very good, but they have too much to do. Staff don’t have the time to spend with individual people.” On the day of our visit some people received their medicines up to four hours late because there were insufficient staff available to provide the personal care that people required in the morning, and to administer the medication safely.