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Care Home: Belvidere Residential Care Home

  • 41-43 Stourbridge Road Dudley West Midlands DY1 2DH
  • Tel: 01384211850
  • Fax: 01384241715

Belvidere is a large extended and adapted detached property, with a large frontage set back from the main road, with a eight car parking spaces. There are large landscaped gardens to the rear, with flowerbeds, mature trees and shrubs, a pond and fountain. There is additional car parking for up to 10 cars at the rear of the premises. The home is located between Dudley and Brierley Hill on main bus routes and close to local amenities. The home provides accommodation and residential care for up to 28 older people, including up to five people with dementia and two with mental disorders. The home does not provide nursing care. Accommodation is provided on two floors and includes 22 single bedrooms, three companion bedrooms, some of which have been improved with en suite facilities. There are bathing and toilet facilities within easy access on each floor. There are three lounges and a conservatory on the ground floor and a main dining room next to the kitchen. There is a hospitality lounge with refreshment facilities, which can also be used for relatives for overnight stays if necessary. The home has a large, well equipped laundry and offices. There is a passenger lift and two stair lifts and a range of aids and adaptations, including a `nurse` call system to assist people. The information relating to fees was contained in the service user guide andBelvidere Residential Care HomeDS0000073181.V377171.R01.S.doc Version 5.2 fees ranged from £378 to £410, with an additional charge of 5% for respite stays. There were no third party top up fees charged. People are advised to contact the home for up to date information about fees. Additional costs included hairdressing and private chiropody, which can be provided within the home for an additional fee.Belvidere Residential Care HomeDS0000073181.V377171.R01.S.docVersion 5.2Page 6

  • Latitude: 52.502998352051
    Longitude: -2.1029999256134
  • Manager: Mrs Jacqueline Spittle
  • Price p/w: £394
  • UK
  • Total Capacity: 28
  • Type: Care home only
  • Provider: Belvidere Residential Care Home Ltd
  • Ownership: Private
  • Care Home ID: 19127
Residents Needs:
Old age, not falling within any other category, mental health, excluding learning disability or dementia, Dementia

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Belvidere Residential Care Home.

Key inspection report CARE HOMES FOR OLDER PEOPLE Belvidere Residential Care Home 41-43 Stourbridge Road Dudley West Midlands DY1 2DH Lead Inspector Mrs Jean Edwards Key Unannounced Inspection 18th August 2009 07:30 DS0000073181.V377171.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Belvidere Residential Care Home Address 41-43 Stourbridge Road Dudley West Midlands DY1 2DH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01384 211850 01384 241715 Belvidere Residential Care Home Ltd Mrs Jacqueline Spittle Care Home 28 Category(ies) of Dementia (5), Mental disorder, excluding registration, with number learning disability or dementia (2), Old age, not of places falling within any other category (28) Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia over 55 years of age (DE) 5 Old age not falling within any other category (OP) 28 Mental Disorder (MD) 2 The maximum number of service users to be accommodated is 28 2. Date of last inspection N/A New Registration Brief Description of the Service: Belvidere is a large extended and adapted detached property, with a large frontage set back from the main road, with a eight car parking spaces. There are large landscaped gardens to the rear, with flowerbeds, mature trees and shrubs, a pond and fountain. There is additional car parking for up to 10 cars at the rear of the premises. The home is located between Dudley and Brierley Hill on main bus routes and close to local amenities. The home provides accommodation and residential care for up to 28 older people, including up to five people with dementia and two with mental disorders. The home does not provide nursing care. Accommodation is provided on two floors and includes 22 single bedrooms, three companion bedrooms, some of which have been improved with en suite facilities. There are bathing and toilet facilities within easy access on each floor. There are three lounges and a conservatory on the ground floor and a main dining room next to the kitchen. There is a hospitality lounge with refreshment facilities, which can also be used for relatives for overnight stays if necessary. The home has a large, well equipped laundry and offices. There is a passenger lift and two stair lifts and a range of aids and adaptations, including a nurse call system to assist people. The information relating to fees was contained in the service user guide and Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 5 fees ranged from £378 to £410, with an additional charge of 5 for respite stays. There were no third party top up fees charged. People are advised to contact the home for up to date information about fees. Additional costs included hairdressing and private chiropody, which can be provided within the home for an additional fee. