Archived: Belle Vue Care Home

Updated 8 June 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We carried out this inspection over four days on 20, 22, 24 and 27 March 2017. The first day of the inspection was unannounced. The first day of the inspection was conducted by two adult social care inspectors and an expert by experience. They were joined by an inspector from the hospital directorate to complete their training. One adult social care inspector returned on the other days. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

We looked at the information we held about the home before the inspection visit, including the inspection history, previous reports and the action plans sent to us by the provider. We looked at other information we held about the home including statutory notifications. Statutory notifications are changes or events that occur at the service which the provider has a legal duty to inform us about.

We contacted the local authority and the Quality and Improvement Team who provided information about the service. We used all of this information to plan how the inspection would be conducted.

During the inspection we looked around the home and observed the way staff interacted with people to help us understand the experience of people who could not talk with us due to living with dementia. We also spent time carrying out a Short Observational Framework for Inspections (SOFI observation). SOFI is a specific way of observing care to help us understand the experiences of people who could not communicate verbally with us in any detail about their care.

During the inspection we met everyone living at the home and spoke with two people who were able to speak with us. We spoke with seven relatives, ten care support workers, three registered nurses, four agency care support workers, cleaner, administration staff member, maintenance man and chef. We also spoke with a visiting healthcare professional. In addition, we spoke with the interim manager and the interim clinical lead.

We also looked at a selection of documents associated with the management and running of the home. This included quality assurance information, recruitment information for four members of staff, staff training and supervision records, policies and procedures and records relating to health and safety, equipment and premises. We also completed a tour of the premises to check on general maintenance as well as the cleanliness and infection prevention and control practices. We discussed the home's action plans and progress being made with regard to providing safe care and treatment.

Updated 8 June 2017

This inspection was unannounced and took place on 20, 22, 24 and 27 March 2017.

Belle Vue Care Home is a purpose built care home registered to provide care for up to 52 people. On the days of the inspection there were 33 people living there. The home is set over three floors, with people receiving general nursing care on the ground floor and a locked unit for people living with dementia and mental health diagnosis issues on the first floor. The lower ground floor contains service areas, such as the kitchen. People living on the ground floor had significant physical ill health and were mainly but not exclusively older people.

Following their last comprehensive inspection on 18 July 2016, the home was rated as Inadequate and placed in 'special measures' due to concerns we identified. These included concerns from the preceding inspection of June 2015 which had not been addressed.

In 2016 we identified concerns in relation to people's safety, staffing levels, management and governance of the home, and lack of caring and respect for people's dignity. Following that inspection, we issued three warning notices in relation to Regulation 12 (Safe care and treatment), Regulation 10 (Dignity and Respect) and 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We met with the provider when they shared the actions they were taking to address the issues identified.

We found some progress had been made by the home when we carried out a focused inspection in December 2016.

We carried out this comprehensive inspection in March 2017. We found not all improvements seen during the focused inspection had been sustained. The required improvements identified at the comprehensive inspection in July 2016 had not been completed. We identified concerns in relation to people’s safety, safeguarding, person centred care, dignity and respect, staffing and good governance.

The home did not have a registered manager, although this person’s name will show on this report as they have not deregistered. There was an interim manager in post at the time of our inspection who had begun the process of applying to the Care Quality Commission for registration. 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.

During this inspection we found that the systems in place to reduce risks associated with people's care and support were not always effective and this exposed people to the risk of harm. In addition to this people were not protected from risks associated with the environment. Some areas of the home needed additional cleaning or maintenance, and there was a significant odour problem, particularly on the first floor dementia unit.

People did not always receive appropriate care and support as staff were not deployed in a way that supported people to have their needs met in a timely way. People were exposed to risk of harm. We observed occasions where people had to wait unacceptable amounts of time for support.

People's right to privacy was not respected and they were not treated with dignity. Staff did not routinely supervise the whereabouts of people. This meant people walked into other people’s rooms uninvited. Some staff were kind and caring in their approach, however other staff were focused on tasks and had limited interaction with people who used the service. Supervision and observations of staff had not identified, or had not addressed these issues in a way that ensured people had positive experiences.

Staff interactions were not always supportive to people. Staff did not support people to make decisions and choices about their care. For example, staff asked people for their meal choice at lunchtime but they did not clearly explain what was on offer and encourage people to make a choice for themselves.

People were disengaged and under stimulated. They were not provided with appropriate person centred stimulation and some people were at risk of social isolation. People spent long periods of time on their own either in the reception lounge area, in their rooms or looking out of the window. We did not see any activities taking place during our inspection.

People were not always protected from risks associated with their care. Risk assessments were not always in place or written in sufficient detail to support people to receive safe care and support, or to manage identified risks. People did not always have sufficient detail in their care plans to provide guidance and direction to staff about how to meet their needs or to care for them in a personalised manner.

People waited extended periods of time for their meals, and some people had been left with their meals but were not offered encouragement or support to eat. Some people’s food and fluid intake charts were not being accurately completed which could lead to confusion about how much they were eating and drinking.

People were not always being protected from the risks associated with medicines. During the inspection we observed unsafe practice. Staff were not always recording when topical creams were applied. Other aspects of medicines management were safe. We saw medicines were stored securely and records were maintained.

There was a lack of effective governance which put people at risk of receiving poor care. Quality assurance and audits systems were ineffective. Whilst systems were in place to assess, monitor and improve the quality of service for people, these had not identified the shortfalls found during this inspection and had not been effective in ensuring the home was compliant with the regulations. In addition to this, timely action had not been taken in response to known issues.

People and their relatives told us the quality, variety and choice of food had improved in recent months. Since the last inspection the home had employed a new chef who was passionate about providing people with nutritional, high quality restaurant standard food. However, we did not find the way that meals were served helped ensure people had a positive experience. The dining rooms were noisy, and people were not always supported well by staff to eat their meals.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. We found staff were recruited safely. Suitable checks were made to ensure people recruited were of good character and had appropriate experience and qualifications.

Improvements had been made to staff training and supervision. The registered provider had an induction and training programme in place that included training specifically to meet the needs of people living at the home.

We found the home was taking appropriate actions to protect people's rights and work within the principles of the Mental Capacity Act 2005 (MCA). Staff were aware of people's right to refuse support and asked people for their consent before they assisted them.

The provider had a written complaints procedure. Information about how to complain was provided to people and their relatives when they moved into the home and was displayed on the wall of both units. Relatives told us they knew how to make complaints.

During our inspection, we acknowledged the manager and interim clinical lead were working hard to make improvements. The manager had identified several areas of concern which they were trying to address. The manager was working hard to maintain a stable staff team and staff felt well supported by the management.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

The service 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.

We are considering our actions in line with CQC's enforcement policy. We will publish a further report that details what action we have taken at a future date . Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.