About the service:

Belper Views Residential Care Home is a care home that provides personal care for up to 25 people, some of whom are living with dementia. At the time of the inspection there were 23 people using the service. The accommodation is split across two floors. The ground floor provides communal space with two lounges, a dining area, conservatory and level access to a secure gardens There are bedrooms, toilets and bathing facilities on both floors.

People’s experience of using this service:

The overall rating for the service is inadequate and the service will be placed in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

After the last inspection the provider had developed an action plan, however we found that the actions agreed to be completed by the provider and registered manager had not been done.

There was a lack of leadership, coordination and oversight which failed to drive the necessary improvement. We saw that audits had not been used to consider how the safety for people could be improved and risks reduced or mitigated. The rating from the last inspection was not displayed.

Staff did not receive the support they required to ensure they were competent in their roles. When they completed training, their knowledge was not checked to see if they understood how to implement their learning. Staff were not always responsive to people’s needs and we saw that the communal areas were frequently unsupervised. Lessons had not been learnt to drive improvements.

People were not safe and staff were not aware of how to raise concerns and we saw incidents which had occurred had not been reported. People’s risks had not been considered and measures put in place to reduce the risks.

Medicines were not managed safely. People had not always received their prescribed medicines, and stocks had not been regularly checked to ensure it was stored in accordance with guidance. When staff administered the medicine, they did not follow the national guidance and we saw this placed people at risk of not receiving their medicines.

People were not protected from the risk of infection. Measures were not in place to ensure cleaning schedules had been followed, to maintain cleanliness and hygiene at the home. People’s needs and choices had not been considered.

People are not supported to have maximum choice and control of their lives and staff had not supported them in the least restrictive way possible; the policies and systems in the service di

The inspection took place on 19 June 2018 and was unannounced. At the last inspection we rated the home overall as ‘Requires Improvement’. There were also regulatory breaches in consent and good governance. Following the last inspection, the provider was asked to complete an action plan to show what they would do and by when to improve the key questions of effective to at least ‘Good’. The home had been rated as ‘Requires Improvement’ at the last three inspections. At this inspection we found that due to a range of breaches and the ‘Well-led’ domain not being consistently maintained the rating for the service remains ‘Requires Improvement’; with ‘Inadequate’ in the ‘Well-led’ domain.

Belper Views Residential Home 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 home provided accommodation over two floors. On the ground floor there are two lounges, a conservatory and access to a secure garden.

The service was registered to provide accommodation for up to 25 people. At the time of our inspection 20 people were using the service.

Belper Views has a registered manager. 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.

Audits had not always been completed to highlight when changes were required to reflect improvements. Care plans were not always up to date to reflect the care being provided.

People were not supported to have maximum choice and control of their lives and staff did not supported them in the least restrictive way possible; the policies and systems in the service did not supported this practice.

Staff knew how to protect people from abuse. Lessons had been learnt from events following concerns in relation to infection control. This was now managed safety. People’s wellbeing had been supported by a range of health care professionals. The home was friendly and welcoming and people could personalise their space.

People felt the staff were kind and caring and provided support when they needed it to maintain their independence. Their dignity was respected and staff considered people’s needs. There was a range of activities on offer to provide interest and stimulation to people, which linked to their life history. There had been no complaints since our last inspection; however peoples and relative felt able to raise concerns if required.

People’s views were considered and partnerships had been developed with a range of partners to support wellbeing and ongoing health. Medicine was managed safety and there was sufficient staff to support people’s needs.

The provider had displayed their rating as required at the home. The provider currently had no website linked to this location. We had received notification about events and incidents relating to the home.

We found two 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 inspected Belper Views Residential Home on 16 January 2017. This was an unannounced inspection. The service was registered to accommodate up to 25 older people, with age related conditions, including frailty, mobility issues and dementia. On the day of our inspection there were 24 people living in the care home.