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. We, the Care Quality Commission (CQC), undertook an unannounced key inspection visit. This meant that the home had not been given prior notice of the inspection visit. We monitored the compliance with all Key National Minimum Standards at this visit. The range of inspection methods used to obtain evidence and make judgements included discussions with the registered manager and staff on duty during the visit. We also talked to people living at the home, and made observations of people without verbal communication skills. Other information was gathered before this inspection visit including notification of incidents, accidents and events submitted to the Commission. We looked at a number of records and documents. The registered manager submitted the homes Annual Quality Assurance Assessment (AQAA) as requested. We looked around the premises, including communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and peoples bedrooms, with their permission, where possible. The home had been operating with the same provider since 2000 and had achieved a Three Stars, Excellent quality rating. A change in circumstances meant that the home received a new registration in 2008 and this inspection was conducted accordingly. Surveys were sent to people living at the home, relatives, advocates, staff and health professionals. Collated views and comments have been included in this report. The quality rating for this service is Three Stars. This means the people who use this service experience excellent quality outcomes. What the service does well: The information about the home was up to date and easy to understand, with alternative versions for people who may not be able to read or understand written information. Everyone living at the home had a contracts and terms and conditions, which were clear and easy to understand. Comments were positive and included, it is a well run home. Each person, and as appropriate, their relatives were involved in the plan of how their care is to be provided. Care plans were well written and up to date, giving staff instructions how to care and support each person. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 7 The medication systems were managed well and people received their medication at the time prescribed by their doctor. There were very good relationships with the local health care services, providing support for people living at the home. A district nurse told us that the staff were knowledgeable about the peoples healthcare needs and always sought advice for any concerns. She also told us that they managed the care of people with diabetes well. Comments from surveys included, efficient, caring staff. This demonstrated the very good level of trust and professional respect between the home and primary care services. People were encouraged to treat the home as their own home and to be as independent as possible. Comments included, staff give people lots of encouragement and I often hear the phrase, of course you can. People could make choices about their daily routines, activities and meals. They were encouraged and supported to take an active part in meetings and surveys at the home. The Friends of Belvidere, relatives and residents meetings were well established and generally well attended, with notes of topics discussed and action taken as a result. There were lots of activities, events and outings, which many people told us they enjoyed. There was good involvement in the running of the home and people had contributed their views about the activities, planned outings and food. The majority of people told us they enjoyed their meals, which looked appetising. Relatives and visitors were invited to have refreshments and meals at the home if they wished. The home had achieved 5 Stars and Gold Awards for food safety and healthy eating. There were good links with local churches and arrangements were in place for people to practice their faith. People knew how to raise concerns and make complaints and were confident these would be dealt with. Up to date policies and procedures for protecting people from harm were available and staff had completed safeguarding training. There was a good understanding about how to keep people safe. The home had a relaxed, homely ambience and it was warm, generally clean and comfortable. Comments from people and their relatives included, I like living here, and the home is always clean, tidy, warm and comfortable There was an on going programme of redecoration and refurbishment and improvements had been made to achieve better facilities such as en suites in some bedrooms. People were encouraged to personalise their bedrooms with their possessions, furniture and bedding if they wished. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 8 The staff were caring, committed, flexible, and well trained. Staff were checked to make sure they are suitable to work with vulnerable people. The home has Dignity Champions, who monitor how people are treated and look for additional ways to improve peoples lives at the home. Comments included, the staff are wonderful and always go the extra mile. There were effective management systems with regular quality audits to make sure people are cared for in a safe environment. Comments included, we feel that the present service and care provided is excellent, and experience at this care home has been very good. The manager came to see X, we also visited the home. I could not believe how well I was treated, I was able to stay overnight when X was very ill. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4, 5. Standard 6 is not applicable. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an easy to read statement of purpose and service user guide and people living at the home have contracts terms and conditions of occupancy. This means that that people and their advocates have good information regarding their rights and entitlements, and how care will be provided. The home uses comprehensive assessment tools so that each persons needs are thoroughly assessed to ensure that their needs and preferences will be met. The home actively encourages introductory visits, which gives people the opportunity and time to make decisions, which are right for them. EVIDENCE: The information contained in the homes AQAA (Annual Quality Assurance Assessment) about what it did well stated, we offer any prospective new service user a trial visit. We ensure that a full assessment of all needs is Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 11 undertaken. Past history, likes and dislikes are assessed when the person centred care plan is devised. Prior to admission we confirm in writing that we can meet