The Belvedere

Updated 7 October 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

The Belvedere 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 does not have a manager registered with the Care Quality Commission. The provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with one person who used the service and five relatives about their experience of the care provided. We spoke with 11 members of staff including the regional director, peripatetic manager, nurses, care staff and ancillary staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 7 October 2021

About the service

The Belvedere is a residential care home providing personal and nursing care for up to 41 people. At the time of the inspection 39 people were using the service. The home specialises in providing care to people living with dementia.

People’s experience of using this service and what we found

Overall people and their relatives were positive about the care and support they received at The Belvedere. People and their relatives indicated people felt safe and were supported by kind and caring staff.

There were enough staff to meet people’s care needs. However, the provider had identified the need for new or increased ancillary roles. For example, a new hospitality role at mealtimes. Recruitment was underway for several roles. Staff had been safely recruited.

Risks to people's safety were assessed and detailed information was recorded in their support plans to manage any identified risk. Some training needs had been identified and were being addressed by the provider in relation to nutritional risks. Some environmental safety checks were overdue, a new maintenance person was undertaking their induction, and these were in progress.

Medicines were managed safely. Part of the provider’s own improvement plan was to review the use of sedative type medicines, to ensure they were being used appropriately. Reviews with people’s GPs and mental health professionals were in progress.

Overall, staff followed Infection prevention and control (IPC) practices, which followed government guidance. The provider gave further assurance about the cleanliness of the premises, as they were recruiting and increasing domestic and laundry staff. Following our inspection, the manager reminded staff about the appropriate disposal of PPE. Improvements to aspects of the home’s environment and decoration were in progress.

There was no registered manager in post. The previous registered manager had left, and a peripatetic manager was providing support. A new manager had been recruited but had not yet applied to register.

The provider had identified areas for improvement in relation to good governance and had recently redesigned their auditing processes. A recent in-depth audit had been carried out and a detailed improvement plan was being actioned. The provider planned to improve outcomes for people in relation to lifestyle and to focus on meaningful activities

Most issues found during this inspection had already been identified by the provider’s audit. However, we further identified some issues around the accurate recording of checks of people in their bedrooms.

There had been some uncertainty due to changes in management. However, overall staff felt supported as a staff team and understood the expectations of their roles.

Feedback indicated that staff engaged regularly and involved people and their relatives in discussions about their care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection.

The last rating for this service was good (published 13 March 2020).

Why we inspected

The inspection was prompted in part due to concerns about medicines, staffing and management. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Belvedere on our website at www.cqc.org.uk.

Follow up

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