This inspection took place on 27 February 9 March and 19 March and was announced. The service was last inspected in October 2017 when we found two breaches of the Health and Social Care Act 2008. These related to Regulation 12: Safe care and treatment and Regulation 17: Good governance. We rated the service requires improvement.

Following the inspection the provider submitted an action plan outlining improvements they planned to make. At this inspection we found improvements had been made and the provider was no longer in breach of regulations and we have rated it good.

Bell View Help at Home Ltd provides personal care and support for people living in their own homes in the North Northumberland area. At the time of our inspection, the service provided care and support to 60 people. The service had close links with Bell View Care Ltd which provides day care; meals; home support; assisted shopping trips and a transport service. Bell View Care Ltd is not regulated by CQC as its services are out of scope of the Health and Social Care Act 2008 Regulations.

The service had a registered manager. They had registered with the Commission in October 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Improvements had been made to the management of medicines. Staff were aware of the procedures to follow and ensured there were suitable gaps between doses by ensuring appropriate times were allowed between visits. Medicine records we saw were completed accurately.

At the last inspection robust procedures were not in place for the safe management of people’s finances. At this inspection we found improvements had been made. A small number of people required support with finances and receipt books and records were in place. Staff were clear about the procedures to follow.

There were suitable numbers of staff on duty and safe recruitment procedures were followed. People told us they valued having regular staff that got to know them well.

Staff had received training in the safeguarding of vulnerable adults and knew the procedures to follow in the event of concerns of a safeguarding nature.

Individual risks to people were assessed and an assessment of the person’s home environment was carried out before the service commenced. Staff followed the correct procedures when providing personal care or service food to avoid the spread of infection. Gloves and aprons were readily available.

Staff received regular training, supervision and appraisals. The registered manager and senior care staff carried out supervision and spot checks. Staff told us they felt well supported by the registered manager and office staff. People told us staff were competent and appeared well trained.

All new staff were enrolled on the Care Certificate. The Care Certificate assesses the fundamental skills, knowledge and behaviours that are required by people to provide safe, effective, compassionate care.

People were well supported with eating and drinking. Clear instructions were available to staff about the level of support people required and any risks such as choking were identified.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. The service was operating within the principles of the MCA.

People and their relatives spoke very positively about the staff and management of the service

This inspection was announced and took place on 19, 20 and 27 October 2016. The service was last inspected in January 2015 and at that time was in breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment. In response to our findings the provider had submitted an improvement action plan, which stated they would have met the breach by February 2015.

The service provides personal care and support for people living in their own homes in the North Northumberland area. At the time of our inspection, the service provided care and support to approximately 50 people. Their office is located in a purpose built resource centre in Belford. The service had close links with Bell View Care Ltd which provides day care; meals; home support; assisted shopping trips and a transport service. Bell View Care Ltd is not regulated by CQC as its services are out of scope of the Health and Social Care Act 2008 Regulations.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in January 2015 we found some concerns with medicines management regarding certain administration and recording procedures. Whilst we saw some improvement measures had been taken, shortfalls remained in the management of medicines. Risks related to medicines had not always been assessed, and information had not been provided to staff about how to mitigate risks. Records showed medicines had not always been administered in line with prescribed instructions.

Staff had been trained in safeguarding people from abuse and staff we spoke with were clear on their responsibility. However procedures to reduce the risk of financial abuse and to maintain the security of people’s homes were not robust.

Contingency plans were in place to ensure the provider could maintain the service in the event of poor weather, and risks within people’s homes had been assessed.

Safe recruitment procedures had been followed and there were enough staff to deliver the service.

People told us staff were sufficiently skilled to care for them and meet their needs. Staff training was monitored and kept up to date. Staff were given opportunities to further develop their skills and knowledge. Records we looked at showed staff met regularly with their manager in supervisions sessions to discuss their practice; however two staff told us they had not yet attended these meetings. Appraisals had not been carried out. The registered manager acknowledged improvements should be introduced by forward planning meetings with staff to ensure they were able to discuss their roles.

Care Quality Commission (CQC) is required by law to monitor the application of the Mental Capacity Act 2005 (MCA), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. The registered manager advised us all of the people who used the service had capacity to make their own decisions, he was aware of the process which should be followed if this was not the case.

People were supported to access healthcare services such as GPs.

People and relatives told us the staff were very warm and caring. Staff told us they enjoyed their jobs, and described to us occasions where they felt they had ‘gone the extra mile’ for people.

People had been involved in planning their care, and staff were very knowledgeable about people’s preferences and care needs.

Staff had received training to help them support people at the end of their lives, and a community matron we spoke with praised staff who provided this care.

Care plans

This inspection took place on the 20, 21, 23 and 27 January 2015 and was announced.

Bell View Resource Centre was first registered with CQC in December 2013. This was our first inspection of the service.

The service provides care for people living in their own homes in the North Northumberland area. At the time of our inspection, the service provided care and support to 30 people. Their office is located in a purpose built resource centre in Belford. The service had close links with Bell View Care Ltd which provides day care; meals; home support; assisted shopping trips and a transport service. Bell View Care Ltd is not regulated by CQC as its services are out of scope of the Health and Social Care Act 2008 Regulations.

There was a registered manager in post who had been registered with CQC since the service was first registered in December 2013. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People told us that they felt safe with the staff who visited them. There were safeguarding procedures in place. Staff were knowledgeable about what actions they would take if they suspected abuse had taken place. The registered manager had reported one safeguarding incident to the local authority. This incident was not concerned with the service or staff who worked there. The registered manager had not informed CQC however about this allegation of abuse.

People told us that they saw the same staff. The registered manager told us, “We try and keep staff to the same areas.” We considered that there were sufficient staff to meet people’s needs.

We found some concerns with medicines management regarding certain administration and recording procedures. 

Staff told us that recruitment checks such as Disclosure and Barring Service checks were carried out. These helped to ensure that prospective staff were suitable to work with vulnerable people. We found however, that improvements were required to ensure that recruitment checks were clearly recorded to demonstrate that safe recruitment practices were in place.

Staff told us that there was sufficient training available. Most of the training was carried out ‘in house’ by the care coordinator. The registered manager informed us that further external training was being sourced.

People’s nutritional needs were met. Staff supported people with their meal preparation. Healthcare professionals such as the GP or district nursing service were contacted if there were any concerns with people’s health care needs.

We found that staff were knowledgeable about people’s needs and they demonstrated a caring approach whilst supporting people.

There was a complaints procedure in place. None of the people or relatives with whom we spoke had any concerns or complaints. The registered manager informed us that there had been no complaints received since they had started the service in December 2013.

People told us they were happy with the service they received. Staff informed us that they felt valued by the provider and morale was good. We found however, that some audits and checks were not documented such as care plan audits and action plans put in place to identify any issues found. In addition, the care coordinator informed us that she had devised a medicines audit however this was not yet in place.

We had not been notified of certain events at the service such as the deaths of people who used the service and one safeguarding incident which the provider is legally obliged to inform us of. The registered manager gave his assurances that he would always send the required notifications in future and he understood his obligations under the Health and Social Care Act 2008.

We considered that improvements were required to ensure that all aspects of the service were monitored and notifications were submitted in line with legal requirements.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This related to the management of medicines. This corresponded with one breach of the new Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safe care and treatment in relation to medicines. The action we have asked the provider to take can be found at the back of this report.