At our last inspection on 8 March 2016 we found quality monitoring systems were inconsistent and ineffective and had failed to identify shortfalls within the service. The premises were not properly maintained and levels of cleanliness were inconsistent. Insufficient staff on duty at times meant people’s care and support needs were not consistently met and the opportunity to pursue meaningful person-centred activities was limited. This represented a continuing breach under the Health and Social Care Act (Regulated Activities) Regulations 2014. We issued a warning notice and advised the provider of the timescale within which these shortfalls would need to be addressed.

During this inspection we found some improvements had been made but further improvements were still required. Improvements had been made with regard to the quality assurance systems in place to ensure that people received high quality, safe and effective care and support. Whilst improvements had been made, further time was required for the new systems and processes to become fully embedded.

People were not consistently supported to make decisions in their best interests. The registered manager, deputy manager and staff demonstrated a limited understanding of the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs). Staff required additional support to fully understand and implement the principles of the Mental Capacity Act 2005. This represented a breach of regulations.

A registered manager was in post. 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, comfortable and relaxed with staff and said they felt safe. They received care and support from staff who were appropriately trained, competent and confident to meet their individual needs. People were able to access health, social and medical care, as required.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were opportunities for additional staff training specific to people’s needs, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

Up to date policies and procedures were in place to assist staff on how keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People’s

We inspected Belper Views Residential Home on 23 March 2016. This was an unannounced inspection. The service was registered to provide accommodation and nursing care for up to 25 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues, diabetes and dementia. On the day of our inspection there were 24 people living in the care home.

At our last inspection, in March 2015, we found one breach of regulations relating to risks at the home that were not always well managed. We also found that guidance for the safe handling and administration of medicines was not always followed and meant medicines were not always managed safely. Following this the provider sent us their action plan telling us about the improvements they intended to make. During this inspection we looked at whether or not those improvements had been met. We found some improvements had been made and other improvements were still required.

During this inspection we found quality monitoring systems were inconsistent and ineffective and had failed to identify shortfalls within the service. The premises were not properly maintained and levels of cleanliness were inconsistent. Insufficient staff on duty at times meant people’s care and support needs were not consistently met and the opportunity to pursue meaningful person-centred activities was limited. We have made recommendations regarding staffing levels and personalised support.

A registered manager was in post and present on the day of the inspection. 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 care from staff who were appropriately trained and confident to meet their individual needs. They were supported to access health, social and medical care, as required.

People’s needs were assessed and their care plans provided staff with guidance about how they wanted their individual needs to be met. Care plans we looked at were centred on the individual and contained the necessary risk assessments. These were regularly reviewed and amended to ensure they reflected people’s changing support needs.

Policies and procedures were in place to help ensure people’s safety. Staff told us they had completed training in safe working practices. We saw staff supported people with patience, consideration and kindness and their privacy and dignity was respected.

People were protected by thorough recruitment procedures. Appropriate pre-employment checks had been made to help protect people and ensure the suitability of staff who was employed.

People received their medicines in a timely way. Medicines were stored and administered safely and handled by staff who had received the necessary training.

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals.

Staff received training to make sure they knew how to protect people’s rights. The registered manager told us that to ensure the service acted in people’s best interests, they maintained regular contact with social workers, health professionals, relatives and advocates.

There was a complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments.

We identified one breach under the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the report.

We completed an unannounced inspection of Belper Views Residential Home on 6 March 2015. The service is registered for up to 25 people who require residential care. At the time of our inspection the home was providing care to 25 people.

There is a registered manager at this 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 our inspection in October 2013 we found breaches in regulations relating to care and welfare, safeguarding, requirements relating to workers and assessing and monitoring the quality of service provision. Following this the provider sent us their action plan telling us about the improvements they intended to make. During this inspection we looked at whether or not those improvements had been met. We that found some improvements had been made and some improvements were still required.

At this inspection, we found that risks at the home were not always well managed. We also found that guidance for the safe handling and administration of medicines was not always followed and meant medicines were not always managed safely.

