Archived: Belle Vue Lodge

Updated 24 January 2020

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.

Inspection team

The inspection team consisted of one inspector, one assistant inspector, a specialist advisor in dementia care and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Belle Vue Lodge 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The inspection was unannounced.

What we did before the inspection

We reviewed any notifications we had received from the service (events which happened in the service that the provider is required to tell us about). We reviewed the last inspection report. We asked Healthwatch Nottingham for any information they had about the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We also asked commissioners for their feedback about the service. Before the inspection we asked the provider to send us their Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We received the PIR after the second day of the inspection, however, we reviewed this information and as part of the inspection process.

During the inspection

As part of this inspection, we spent time with people who used the service talking with them and observing support; this helped us understand their experience of using the service. We observed how staff interacted and engaged with people.

We spoke with eight people who used the service, six visiting relatives and a relative on the telephone. We also spoke with five visiting health and social care professionals and a representative from Age UK who was a befriender.

We spoke with the registered manager, operations manager, deputy manager who was also the clinical lead, the safeguarding and dementia lead, the Human Resources manager, three nurses, the cook, a housekeeper, a senior care worker and five care workers.

We reviewed a range of records. This included 11 people's care records. We looked at four staff files. We reviewed a variety of records relating to the management of the service, including accidents and incidents, numerous medicine records, policies, audits, staff training and checks on health and safety.

After the inspection

We continued to seek clarification from the provider to validate evidence found in relation to resident and staff meetings, social inclusion and the current action plan. This information was included in the inspection.

Updated 24 January 2020

About the service

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.