the specific needs of the service user. All service users are issued with a terms and conditions of residence after their trial period. Copies of our statement of purpose and service user guide are openly accessible and available in our main reception along with our complaints procedure and details of our advocacy service. We have on display various publications which include Real Voices, Real Choices, and Choosing the Right Service. We were able to verify the information in the AQAA. We saw that the home had an up to date statement of purpose and service user guide on display and in comprehensive welcome packs in each bedroom. These documents could also be provided in alternative formats on request. The aims, objectives and admission criteria were clearly set out and information about the home was easy to read and understand. The service user guide also had information about the range of fees and payment arrangements. Overall the information was useful for people to help them make decisions about their choice of home. We looked at a sample of case files of people recently admitted to the home, which showed that each person was provided with a contract and statement of terms and conditions. This document had been updated and was easy to read and understand and set out in detail what was included in the fee, the role and responsibility of the provider, and the rights and obligations of the person living at the home. Responses from discussions during the inspection visit confirmed people felt they had the right information to make a choice about the home and had received a copy of their contract or terms and conditions for their stay at the home. A relative of someone no longer living at the home, who had continued to visit told us, I have booked my place here, when my times comes. There was also evidence from the sample of care records and from discussions, which confirmed the good practices claimed in the homes AQAA, such as pre admission assessments. These were conducted professionally and sensitively and had usually involved the family or advocate. The pre-admission assessment documentation was well completed and individual preferences were recorded such as rising, retiring, preferred activities, likes and dislikes. There were also life history books for each person. This meant that staff had good and accurate information about each persons needs and preferences about how they wished their care to be provided. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk management provide staff with the information and guidance to meet peoples needs and preferences. Good multi disciplinary working takes place on a regular basis, giving people assurances that their health needs care needs are identified and well met. People living at the home can feel confident they will receive their medicines as prescribed by their doctor. Each person living at this home can be assured that they will be treated with dignity and respect. EVIDENCE: We looked at a sample of care records for new people admitted to the home and people who had lived at the home for longer periods of time. Each person had a comprehensive care plan to meet their needs for care and support. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 13 There was good practice of involving the person and their relatives or advocates in the development and review of their planned care. Care plans were based on very comprehensive assessment information and included all essential information about each persons needs and identification of any associated risks. The personal preferences such as gender of carer, recording each persons preferred daily routines for staff guidance, and the introduction of my life history, made sure that care was delivered with a person centred approach. This initiative was implemented well. From records and discussions we saw that each persons health was carefully monitored with appropriate action taken. There was evidence of well documented health care assessments, and screening tools, such as falls assessments, tissue viability and the Malnutrition Universal Screening Tool (MUST), which were used to assess skin condition and weight. The records for a person who was admitted to the home on a Guardianship Order for their safety, showed refused to be weighed recorded every day since admission. This told us staff had persevered to monitor this persons weight and the registered manager told us though staff had also tried to use the MUST this had also not been possible. We noted that this person had a tissue viability sore assessed as low. The form devised by the home did not clearly identify the risks, such as previous pressure ulcers, poor appetite and medical conditions. We recommended that the form should be reviewed to give an accurate assessment or a recognised tissue viability screening tool should be used. The registered manager introduced the Waterlow screening tool, used by Dudley Primary Care Trust (PCT) immediately following our inspection visit, and sent us documentary evidence of its implementation. There were examples where significant changes had been referred to doctors and health care professionals such as dieticians, speech and language therapists and the falls team for advice and support and appropriate reviews and monitoring. A visiting district nurse told us that she felt staff were helpful and knowledgeable about peoples needs and she was satisfied with the care and monitoring arrangements for people with diabetes living at the home. She commented that the home was managing the care of someone with very unstable diabetes and early onset dementia exceptionally well. Although we saw evidence that the district nurses were involved in monitoring diabetic care we noted that in one persons care plan from the funding authority, diabetic nurses to follow up and we recommended that the home should make use of Dudley PCT specialist diabetic nurse services for advice, support and training for staff. We saw that all persons living at the home