Care Home: The Belvedere

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What the care home does well The care plans written for people`s needs are of a good standard and are evaluated so that people know their needs are being checked. Staff are highly regarded and we received a variety of positive comments, "All the staff are so kind and so attentive to her needs and so tolerant, I would like to say thank you to all the staff who care for my relative - it makes my life so much better knowing how well she is cared for." People living in the home are given the opportunity to engage in activities and the standard of catering is good. The complaints procedure is displayed and people know who to speak to if they have any concerns. The Belvedere is a new purpose built care home and the building is fit for purpose and the fixtures and fittings are of a good quality so people live in pleasant surroundings. The home is well maintained. Mechanisms are in place to check that the quality of service provided is good so people know that the home is run in their best interests. What has improved since the last inspection? This is the home`s first inspection. What the care home could do better: The home should ensure that information about the home [Service User Guide] is available at all times so people know what services and facilities the home provides. The manager should ensure that assessments of people`s needs are accurate and carried out by someone skilled and competent to do this. The manager should ensure that care plans are kept in a lockable cupboard to preserve people`s confidentiality. Appropriate protection should be provided for people`s clothing at mealtimes to maintain their dignity. The home should demonstrate that people are given choice in their daily lives. All staff should undertake training in safeguarding adults so they know how to recognise abuse and what action to take if they suspect someone is being abused. There should be adequate staffing levels at all times to meet the care needs of people living in the home. Recruitment procedures need to be more thorough so that the home has obtained full information about staff before they start work at the home. All staff should take part in regular unannounced fire drills so they know what to do in the event of fire. The manager must tell us about events taking place in the home which can have an adverse effect on people living in the home and as required by law. Key inspection report Care homes for older people Name: Address: The Belvedere Horseshoe Lane Alderley Edge Cheshire SK9 7QP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: June Shimmin     Date: 0 9 1 2 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 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. 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 Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Belvedere Horseshoe Lane Alderley Edge Cheshire SK9 7QP 01625865020 01625590960 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Maria Mallaband Properties (5) Limited Name of registered manager (if applicable) Ms Sandra Rainey Type of registration: Number of places registered: care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories Old age, not falling within any other category - code OP Dementia - code DE The maximum number of service users who can be accommodated is 41. Date of last inspection Brief description of the care home The Belvedere Nursing Home is a new purpose built care home close to Alderley Edge. It offers permanent or respite nursing and dementia care to the elderly. The building and furnishings are of a high standard. The home is registered to take 41 residents. The home is built on four floors, with the laundry, kitchen and staff areas on the top floor. All bedrooms have ensuite facilities. Separate baths and showers are Care Homes for Older People Page 4 of 26 41 0 Over 65 0 41 Brief description of the care home provided for people who need assistance. Lounges and dining rooms are accessible to all residents. There is a garden which residents can use. The charges for living at the home are £750 to £1020, which includes the nursing contribution. This information has been provided by the manager. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The overall quality rating for this service is two stars. This means that the people who use the service experience good quality outcomes. This unannounced inspection took place over one day and lasted seven and a quarter hours. One inspector carried out the visit. The report will refer to we and us as it is written on behalf of the Care Quality Commission. This visit was just one part of the inspection. Other information we had received was also looked at. Before the visit the manager was asked to provide information about the home as part of the inspection process. We spoke to three people living in the home, three relatives and a number of staff members during our visit to the home. We also received written comments from a relative on behalf of a person living in the home. Their views are incorporated into this report. During our visit we looked at various records and the premises. Care Homes for Older People Page 6 of 26 What the care home does well: 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 Care Homes for Older People Page 7 of 26 order line 0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not always have their needs accurately assessed before admission so they do not know if the home can fully meet their needs. Evidence: As this is a new service we looked at the information that was given to people before they come to live in the home or at the time they move into the home. There was a leaflet about the home available in the reception area but this did not contain much information about the home, its service and facilities. Staff in the home thought that a full information leaflet [Service User Guide/SUG] was available but could not find one during our visit. Several people had moved from the next door care home and one relative said that she had watched the care home being built. She also commented that, she had spoken to the deputy manager at length on admission about her relatives background and history, been asked to bring in photos and information and felt that the staff were genuinely interested. The manager provided us with information before the visit in the form of an Annual Quality Assurance Assessment Care Homes for Older People Page 10 of 26 Evidence: [AQAA] in which she told us that the home provides a detailed SUG and that people are invited to visit the home prior to admission to look around and to have a meal with other people living there. The nurse in charge on the day of our visit told us that either the manager or her deputy assessed people before they were admitted to the home to make sure that the home could meet their needs. We looked at two assessments but there was not much information contained in either assessment. For instance there was little information about various risks relating to either persons care so that staff might be unaware of those risks before the people came to live at the home. The persons care needs were reassessed on the day of admission and further information was recorded about the risks. The nurse on duty told us that the deputy manager carried out both assessments but no longer works at the home. She also said that the home had tried to obtain further information by telephone. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 health and personal care needs of people living in the home are met. Evidence: We looked at two care plans and these were of a good standard overall. Although they were not totally person centred in content there was evidence that they were moving in that direction so that people would receive individualised care. The care plans had been reviewed but sometimes the changing needs were not added to the care plan so staff might not be aware of what new actions needed to be taken to meet peoples needs. The home used a variety of risk assessment tools so that any risks were identified and documented. We noted that the care plans were kept at the nurses station but that they were not locked up and could potentially be read by anyone. There was good evidence that staff contacted various health professionals including GPs, dentists and chiropodists to make sure that further health care needs were met. We looked at how medication was being managed and this again was of a good standard so that people received their medication in a safe manner. Several minor issues were brought to the attention of the nurse on duty who said that these would be addressed. Care Homes for Older People Page 12 of 26 Evidence: We observed care practices during our visit and noted that staff interacted well with people living in the home, demonstrating sensitivity and patience. We spoke to three relatives who said that staff were, so caring - theyre lovely and, extremely kind to us. We observed people at lunch and saw that blue plastic aprons were being used to protect the clothing of people. This form of protection is unsuitable as it does not support the individuals dignity and an alternative form of protection should be sought. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 good standard of nutrition and tries to ensure that people are stimulated. However, people may not always be able to express choice in their daily lives. Evidence: The Belvedere employs a person to provide activities so that people in the home are offered stimulation in their daily lives. We saw several people engaging in a cooking activity during the afternoon of our visit and they seemed to be enjoying themselves. The activity coordinator told us that she does 121 and group activities with people so that they can benefit from both types of activity. The home also provides joint activities with its sister home, Cavendish Court, which is next door. We saw details displayed of the activities taking place during the week but this was in very small print and would be difficult for anyone with poor eyesight to read. We saw the lunch provided for people in the home and this appeared appetising and nutritious. The main meal is served at lunch and there is a lighter meal in the evening, consisting of soup and sandwiches. We were told that there is currently no choice at lunch but that this will change during coming months. There were no menus displayed in the dining area so people might not know what the meal would be. People living in the home and relatives said that the quality of food was good, my relative likes the Care Homes for Older People Page 14 of 26 Evidence: food - very good chef. One person living in the home is no longer able to smoke. Means should be sought to ensure that this is discussed with the person and/or his advocate so that a solution is achieved that will ensure that the person is able to express choice and so that his rights are preserved. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Measures are in place so that people can complain if they wish but staff need to undertake safeguarding adults training so they are fully aware of their responsibilities in relation to the protection of vulnerable adults. Evidence: Although we could not see the complaints policy, the procedure was displayed at the entrance to the home so that people would know how to complain and how to contact us if they wished to do so. We also could not see the complaints procedure in the SUG but people we spoke to knew who to speak to if they had any concerns about the home. The registered manager told us in the AQAA that the home had received one complaint since it opened and that this complaint was not upheld. The safeguarding adults policy was not available during our visit but there was a notice about Whistleblowing at the nurses station. We spoke to several staff members who said that although they would know what to do if they suspected someone was being abused they had not received any training on the subject since starting work at The Belvedere. There was no training matrix available during our visit so we could not check what training had been delivered. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 living in The Belvedere are accommodated in pleasant, clean and well maintained premises. Evidence: The Belvedere is a newly built care home and is well appointed with good quality fixtures and fittings. Accommmodation is provided on three floors and the kitchen and laundry are located on the fourth floor. At present people living in the home are only accommodated on the first floor. During our visit there was no one available to answer the front door so that staff had to come down to let people in. Each floor provides single bedrooms with ensuite facilties of toilet and washbasin and there is a large lounge/dining room. The bedrooms were well furnished and people living in the home had been able to personalise them. At one end of the lounge is a small quiet area with a screen provided to give privacy. We noted that although the television was on the volume was not too loud so that people could engage in conversation. The corridors are wide so that people can pass easily and so that equipment can be moved safely. The home provides a variety of equipment suitable for people with varying disabilities. We noted several issues; hoists were being stored in the corridor outside the bedrooms of two people and might present a trip hazard; the bath does not rise so that staff have to bend over the bath when assisting someone to bathe. We asked the registered manager to look into both issues so that the home was safe for both people living in the home and staff. Care Homes for Older People Page 17 of 26 Evidence: Standards of cleanliness in the home were high and relatives commented about this, standards of cleanliness are excellent. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some aspects of the recruitment process may not be thorough and staffing levels may not always be sufficient to meet the needs of people at all times so that people living in the home may not receive appropriate supervision and care. Evidence: There were three staff on duty during the morning of our visit but this was insufficient to meet the needs of people living in the home at that time. This was because the dependency levels of several people living in the home was very high and they needed frequent supervision, which staff were unable to deliver. A number of other demands were made on the nurse in charge, including answering the main entrance for visitors and trying to find an additional staff member for the afternoon shift. When senior management were contacted an administrator from the next door home provided support for several hours. There were adequate staffing levels during the afternoon as the activity coordinator was able to provide support if required. The registered manager was aware that staffing levels were not ideal prior to our visit and had requested additional staffing. This had been agreed for the twilight/evening shift so that there was an additional staff member for two nights that week but on other evenings staff would have to cope. We looked at the recruitment records of two staff members. Incomplete information was available about one staff member at the time of our visit but the registered manager later sent us some information. However, she could not find the references Care Homes for Older People Page 19 of 26 Evidence: for one of the staff members or the initial security check so that we could not confirm that all necessary security checks had been carried out and all necessary documentation was in place. We also asked to look at training records but these were not available. The nurse in charge told us that two staff had achieved the NVQ2 in care qualification. The registered manager later told us that three more staff will be starting this award in the new year. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 Belvedere is run in the best interests of people living there. Evidence: The registered manager was not available during our visit but we were able to speak to her after the visit. The registered manager sent us the AQAA when we asked for it and provided us with sufficient information about the home in advance of our visit. The registered manager is an experienced first level registered nurse with nursing home and multi site management. She has operated a 90 bedded service and up to 500 beds for a large organisation. She has specific knowledge of dementia care and has commenced an honours degree in Dementia studies. The manager told us in the AQAA that the home is well maintained, health and safety matters are taken seriously and the home has a variety of policies and procedures to ensure compliance. We looked at fire safety records and training. Although staff had attended fire training they had not taken part in a fire drill so may not be fully aware of what to do in the event of fire. We had been notified of several events involving people living in the home and as Care Homes for Older People Page 21 of 26 Evidence: required by law. However, there were a number of other events that we had not been notified about so that we were unaware of events that might be having an adverse effect on people living in the home. Various mechanisms are in place to find out if the home is providing a good quality service. A senior manager visits the home monthly and provides a written report about the home. The registered manager told us in the AQAA that she carries out monthly audits of various aspects of care management and accidents. We looked at the way in which the home manages finances and this was satisfactory. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The registered manager should ensure that a Service User Guide is made available at all times so people have written information about the home and what facilities and services it provides. The registered provider should ensure that an appropriately qualified and skilled person carries out assessments so that people know that their needs can be met by the home. Staff should ensure that care plans are updated to include changing care needs so that staff are aware of what actions need to be taken to meet those needs. The registered manager should ensure that care plans are kept in a secure location at all times so that confidentiality is maintained. An appropriate form of protection for clothing should be used at meal times so that peoples dignity is protected. The home should ensure that,within reason, people living in the home are offered choice in their daily lives so that their preferences are respected. The registered manager should ensure that all staff Page 24 of 26 2 3 3 7 4 7 5 6 10 14 7 18 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations undertake mandatory training in safeguarding adults so they know how to recognise abuse and what to do if they suspect someone is being abused. 8 27 The registered person should ensure that staffing levels are sufficient at all times to meet the dependency levels of people living in the home so that their care needs are met and people are protected. The registered manager should ensure that a minimum of 50 per cent of care staff achieve the NVQ2 qualification or equivalent so that staff have the knowledge and skills to carry out their role. The registered manager should ensure that references and an initial security check are obtained for all staff members so that full and thorough information is obtained about staff before they start work. The registered manager should ensure that all staff take part in regular unannounced fire drills so they know what to do in the event of fire. The registered manager should ensure that we are provided with information as required by law about any incidents or events in the home that may have an adverse effect on people living there. 9 28 10 29 11 38 12 38 Care Homes for Older People Page 25 of 26 Helpline: 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). 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