We found the principles of the Mental Capacity Act 2005 (MCA) were not always followed and people who were subject to supervision and restrictions to keep them safe had not been referred for authorisation using the Deprivation of Liberty Safeguards (DoLS). This legislation ensures people who lack capacity and require assistance to make certain decisions receive appropriate support are not subject to unauthorised restrictions in how they live their lives. We have made a recommendation about staff training on the subject of the MCA and DoLS .

The provider’s arrangements to check the quality and safety of people’s care were not being followed and related records were not always up to date. The provider’s operational policies and procedures did not always provide staff with the up to date guidance they needed to follow in relation to the care provided at the service.

People were pleased with the substantial refurbishment of the home. The registered manager and deputy manager were both visible and accessible to people and their relatives and provided open and transparent management and support.

People felt cared for safely by staff who understood how to raise concerns. There were sufficient staff to care for people safely and the provider’s procedures for recruiting staff made sure they were suitable to work at the service. Staff told us they received adequate support from their managers and from training courses to enable them to do their job well. People were cared for by staff with the skills and knowledge to meet their needs. People had mixed views on the choices and quality of food, but all people we spoke with told us they had enough to eat. People had timely access to any additional healthcare services that they may require, including opticians and doctors.

People told us they were cared for by kind, respectful and patient staff. Staff were caring in their approach to the support they provided. People told us staff were respectful of their privacy and promoted their dignity at all times. Most, but not all of the time, people’s independence and choices were supported. Staff knew what was important to people and people we spoke with told us they were happy with their care.

People were supported to engage in their some of their preferred hobbies and interests; however they told us they also wanted to see more entertainment and trips out. People were supported to maintain their relationships with families and friends, who could visit at any time. People were asked for their views and their preferences for their care and these were respected. People contributed to their care plans and staff responded promptly when people needed them. This meant people experienced care that was personalised and responsive to their needs.

We identified one breach under the Health and Social Care Act (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.

People that lived at the home told us that they were happy and well cared for. We spoke with five people that lived at the home and three visitors. One person told us, ''I love it here. It is so comfortable and homely.’’ Another person told us, ‘’The staff are so caring and respectful. They see to my every need.’’

We found people were supported in an unhurried way and helped to live as independently as possible. One person we spoke with told us, ‘’I like to feed the fish every morning, and the staff help me do that even though it takes me quite a while to do it.’’ A visitor told us, ‘’My relative is very happy here. They have a lot of fun and are supported well to be active. My relative was helped to deadhead the flowering plants outside the other day.’’

We found that care staff were knowledgeable about how to safeguard people against abuse. However we found the provider did not have a policy on safeguarding that gave up to date information.This meant that care staff did not have access to current information on safeguarding.

We found that the provider needed to make improvements to the way they updated care plans so it reflected people’s current care needs, to the way they recruited staff, and to the way they checked that the people that lived at the home received a quality service.

We visited Belper Views Residential Home to follow up on one area of non compliance from our previous visit. We did not speak with people who used the service during this visit, although we spoke with the registered manager and reviewed the arrangements for storage and recording of medicines.

We found that the provider had taken steps to ensure that controlled drugs were stored in accordance with legal guidelines and that suitable arrangements had been made for record keeping.

The people who used the service we spoke to told us that they understood the care, treatment and support choices that were available to them. They said that the staff discussed the care plans with them and the people using the service were involved in decisions. One person told us the staff who worked at Belper Views were “always asking if I’m happy with what is happening and asking me if I need anything else”. The people who used the service all provided positive comments about the home. One person told us that she “felt safe and had never been so well looked after”. All of the people we spoke with said that they felt there were sufficient staff on duty at all times to ensure that their needs were met. One person said “there were always enough staff working and they always had enough time to do whatever I need them to”. The staff had all received induction training when they commenced employment. Staff received NVQ training, which enabled them to acquire further skills in the area they worked as well as receiving refresher training in mandatory areas. The provider had clear systems in place to obtain feedback from all persons involved in the service as well as auditing their own service. Arrangements for managing controlled drugs were not in line with the requirements of the Misuse of Drugs Act 1971 and the Safer Management of Controlled Drugs Regulations 2006.