had good access to health care services to meet their assessed needs. The home had a contract with a local GP who provided care for the majority of people and attended the home for a weekly surgery. We were told that some people were able to remain with their own GP within the limits of geographical borders. There was documentary Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 14 evidence to demonstrate that all persons had good access to dentists, opticians, and other community services such as chiropody. The home operated a key worker system to enhance the quality of individual, person centred care for people living at home. This fostered good relationships between each person and their named worker. Staff spoken to demonstrated that they knew about each persons needs and preferences. The registered manager had also introduced a system of daily task cards for all staff on duty so that there was a fair allocation of duties, which also promoted accountability. The laminated cards all carried the statement, residents needs come before all tasks. We were told this system had improved team working. We looked at the homes systems to manage the medication. The home used a Monitored Dosage System (MDS) for people living at the home on a permanent basis. We saw that the supplying pharmacy supported the home with advice related to medication issues at regular audit visits. The most recent audit reports stated, Excellent. We were told that all senior staff had received ASET accredited medication training, and we saw the certificates on file. The deputy manager and senior staff were knowledgeable about each persons medication and the systems for ordering, receipt, storage and administration were very well managed. The lockable medication refrigerator was checked daily, with the minimum and maximum temperatures documented and recorded. This meant that peoples medication requiring refrigeration was stored at the correct temperatures to maintain its integrity and effectiveness. The storage of medication was well organised and there was good stock control with no excessive medication stocks. The area used for storage had no external ventilation and was not currently monitored for temperature control. A thermometer should be provided with daily temperatures recorded to make sure medication was appropriately stored in accordance with manufacturers guidance, below 25 degrees C. Where temperatures are in excess of 25 degrees C, there must be appropriate arrangements, such as use of an air conditioning unit, to ensure medication does not lose its effectiveness for peoples health and well being. There was appropriate storage and records of Controlled Drugs and the random audits we carried out were accurate. We looked at a sample of MAR (Medication Administration Records) charts, which document each persons current medicine requirements and regime. These were well maintained, which meant that there was an accurate record to show medicine prescribed by their doctor was recorded, checked, monitored and administered in accordance with instructions. There were appropriate procedures and checks in place to make sure that people received their correct Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 15 medicine at the right time. Protocols and care plans had been put in place for the administration of when and as required (PRN) medication. We saw effective practices such as variable dosages recorded and handwritten entries on MAR charts signed and witnessed by two staff to make sure the information was correct, which reduced the risk of errors. The receipt, administration and disposal of medicines was also well recorded. The date of opening of medicines in original containers was documented, which meant it was easy to carry out audits. We carried out audits on a random sample of medication to ensure that medicine had been given to each person as prescribed by the GP. The random audits undertaken of prescribed medication were found to be accurate. However we recommended that a triangle should be obtained for hygienic and accurate audits of tablets dispensed in original containers. From our observations and in discussions it was evident that all staff were aware of how to treat each person with respect and to consider their dignity when delivering personal care. A relative commented, staff always go the extra mile. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person can always be assured that there will be appropriate activities for them to enjoy. People are enabled and encouraged to maintain good contact with family and friends. The dietary needs of each person are catered for with a balanced and varied selection of foods that meet their preferences and nutritional needs. EVIDENCE: The homes AQAA cited the following evidence of what was done well, we encourage contact with families and friends and always promote personal choice and autonomy for service users. We provide a well-balanced, wholesome, nutritional menu. (We have received an award from the NHS, Dudley Food for Health Award where we achieved Gold. We have formed Friends of Belvidere Association where we seek views or service users and families regarding activities and outings. The chairperson of this association is the daughter of one of our current service users. Since the Association we started we have made trips to the Black Country Museum, Merry Hill shopping Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 17 centre, Musical Matinee at Dudley Concert Hall, the West Midlands Safari Park, Himley Hall Park, pub lunches and a visit to the Grand Theatre, Wolverhampton to see Chitty Chitty Bang Bang. We have live entertainment by Ken on a monthly basis. We have held several fund-raising events including a table top sale, race night, and a summer fete. We have in-depth social and leisure care plans which are person centred. We saw ample evidence which confirmed the accuracy of the claims made in the homes AQAA. We saw that staff listened to people living at the home