8 January 2020
During a routine inspection
Belle Vue Lodge is a nursing home and accommodates up to 59 people in one building. There are six individual living areas over three floors with an atrium on the ground floor available to all. People living at the service were older people, some of whom were living with dementia. At the time of our inspection, 35 people were living at the service.
People's experience of using this service and what we found
People did not receive consistent care from staff who showed dignity and respect. Whilst some shortfalls were identified, positive feedback from people who used the service and visiting relatives were received about the caring approach of staff. This was confirmed by some positive staff engagement with people. People were involved as fully as possible in day to day decisions about their care. The registered manager was introducing formal procedures for people and their relative or representative, to participate in review meetings about the care and treatment provided. Advocacy information was available, and people were supported to access advocacy services when required.
People’s diverse needs, preferences and routines had been assessed and planned for. Improvements were required to the approach and opportunities of social inclusion, activities, stimulation and occupation. Action was being taken to make these improvements. There was an accessible complaints procedure available for people. Complaints were responded to in accordance with the provider’s policy and procedure. End of life care was planned with the person and others, to ensure care reflected people’s wishes that they were kept comfortable and received dignified care.
Recent improvements had been made to the leadership of the service. A new management team had been developed. They were taking action to identify the areas of improvement required and had an action plan, and the support from the operations manager to drive forward improvements. The registered manager had introduced management surgeries, as a method to improve communication and engagement with people and relatives. Systems and processes were in place that monitored the quality and safety of the service. Staff did not consistently feel positive about working at the service, improvements were required to address the staff culture and understanding roles, responsibilities and accountability.
People received safe care. Staff were aware of their role and responsibilities to protect people from risks and avoidable harm. Risks associated with people’s care needs had been assessed and were regularly reviewed and staff had guidance of how to mitigate and manage known risks. There were sufficient staff employed. Recruitment procedures supported the provider to make informed decisions about the suitability of staff employed. People received their prescribed medicines safely and national best practice guidance was followed in the management and storage of medicines. Infection prevention and control measures were used. Incidents were reviewed and lessons were learnt, and action taken to reduce reoccurrence.
People received effective care. The registered manager had recently introduced, and had pledged to use, new recognised assessment tools that reflected national best practice. Improvements to staff training in understanding care needs associated with dementia had been introduced. Additional action was planned, to further upskill staff’s awareness and competency. Staff supervision and appraisals had not been at the frequency the provider expected, but this had been addressed and action taken to make improvements. People received enough to eat and drink, and their health needs were assessed and monitored. Staff shared information and worked with external health care professionals to meet people’s ongoing health care needs. Improvements to decoration and furnishings were being made. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
We have made a recommendation about motivating staff and team building.
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 requires improvement (published 8 January 2019) and there were two breaches in regulation. The provider completed an action plan after the last inspection, to show what they would do and by when to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations. However, the service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.