Belle Vue Nursing Home

We found the following examples of good practice.

¿ The registered manager had identified, assessed and mitigated all COVID-19 related risks to people, staff and visitors. This included providing visitors with their own personal hand sanitisers to mitigate the risk of some people attempting to swallow or remove this from PPE stations.

¿ The registered manager had an effective monitoring system in place to check that the service was following government guidance and the provider's own policies. The provider’s Head of Compliance was providing support at the home. The registered manager told us that they had managed the service when they were absent to ensure there was consistent leadership.

¿ Staff were confident and knowledgeable about government guidance and what visitors were required to do prior to entering the service. Professional visitors and relatives were tested for COVID-19 at the service or provided a negative lateral flow test result from that day. Visiting professionals and staff provided evidence of their vaccination status to the registered manager before entering the service.

¿ Staff and people received regular testing for COVID-19 and emergency care givers were included in this testing programme.

¿ People were encouraged and supported to leave the service to visit relatives or access the local community. Relatives were able to visit their family members either in their rooms or communal lounge areas. During our inspection we observed relative visits to people.

¿ Staff wore appropriate PPE and had access to this throughout the home. Staff had received additional training during the pandemic about correct PPE usage and infection prevention and control from the provider.

Belle Vue Nursing 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.

Belle Vue Nursing Home can accommodate 49 people in one adapted building across three floors. At the time of the inspection 39 people were resident, some of whom were living with a dementia.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well-led to at least good. During this inspection we found improvements had been made.

The service had a registered manager who had been registered with the Commission since August 2013. 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.

It was evident that lessons had been learnt since the last inspection. Audits used as part of the quality assurance process had been reviewed to ensure they were robust enough to identify any necessary improvements.

Care records had been audited and re-written to ensure they reflected people’s current needs. Plans were being developed for nurses to implement a peer reviewing system so they audited care records written by another nurse.

Improvements had been made to the management and investigation of any accidents and incidents. Safeguarding procedures were robust, well documented and investigated. Processes were used to identify any triggers and review for any learning. Improvements had been made to the admission procedure following a lessons learnt exercise.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice, however, we have made a recommendation about mental capacity assessments and best interest decisions. Specifically, in relation to locking people’s bedroom doors.

Appropriate safety checks of premises and equipment was in place. The provider was reviewing fire safety procedures, and work was underway to ensure compliance following a recent inspection by the fire service. All staff had been involved in fire drills and personal emergency evacuation plans were in place.

Staffing levels were sufficient to ensure people’s needs were met. Staff told us they worked well together to ensure everyone’s needs were met. Safe recruitment practises were followed.

Training was provided for staff which care staff were positive about. Nurses commented that they felt well trained however competency assessments were not always completed. It was explained that due to people’s needs nurses were not using these skills however, should this change competency assessments would be organised. Everyone told us they felt well supported.

Medicines were managed safely and the registered manager had reviewed the medicine administration round to ensure everyone received their medicines in a timely and safe manner.

People were supported with their nutrition and hydration needs and given a recent heat wave hydration levels were being carefully managed. The home was involved in a study project with a local University in relation to assessing the impact of good hydration on the health and wellbeing of people living with a dementia.

If people’s needs were such that specialist intervention was needed people were referred to healthcare professionals. For example, physiotherapists, speech and language therapy, dentists, options and specialist consultants.

A range of activities were provided and the activities coordinators worked to provide physical and mental stimulation for people. The sensory area had been moved into an empty bedroom which provided increased privacy for people.

Everyone we spoke with was complimentary of the care provided at the home. Care staff were respectful of people and treated people with dignity. We observed kind and compassionate relationships with people. One staff member was nominated for an unsung hero award at the providers forthcoming Gala event following observations of their compassionate approach.

Relatives told us they had no complaints but were aware of how to complain if they needed to. Lots of compliments had been received in relation to the care provided, particularly so in relation to end of life care.

Belle Vue Nursing Home is a 49 bed care home that provides personal and nursing care to older people, most of whom were living with a dementia. Accommodation is provided over three floors, which each bedroom having ensuite toilet facilities. In addition specialised bathing and showering facilities are available.

At the time of the inspection there were 32 people using the service. The ground floor of Belle Vue Nursing Home was undergoing extensive building and redecoration work following burst pipes in December 2016. This area of the home was ‘out of bounds’ to people and all the people normally resident on this floor had been moved to one of the providers sister homes. The provider was proactive in ensuring staff from Belle Vue Care Home had temporarily transferred with people to ensure consistency in support until they returned to Belle Vue Care Home.

A registered manager was registered with the Care Quality Commission at the time of the inspection. They had been registered since August 2013 so were well established. 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 the inspection we found areas of concern which constitute breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely safe care and treatment, need for consent and good governance.

Care documentation had not been updated in respond to people’s changing needs. This meant staff did not have access to accurate or up to date written information about how to provide safe care and support for people.

Incidents had not always been reviewed and investigated to see if there was cause for concern.

People were not consistently supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible; the policies and systems in the service did not support this practice. There was a failure to follow the principles of the Mental Capacity Act (2005) in relation to mental capacity assessments and best interest decisions.

Emergency evacuation plans had been completed and were reviewed on a monthly basis. One person’s evacuation plan had not been updated to reflect their changing needs which would impact the safe evacuation of that person.

Fire drills were completed but there was a failure to ensure documentation accurately reflected that some staff had been deployed to a sister home since December 2016 and were completing fire drills at their temporary place of work.

We have made a recommendation about staff deployment.

The medicines administration round took a significant period of time however we received assurances following the inspection that time specific medicines, and as and when required medicines were administered at the appropriate times, and with the appropriate gaps in between administration.

Safe recruitment practices were followed. Staff said they felt well trained and had regular supervision and appraisal. There were mixed views about the value of supervision meetings.

Safeguarding concerns had been reported and investigated. There had been no complaints raised.

People were supported with their nutrition and hydration needs, and where appropriate relevant professionals were involved in people’s care.

Staff had a kind and compassionate approach and we observed warm and caring relationships between people and staff.

Staff and relatives spoke well of staff and the registered manager, as did the nominated individual.

Activities were varied and included entertainers, outings, visiting tai chi and the discovery zoo. There was also a sensory area for people to use with staff support and the provider told us there were good community networks.

The provider was proactive in liaising with a local university to support placements for students completing health related courses.

You can see what action we told the provider to take at the back of the full version of the report.

We observed staff were kind and sensitive as they provided care and support to people. All people we spoke with said they were respected by staff. Comments included; "My privacy is respected at all times".

People were also treated with consideration and respect.

We spoke to six people who lived at the home who told us staff were kind and helpful. One person said; "The staff are very kind." We spoke with a relative who said; "The staff are great, they know and understand my mother."

We saw before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person we spoke with said they "understood completely", the care and treatment they were receiving. Another person said; "I can get up and go to bed when I want."

We saw there were enough qualified, skilled and experienced staff to meet people's needs.

The building was well maintained and people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We saw the provider had systems in place to gather feedback from people, who used the service, and to regularly assess and monitor the quality of service people received.