and made considerable efforts to provide flexible daily living routines, which enabled people to enjoy a good quality of life according to their personal preferences. We noted earlier in the report that the home has a key worker system, which enabled closer relationships between the people accommodated and staff, where likes, dislikes and needs were known in more detail and were met in a person centred way. We were told that the home had employed a senior carer who was also allocated additional hours as an activities organiser. Staff at the home also took responsibility for collating the information gained from Friends of Belvidere, residents and staff meetings and used their knowledge of peoples preferences to help to plan activities, which each person could enjoy. There was a range of activities available and good access to the community. We saw people doing craftwork, singing and participating in a quiz, which also involved visitors. We saw pictures of trips and outings. We were told that ideas from meetings were discussed and planned so that people were involved as much as possible. We saw information displayed in attractive formats in the reception bringing peoples attention to community events and activities. The home had introduced theme days, which included, a day at the seaside, a day at the zoo, cops and robbers, famous movie stars, we were told these events were enjoyed by the people living at home and staff who participated enthusiastically. A new large flat screen, plasma TV had been provided so that people could view the screen more easily for enjoyment of events such as, movie night. Relatives surveys returned to us included comments such as, motivation is a key factor and all residents are invited to take part in activities like games, craftwork, baking, drawing and colouring or just listening to music or sing-a-longs friends and relatives are invited to meetings, functions and outings, children are always made welcome. It was understood and respected that some people preferred to spend their time in their own bedrooms, and they were supported with individual interests. We saw evidence that the staff knew and understood about peoples faith and where this was an important part of their life, they were supported to attend services as and when they wished. One person received regular visits from the Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 18 local Roman Catholic Church so that they could receive Holy Communion, which was an important aspect of their faith. We also noted that staff were completing my life story for each person, which often gave staff valuable insight into each persons past life and improved the person centred aspect to their care. We spoke with staff who told us about one person who had been a senior manager in a large organisation. Their knowledge about this persons previous lifestyle gave them an appreciation of some of the reasons for behaviours associated with their condition. We saw evidence that family and friends were welcomed and people we spoke to told us they knew they could visit the home at any time. We were told that the management and staff team always made time to talk to visitors, offer refreshments and share information where this was appropriate. Comments included, you are made very welcome with a cup of tea and biscuits and a friendly smile by Jackie and the rest of the staff. We saw that people were encouraged to bring in their personal possessions to personalise their room. We saw inventories of personal possessions on the sample of files examined, which were up to date, signed and dated by the person or their representative and witnessed by the member of staff. We discussed nutrition with the staff and the manager. They were knowledgeable about each persons nutritional needs and we saw that a choice was always offered. There was regular use of the MUST (Malnutrition Universal Screening Tool) and BMI (Body Mass Index) screening. This made sure that any concerns about each persons weight were quickly identified with action taken to involve doctors and dieticians as needed. We saw that the monitoring arrangements also reflected the good hydration and nutrition at the home. We saw plenty of cool drinks available around the home and heard staff offering frequent warm drinks. Special diets such as diabetic and soft diets were provided. There was also added calorific value at mealtimes for people with poor appetite or at risk of weight loss, using cream, butter and cheese. The home had achieved the Gold Award from Dudley Environmental Health for healthly eating and a 5 star rating for Scores on Doorsaward for food safety. We discretely observed mealtimes and saw that staff were aware of the needs of people who found it difficult to eat and we noted that they offered sensitive assistance with feeding. They were aware of the importance of offering food at the persons pace, so that they were not hurried. A small number of people chose to have their meals at a different time, or in their bedrooms, to allow them time and space to eat at their own pace. Efforts had been made with the dining room to make it look inviting with attractive tablecloths, crockery and condiments. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 19 There were colourful pictures of meals and snacks, which looked appetising and appealing. There were also large print menus to show daily meal choices. These assisted people make real choices for their meals. The meals appeared appetising, and meal times were protected to provide a sociable, enjoyable experience. We asked a sample of people about the food at meal times, and received generally very favourable comments, the food here is very good. Two people told us they did not like the food; however we observed that people were offered other alternatives to the choices offered at each mealtime. We noticed that the fish alternative had been served with gravy to some people and although the catering staff told us this was their choice, we were unable to verify this. We raised this with the registered manager, who agreed to monitor that people were actually being served their choices. Relatives and visitors told us that they were invited to have meals if they wished. One person told us she regularly had a meal with her husband on three days each week and told us she really enjoy the food. We spoke to a member of Friends of Belvidere Association, who was visiting the home and stayed for lunch, which she told us was, very tasty. