The Belfry Residential Home

The Belfry is a residential care home providing personal care to 11 people aged 65 and over at the time of the inspection. The service can support up to 12 people.

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

The provider did not have robust systems in place to assess and monitor risks to people’s safety and welfare. People’s care plans and risk assessments were not always up to date and did not provide staff with clear guidance about how to support people safely in a number of key areas including their mobility, eating and drinking and personal care. People’s medicines were not always safely managed, and the provider’s medicines audits had failed to highlight the errors found on inspection.

We could not be assured the service had adequate staffing levels in place to provide people with personalised care which reflected their individual needs and preferences. Staff had not received a comprehensive induction and training was not always completed or renewed in line with best practice. The provider had not always completed the relevant recruitment checks in line with best practice. We have made a recommendation about the provider’s recruitment processes. Despite these concerns, people were generally supported by a consistent staff team and relatives spoke positively about the staff employed.

People’s care was not always personalised and their involvement in their care planning was not evident from their care records. People’s care centred on their physical health needs and people were not always supported to take part in meaningful social interactions or leisure activities of their choice. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider had safe infection prevention and control processes in place and the service was environmentally clean and homely. People were supported to stay in regular contact with relatives and the provider ensured visitors were welcomed into the service.

The provider encouraged people, relatives and staff to give feedback on the care provided and responded to concerns and complaints appropriately. A safeguarding policy was in place for staff to follow if they had any concerns people were at risk of abuse.

People’s relatives spoke positively about the culture and management of the service and the provider had built positive working relationships with other health professionals in order to support people’s health needs and improve their care.

The provider responded promptly to the feedback we gave during our inspection, putting measures in place to address concerns and make improvements.

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 17 April 2018)

Why we inspected

We received concerns in relation to the safe management of medicines, the management of risks to people’s health and safety, safeguarding people from the risk of harm and staff training and knowledge. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

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.

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

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 improvement. Please see the safe, effective, responsive 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 Belfry on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people’s safety, staffing and the oversight of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

We found the following examples of good practice.

People's wellbeing was being supported by contact with family and friends. The benefits of these visits helped people’s mental health.

Staff employed at the service had received training on infection prevention and the correct use of personal protective equipment (PPE).

Staff were well supported by the management team and had access to support services.

There were clear arrangements at the entrance to the building and at other key areas to minimise the risk of infection.

PPE was available and accessible. The service was well maintained and visibly clean. Schedules were in place to show that regular cleaning was undertaken. Audits and observations of practice were completed to show the service was following good practice guidance.

The provider was following the government guidance on whole home testing for people and staff.

This inspection took place on 15 March 2018. The inspection was unannounced, this meant the staff and provider did not know we would be visiting. At the last inspection on 10 January 2017, the service was rated ‘requires improvement’. 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 to at least good. At this inspection, we found that the service had made improvements and this was now good.

Covert surveillance in the lounge and communal areas was being used and the provider had obtained people’s consent to do this. The security of people was maintained. People were supported to have maximum choice and control of their lives and the systems in the service supported this practice.

Medicines were managed safely and people got them on time and in the correct way. There were enough staff on shift to meet people’s needs and people could access activities of their choice and these included trips out of the service.

People, staff and visitors had been asked about their experiences and this information was being used to look at the ways the service could be improved.

Staff knew how to recognise and report any suspicions of abuse, and people told us they felt safe and cared for. The registered manager had a robust recruitment process, and supported staff to develop their skills and knowledge. Staff told us they enjoyed their work and worked well as a team.

Accidents and incidents were appropriately recorded and when these had occurred investigations had been carried out. Risk assessments were in place for people who used the service. Staff worked well with health care professionals, to ensure people maximised their health and wellbeing and had access to medical services when this was needed. People and their relatives told us they were aware of how to make a complaint and that the registered manager listened to them.

The registered manager carried out audits to look at the quality of the service people received. They asked for people’s feedback and used this information to look at ways the service could be improved.

At the last inspection, the service was rated good, however we have found that the service requires improvement in some areas. We found a number of 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.

People were not supported to have maximum choice and control of their lives and the systems in the service did not support this practice.

People’s consent had not been obtained to film them using covert surveillance in the lounge and communal areas. There were no signs telling people that they were being covertly filmed. Consent to provide care was verbally obtained but formal consent forms had not been signed as part of the assessment process.

We could not be assured that the security of people would always be maintained. On arrival, the front door was unlocked and we could freely access parts of the home undetected.

