Belvidere Nursing Home Limited

Belvidere Nursing Home provides accommodation for up to 35 people who need help with their personal care. At the time of the inspection 23 people lived in the home. Some of the people living in the home, lived with dementia.

People's experience of using this service

Wirral NHS Infection Control Team raised concerns with CQC about infection control practices within the home. CQC visited to inspect infection control standards. We identified serious concerns with the management of infection control and COVID-19. Infection control standards and procedures did not comply with government guidelines. This meant people were not adequately protected from the risk of infection. We spoke with the manager immediately to ensure improvements were made.

We returned to the service three days later, to check on progress and saw that infection control improvements had been made. During this visit, concerns relating to medication management, record keeping, leadership and governance were also identified.

The management of medication was not always safe as it did not adhere to recognised standards of best practice. The competency of staff to administer medication safely had also not been properly assessed. This placed people at risk of harm.

People’s risks were assessed but information and guidance for staff to follow was not always up to date or sufficient. Other records relating to the care people received were repetitive and not always meaningful. This meant it was difficult to tell from people’s records what care they received. We asked the manager to ensure people’s care plans and daily records were updated without delay. A lack of accurate record keeping in places people at risk of inappropriate or unsafe care.

Accident and incidents were recorded but record keeping in relation to this and other aspects of service delivery also required improvement. For instance, audit records and safeguarding records did not provide sufficient information about what had been reviewed and what action had been taken to respond to or, drive up improvements.

The systems in place to monitor the quality and safety of the service were ineffective. This meant the concerns we identified had not been picked up and addressed. The manager’s knowledge of best practice guidance required improvement to ensure the service complied with relevant standards and legislation.

Staff recruitment was safe and there was enough staff on duty to meet people’s needs. People’s relatives told us staff were kind, caring and attentive and felt people were well looked after. Everyone was complimentary about the home and felt it was a good service. This provided some assurances that people were not at significant risk of harm whilst improvements to the service were being made.

Rating at last inspection and update

The last rating for this service was good (published 20 September 2018).

Why we inspected

The inspection was prompted in part due to concerns received about infection control from Wirral NHS Infection Control team. A decision was made for us to inspect and examine those risks. A targeted CQC inspection looking specifically at infection control standards took place on the 04 February 2021. We have found evidence that the provider needed to make urgent improvements with regards to infection control and COVID-19

As a result of these concerns, we widened our inspection and undertook a focused inspection on the 09 February 2021. This inspection included the key questions of safe and well-led. During this inspection we found that the provider needed to make improvements in respect of medication management, record keeping and the leadership and governance of the service.

We looked again at infection prevention and control measures under the Safe key question. We saw that progress on the provider’s infection control action plan was being made.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions 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.

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 monitor the service. 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 Regulation 12 (safe care and treatment) and Regulation 17 (good governance) with regards to the service.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Staff were provided with current infection prevention and control (IPC) guidance and the provider kept them up to date through regular meetings, newsletters and emails. Staff completed IPC training and regular competency checks to ensure they followed correct procedures and knew how to keep people safe during the COVID-19 pandemic.

Well stocked and clearly signed personal protective equipment (PPE) stations were located around the service. Staff were observed using correct PPE equipment when carrying out their duties.

There was a designated infection control lead who worked effectively with other staff to ensure they followed correct IPC procedures. Risk assessments and cleaning schedules related to Covid-19 were in place and regularly monitored. Increased cleaning schedules were in place.

Staff told us they felt safe at work and well supported by the registered manager and senior staff. Staff were provided with details of appropriate services should they wish to access independent support with their wellbeing.

People told us staff always wore the correct PPE and they felt safe living at Belvidere. Staff were observed social distancing whilst supporting people.

People received support to stay in touch with family and friends through telephone and video calls. Staff maintained regular contact and updates about people's health and well-being. Appropriate safety measures were in place to allow for any future visits to occur in a safe and controlled way.

People, staff and family members received regular updates to make sure they understood the precautions being taken, and how to keep people safe. Visitors to the home were managed in a controlled and safe way and given clear guidance around the correct use of PPE and the risks associated with Covid-19.

Further information is in the detailed findings below.

At our last inspection we rated the service Good At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The home has a registered manager who was supported by a deputy manager and the provider. 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.

Medications were safely managed. People who lived in the home and relatives we spoke with all gave positive feedback about the home and the staff who worked in it. The service had a relaxed feel and people could move freely around the service as they chose. People were able to have control over their lives and participate in activities they enjoyed.

Care plans and risk assessments were person centred and detailed how people wished and needed to be supported. They were regularly reviewed and updated as required with input from people and their families. Care plans showed that people's GPs and other healthcare professionals were contacted for advice about people's health needs whenever necessary. We saw the service had responded promptly when people had experienced health problems.

The registered manager and provider used different methods to assess and monitor the quality of the service. These included regular audits of the service and staff meetings to seek the views of staff about the service. The staff team were consistent and the providers were also involved in the running of the service.

Staff were recruited safely, received a robust induction and suitable training to do their job role effectively. All staff had been supervised in their role.

The home had carried out various checks to ensure the environment was safe and infection control processes were in place.

Further information is in the detailed findings below.

Belvidere Nursing Home is situated in a residential area of Wallasey and can provide nursing and residential care or short term care for up to 35 people. There is parking to front and rear and a pleasant garden area at the back of the property.

The home required a registered manager. 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. There was a registered manager in post, who is registered with the Care Quality Commission.

The staff in the home knew the people they were supporting and the care they needed. We observed staff to be kind and respectful and the home provided a range of activities to occupy and interest people. This promoted their well-being. People who lived at the home and staff told us that the home was well led and staff told us that they felt well supported in their roles. We saw that the manager was a visible presence in and about the home and it was obvious that they knew the people who lived in the home extremely well

We observed a medication round and saw that this appeared safe, the drugs were given and

people were observed taking them. All the medication was in date and appropriately labelled and the Medication Administration Records were well maintained and completed appropriately with

staff signatures. This showed people’s medicines matched what had been administered. Medicines were stored safely and there was evidence that staff administering medication were trained and competent to do so.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to in the home. We also saw that that 14 staff had attended Deprivation of Liberty (DoLS) training, this included senior staff and care staff.

Staff were recruited safely and there was sufficient evidence that staff had received a proper induction or suitable training to do their job role effectively. The majority of staff had been supervised and appraised. The registered nurses had the appropriate checks regarding their registration with the Nursing and Midwifery Council.

The provider had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults.

The provider’s emergency procedures and some health and safety checks required improvement to ensure people could be evacuated safely in case of emergency and this was carried out during and following the inspection.

People said it was, 'a lovely home, the staff are ever so nice', and a new member of staff said they had wanted to work there after visiting a person resident at the service because it was 'so good.' Relatives said that they had been involved in discussions about their parent's needs and had seen and signed care plans.

We spoke to people and observed the administration of medicines and saw that documented policies were adhered to in a safe way.

The people that we spoke to said that they had never had reason to make a complaint but that they believed that it they did raise concerns they would be taken seriously and acted upon. We saw staff interacting and caring for people who use the service and they did so in a caring way, calling people by name. Staff were able to describe the needs of different service users showing us that they understood what care individuals needed.

Staff told us that they were encouraged to do NVQ training and that they received regular update training and we saw records of training received. Staff said they felt supported by their managers.