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be sure that any concerns and complaints are listened to and action is taken to look into them, with systems in place to record investigations and outcomes. There are good arrangements in place to safeguard people living at the home from risks of harm. EVIDENCE: There were copies of the homes complaints procedure displayed in the reception area, and there were versions in other languages and pictorial formats. There were also copies in the service user guide and in information packs given to each person. We saw signatures in care records demonstrating each person had received their copy. The AQAA cited the following about what the home did well, we ensure that our service users have access to advocacy services. We are sure that all staff, service users and families are aware of our complaints procedure and we uphold the ethos of welcoming any comments or complaints in whatever form and use information positively to learn from and improved service we provide. All staff are aware of the whistle blowing and protection of the vulnerable adults procedures. All staff are trained in the Protection/Safeguarding of Vulnerable Adults. This has been delivered by Dudley Metropolitan Borough Council Social Services. The manager and another senior member of staff had Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 21 attended a course in the Management Responsibilities in the Protection of Vulnerable Adults, which was run by Sandwell Social Services. The manager and two other staff members attended training in Deprivation of Liberty safeguards. Information in the Homes AQAA told us that the home had received four complaints, over 12 months, which had been investigated and upheld by the provider within 28 days, with satisfactory resolutions implemented. There were complaint forms available, which provided detailed information. The responses during the inspection indicated that people were aware of how to raise concerns or use the homes complaints procedure. This demonstrated positive practice and the homes proactive response to peoples experiences and perceptions of the service. We also saw that advocacy information was readily available around the home. There was a copy of Dudley DACHS (Directorate of Adult Community and Housing Services) multi-agency Safeguard and Protect procedures relating to safeguarding vulnerable persons. There were also policies and procedures such as Whistle blowing, which were in line with regulations and other external guidance readily available, with staff signatures to demonstrating their awareness. We saw evidence that the registered manager and some senior staff had attended training regarding Mental Capacity Act and Deprivation of Liberty safeguarding (DOLs) regulations and she told us about her plans to make this training available to the staff team, which demonstrated a very positive proactive approach. The manager had made a referral for one person who was deemed to be a risk in the community and had been admitted to the home. In addition to a Guardianship Order there was Deprivation of Liberty safeguarding documentation in place from the appropriate agency, for three months, which gave the home clear guidance for actions for this persons care. The majority of staff had attended training, which provided appropriate awareness of safeguarding vulnerable adults and staff we spoke to were aware of what they needed to do should an incident occur. The organisation followed appropriate recruitment processes to make sure only staff suitable to work with vulnerable people were employed at the home. However we saw one staff file where information needed to be clarified. The registered manager sent us evidence that she had taken action to do this immediately after the inspection visit was concluded. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a warm, homely and comfortable environment for people living there. There are sufficiently robust systems in place for maintaining infection control. EVIDENCE: Belvidere was a large detached property, extended, adapted and renovated to high standards. There have been considerable efforts to make it homely and comfortable with people living there. There were three lounges and an attractive conservatory, in addition to the dining room, which meant that people could move freely around the home if they wished. The interior of the home was a bright, cheerful and homely. There were attractive rear gardens, with a large pond, appropriately guarded, and water fountain and garden furniture for people to use in the warm weather. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 23 We saw that the registered manager had a maintenance and renewal plan and a reporting system for minor repairs, which required a reactive response. She told us that the organisation employed maintenance staff to carry out on-going redecoration, renovation and refurbishment and we saw evidence of this during the inspection visit. We looked at a sample of bedrooms with peoples permission where possible. The majority were attractively furnished and some had been renovated and improved with en suite facilities. These had been attractively redecorated and personalised according to individual preferences, such as family photographs, ornaments and small items of personal furniture. We were told this was a rolling programme so that everyone at the home could have the very best facilities. The registered manager told us about her plans to continue to improve