Activities arranged for people were limited and focused on activities that took place in the home. Some people told us they would like to do more activities based on their likes and interests and to have more trips out of the home in order to meet their social needs.

People’s medicines were not always managed safely and there were was not always enough staff on shift. Increasing staffing levels would help ensure that people were supported to follow their interests and take part in activities that are meaningful to them.

Information was not used to continuously improve the service. People, staff and visitors had not been asked about their experiences of using the service, so any changes made had had not been directed by the people who were living there.

Food met people’s nutritional needs, but people told us the menu choices and the quality of the meals could be improved.

Staff knew how to recognise and report any suspicions of abuse, and people told us they felt safe and cared for. The registered manager had a robust recruitment process, and supported staff to develop their skills and knowledge. Staff told us they enjoyed their work and told us they worked well as a team.

Accidents and incidents were appropriately recorded and investigated, and risk assessments were in place for people who used the service.

Relatives and visiting health professionals told us there was a positive atmosphere and staff were approachable and knowledgeable.

Staff worked well with health care professionals, to ensure people maximised their health and wellbeing and had access to medical services when this was needed and people and their relatives told us they were aware of how to make a complaint and felt that they were listened to by the registered manager.

Further information is in the detailed findings below.

This inspection was conducted by a single inspector. Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary, please read the full report.

We spoke with five people who lived at the home. The manager was not present in the home, although we spoke with them on the telephone. We also spoke with three members of care staff. We looked at written records, which included people's care records, medication systems and quality assurance documentation.

Is the service safe?

We found the accommodation to be warm and clean and the provider had taken steps to ensure it was suitably maintained. There were sufficient skilled and experienced care staff on duty. There were proper processes in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

The provider ensured that medicines were stored safely within the home. However, the provider did not have a sufficiently robust system for the safe receipt of medicines into the home and the administration of medicines to people. The provider could not always demonstrate that people had received their prescribed medicines and could not always account for the amount of medicines stored in the home. This meant that people were not always protected by safe and effective medication administration systems.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring safe and robust medication administration systems.

Is the service effective?

People we spoke with were satisfied with the care and support they received. No one raised any concerns with us.

People were treated with dignity and respect. People were given information and support to help them understand the care and support available to them. Care plans and risk assessments were informative, up to date and regularly reviewed. All of the staff we spoke with were knowledgeable about individual people's care needs, and this knowledge was consistent with the care plans in place.

Is the service caring?

We spoke with five people who lived at the home. One person said to us, "I've lived here a long time. The staff are very kind and can't do enough for you." Another person said, "The home suits me well. You can have a laugh and a joke with the staff. I'm very happy."

We witnessed the care and attention people received from staff. All interactions we saw were respectful, kind and friendly. There was a good rapport between staff and the people who lived there.

Is the service responsive?

People were consulted about and involved in their own care planning and the provider acted in accordance with their wishes. Where people did not have the capacity to give consent, we found the provider acted in accordance with legal requirements.

Three staff members told us that the manager was approachable and they would have no difficulty speaking to them if they had any concerns about the service.

Is the service well led?

Staff said that they felt well supported by the manager, there was a good team ethic and they were able do their jobs safely. People who lived at the home and their representatives were asked for their views about their care and support, and their views were acted upon by the manager.

We saw that there was enough staff on duty to keep people safe and that staff were attentive to their needs. We observed that staff respected people's privacy and dignity and sought their agreement before providing any support or assistance. The people we saw were relaxed, engaged with their surroundings and interacted with each other.

People told us they were comfortable and liked living at the service. One person told us, 'It's not so bad here, they (the staff) are good and work very hard.' Another person told us, 'I have lived here four years now and wouldn't want to go anywhere else.' People told us that staff always asked their consent before they supported them, one person told us, 'They (the staff) take their time and don't rush me.'

One person's relative we spoke with was complimentary about the service and found that the staff were caring and supportive. They told us that, 'They are marvellous here, I have no worries and no complaints.'

We saw that the service had taken precautions to protect people from infection and that staff had received training in infection control and food hygiene.

We saw that the provider had an effective system in place to enable people to make complaints and that they were managed properly.

A number of people were not able to tell us directly about their experiences. However, we observed that they were relaxed and comfortable with the staff. Staff interaction was positive and respectful. For example staff knocked on bedroom doors before entering and assisted people to eat their lunch in a patient and gentle way.

The Belfry had all the necessary policy and procedures, records, quality assurance and monitoring systems in place for the protection of people who used the service. Staff were recruited appropriately, carried out their caring responsibilities well and people and their families were involved in their care arrangements.