décor and the orientation of the communal environment for people with dementia, for example replacing floor coverings, renovating and using contrasting colours for bathrooms and toilets. The homes AQAA cited the following improvements to the environment, we have upgraded our larger single rooms with a WC / shower en-suite. We have laid non-slip flooring in one of our lounges and ground floor corridors. We have replaced the carpets in two single rooms with washable flooring. (this was to prevent infection). We have made alterations to one of our shared rooms, which has been upgraded with an en-suite WC. this room has been completely revamped this new carpet, furnishings and bedroom furniture. We have purchased and air conditioning unit for the conservatory for hot days. we have purchased new furniture for the conservatory and new dining room tables and chairs. We have made alterations to the main bathroom by replacing shower tray and creating a storage area. There large laundry was well equipped with commercial washers and tumble dryers and a rotary iron. The laundry service was generally well organised and the staff demonstrated good standards of infection control. There was a laundry procedure and supplies of disposable gloves and aprons readily available in the laundry at all times. The kitchen was maintained in good order, and it was clean and tidy and well organised. There were ample stocks of dried, frozen, and fresh foods, which included alternatives for people with special diets such as gluten-free, low-fat and reduced sugar items. The home had achieved the NHS and Dudley MBCs Environmental Health 5 Star Scores on the Doors and Gold Food Award for healthy eating and food hygiene. People told us that the home was clean, warm, and comfortable. These views were also confirmed in responses in surveys returned to us. Comments Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 24 included, the home is always clean and tidy and always warm, and the home and residents are always kept clean and tidy. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a stable staff team and good skill mix so that people receive consistent and good standards of care. The staff recruitment processes are robust, which means that there are effective safeguards for people living at the home. There is a strong commitment to staff training and development. EVIDENCE: The homes AQAA cited the following as evidence of what they do well, 95 of all care staff are trained or undertaking training to NVQ level 2 or above in care. All staff undertake Skills for Care induction. We have access to quality training providers. The manager, deputy and a senior carer are all qualified A1 Assessors and support staff through their NVQs. Four of our domiciliary staff have just completed their NVQ level 2 in hospitality and housekeeping, and are awaiting certification. we have seven senior members of staff who have achieved NVQ 3 in care. we have four members of staff trained to NVQ 4 in care management. the manager, senior care officer and a senior carer have attended training on infection prevention and have become Champions of Infection Prevention; this training was delivered by the Country Partnership for Care. we operate a robust recruitment procedure to ensure our service users are protected. We hold regular meetings to ensure inclusion and give support. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 26 We were able to verify the good practices claimed from observations, discussions and examination of samples of records during this visit. We noted that there were 26 people accommodated, with a variety of dependency levels and diverse needs. The registered manager told us that she reviewed staffing levels on a regular basis, taking account of the occupancy and dependency levels of the people accommodated. Assessment of staffing rotas and information from the AQAA and staff personnel records demonstrated that the home was maintaining satisfactory staffing levels. The Home has had a stable staff team including 19 care staff, 7 ancillary staff, the Registered Manager and Homes Supervisor. A small number of staff had left the homes employ since in the past 12 months, for valid reasons and there was ongoing recruitment as staff vacancies occurred. We looked at a sample of staff personnel files, which were well organised and contained necessary documentation. The registered manager was able to tell us about the recruitment procedures, which were robust. We discussed information for one person where references had not been obtained from the previous employer. Although the registered manager felt there were valid reasons and this person had previously worked for her, we recommended that references should be sought from the previous employer, which would show that procedures were being diligently followed. The organisation and registered manager continued to demonstrate a strong commitment to staff training and development and had continued to provide all staff with appropriate training to raise awareness and skills to respond to peoples changing needs. We saw evidence that the majority of care staff had achieved an National Vocational Qualification (NVQ) level 2 care award with new candidates registered for training. The majority of the senior team had achieved the NVQ level 3 management and A1 Assessors Awards and the deputy manager two additional senior staff had achieved the NVQ 4 in care management. The domestic staff had also achieved NVQ awards. We spoke with a visiting district nurse who told us it was a pleasure to visit this home and the staff were welcoming, knowledgeable and helpful. The staff told us they felt supported and this was confirmed in surveys returned to us. The comments received from staff included, warm friendly home, approachable management team, we feel we are listened to, and This is a lovely, friendly home and I feel proud to work here. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are effective management systems providing good leadership and direction, which ensures continuity and safeguards people. There are systems for consultation with people living at the home with peoples views formally sought and acted upon. EVIDENCE: Jacqui Spittle has been the registered manager at Belvidere for a year. She had previously worked at this home for a number of years in various roles. She had considerable managerial experience, and had achieved the NVQ level 4 Award and the RMA (Registered Managers Award). She continued to demonstrate a commitment to her own professional development. She had a good awareness of the recently implemented Deprivation of Liberty Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 28 Safeguarding Regulations and its implications for people living at the home as reported at the Complaints and Protection section. She planned to arrange for staff to receive appropriate training to raise their awareness and knowledge to benefit people using services provided at the home. The registered manager was very ably supported by the deputy manager, home supervisor, a qualified social worker, and the senior team. During discussions there was evidence of an open, approachable ethos, which encouraged good communication with people living at the home, their relatives and staff. We saw evidence that the registered proprietor visited the home regularly. We looked at the Regulation 26 Reports held at the home and noted that they were comprehensive and constructive. The quality assurance system was based on KLORA (Key Lines of Regulatory Assessment) and equality and diversity. We saw evidence of very positive quality audits during this inspection visit, which meant positive outcomes for people receiving the service. There were clear lines of accountability within the home, and through the management structure. We noted that the registered manager had devised and implemented the homes annual business and development plan for the current year. We saw very good evidence that the registered manager had used self auditing systems, and these included monthly audits of areas such as peoples case files, medication, food, the environment, staffing levels and accidents, incidents and falls, with remedial actions to minimise risks identified. The registered manager and staff team have continued their efforts to involve people living at the home, their relatives, representatives and other community stakeholders in the running of the home. We noted that there were regular monthly residents meetings with minutes available and efforts to encourage participation. The home had good support from The Friends of Belvidere, who helped with fund raising, activities and outings. The homes survey questionnaires had been distributed to people at the home, relatives and stakeholders, with completed forms returned, and results collated and published. We saw evidence that the results had been acted upon in any area where there were concerns or where performance needed improvement. For example the meals were regularly discussed and reviewed. We noted that staff meetings were taking place, with minutes available. The structured formal supervision system appeared to be effective with supervision sessions identifying training needs, personal development and support. This staff development had benefits for people living at the home. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 29 We noted that people were offered the opportunity to manage their own money if they wished, and the home provided facilities to help keep it safe. We looked at a random sample of balances and records of monies held in temporary safekeeping on behalf of people living at the home, which were accurate, with well documented records of all transactions. We looked at a sample of heath and safety, fire safety and maintenance documentation, which was satisfactory and very well organised. There was evidence that all staff received mandatory training appropriate to their roles, such as fire training, drills twice each year, moving and handling, first aid, food hygiene, health and safety and infection control training. The registered manager had an effective system for auditing, analysing and evaluating accidents involving residents, with effective measures implemented. Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 3 4 4 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 4 3 3 3 X X 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 3 3 3 Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement To provide a thermometer with a record of daily temperatures of the storage area for medication and where temperatures are in excess of 25 degrees C, there must be appropriate arrangements, such as use of an air conditioning unit, to ensure medication is stored in accordance with manufacturers guidance. This is to ensure peoples health and well being is maintained. Timescale for action 01/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is recommended that care plans should be expanded to include additional information related to assessed identified needs, such as sleep patterns and night care needs. DS0000073181.V377171.R01.S.doc Version 5.2 Page 32 Belvidere Residential Care Home 2 OP8 Advice from Specialist Diabetic Nursing Service should be sought for people with diabetes, living at the home, with records of screening, support and advice offered and that a record be maintained of staff training in relation to diabetes. It is recommended that a triangle should be obtained for hygienic and accurate audits of tablets dispensed in original containers. References should always be sought from the previous, or most recent employer with reasons verified and recorded where this has not been possible. 3 OP9 4 OP29 Belvidere Residential Care Home DS0000073181.V377171.R01.S.doc Version 5.2 Page 33 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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Belvidere Residential Care Home 18/08/09

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