We carried out an unannounced inspection of the service on 13, 14 and 21 November 2018. Belle Vue Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service supports older people.

Belle Vue Lodge accommodates up to 59 people in one building. At the time of our inspection there were 31 people living at the home. This is the service’s third inspection under its current registration. At the previous inspection on 2 and 3 May 2018 we rated the service as ‘Requires Improvement’. For the question, ‘Is the service Well-led?’ we rated this as ‘Inadequate’. We also identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Due to the seriousness of the issues we identified, we issued the provider with a warning notice and a deadline by which they needed to make changes to address the immediate risks to people’s health and safety.

During this inspection we found some improvements had been made, but further improvements were still needed. We identified two breaches of the Health and Social Care 2008 (Regulated Activities) 2014. These were continued breaches from the previous inspection. Overall the rating for this service will remain as ‘Requires Improvement’. The rating for the question, ‘Is the service well-led?’ has improved from ‘Inadequate’ to ‘Requires Improvement’.

A registered manager was not present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. The operations manager was currently managing the home alongside a newly appointed manager. 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.

Risks to people’s safety were not always appropriately assessed and acted on.

We have made a recommendation for the provider to take action to address to the assessment of the risks to people’s safety.

People were supported by staff who understood how to protect them from avoidable harm. There were enough staff in place to support people and to keep them safe, but there were delays in providing people with timely care. People’s medicines were administered safely, but storage and recording procedures were not always appropriately followed. The home was clean and tidy and staff understood how to reduce the risk of the spread of infection. However, cleaning products were not always stored safely. Accidents and incidents were reviewed, assessed and investigated.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Improvements were needed in the way conditions placed on DoLS authorisations were recorded and checked to ensure they were carried out.

People’s physical, mental health and social needs were mostly assessed and met in line with current legislation and best practice guidelines. Staff received regular training and their practice was assessed. Staff felt supported by the registered manager. People were supported to follow a healthy and balanced diet; however, people did not always receive their meal in a timely manner. People had access to external health and social care agencies. The home environment was generally well maintained and had been adapted to support people with a physical disability. However, the layout did not fully support people living with dementia.

People liked the staff and found them to be kind and caring. However, people did not always receive timely, person-centred care and support from staff. People were unable to recall if they had been involved with c

We inspected the service on 2 and 3 May 2018. The inspection was unannounced.

Belle Vue Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the

premises and the care provided, and both were looked at during this inspection. Belle Vue Lodge is a nursing home and accommodates up to 59 people in one building. There are six individual units over three floors. On the first day of our inspection, 48 people were living at the service and on the second day, 49 people were present. People living at the service were older people, some of whom were living with dementia.

A registered manager was in place until 27 March 2018, when they left the service and de-registered. However, they returned to the service on the day of our inspection. The manager said they were taking up their previous position and would submit a registered manager application again. We will monitor this. 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.

Risks associated with people’s needs had not been effectively assessed, planned for or monitored. Information to guide staff of how to manage risks lacked detail and did not reflect people’s current needs. Where people experienced periods of heightened anxiety that affected their mood and behaviour, staff had limited information about the strategies to support people. Staff were aware of their responsibilities to protect people from abuse and avoidable harm. The provider was working with the local authority safeguarding team who were investigating safeguarding incidents and concerns.

Equipment used to reduce and manage some people’s risks, were found to not be used effectively to mitigate risks. The systems in place to record, monitor and analyse accidents and incidents people had experienced had not been fully completed. This impacted on the provider having clear oversight and the ability to consider if lessons could be learnt to make improvements.

The deployment of staff required reviewing to ensure people’s safety and individual needs were consistently met at all times. Safe staff recruitment procedures were in place and followed. Some shortfalls were identified in the management of medicines. Infection control and prevention measures were in place to reduce the risk of cross contamination.

The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had not been fully adhered to meaning people’s rights had not been fully protected. People’s communication needs had not been considered when assessing people’s mental capacity, and assessments lacked detail or had not been completed when required. Where people had conditions specified in their Deprivation of Liberty Safeguards authorisation, these had not been monitored.

The provider used recognised assessment tools when assessing people’s needs. People’s nutritional needs were assessed and referrals were made to external healthcare professionals, when concerns or changes occurred such as a change in a person’s weight.

Staff received an induction, ongoing training and support.

Systems were in place to work with other organisations. The staff worked with external healthcare providers to meet people’s health outcomes. Monitoring of wound care was found to not always be effectively managed. The design and layout of the building was not fully conductive to meeting the needs of all people that used the service.

Staff were inconsistent in their approach in providing people with dignified and respectful care. Additionally, there were inconsistencies in staff promoting choice. Relatives were positive that they were involved in their family member’s care and tre

This inspection was carried out on 30 August 2017 and was unannounced. We last inspected this service in July 2015. We found the service was meeting the requirements of the regulations.

Belle Vue Lodge is a care home registered to provide personal and nursing care. Accommodation is provided over two floors, arranged into separate units. It is situated in Nottingham and accommodates up to 59 older people, many of whom are living with dementia. At the time of our inspection there were 56 people using the service.

The service had a registered manager 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.

Belle Vue Lodge had a calm atmosphere and people told us they felt safe. Staff had been trained in safeguarding (protecting adults from abuse) and understood the importance of protecting the well-being of people who might not be able to say if something was wrong.

The risks to people's safety and well-being had been assessed and minimised. Staff knew what action they needed to take to keep people safe. Staff followed risk assessment guidance in order to keep people safe.

There were enough staff on duty to keep people safe and meet their needs. Staff had time to interact and socialise with people as well as providing personal and nursing care. Staffing levels were responsive to the needs of people. The registered manager followed the provider's staff recruitment policy to help ensure the staff employed were suitable to work with people who use care services.

People were supported to take their medicines when they needed them and as prescribed. Staff undertook training to help ensure people's medicines were administered safely.

Staff had completed training to support people effectively. However, we found that staff would benefit from further specific training in dementia and managing complex behaviours. This would enable staff to respond consistently when people were distressed, agitated or confused.

The registered manager had reduced the number of agency staff working within the service to ensure people received effective care from staff who were known to them.

Staff told us they felt supported in their roles and the registered manager and senior staff provided staff with clear guidance and leadership.

People's capacity to make decisions and choices had been assessed. Staff understood the importance of offering people choices. They followed the principles of the Mental Capacity Act when supporting people to make decisions and providing people with care.

People had their health needs assessed and care plans were put in place to meet their needs. Where appropriate, people were referred to external health professionals for support and guidance to ensure they remained as healthy as possible. Care records did not always reflect that people were receiving care and support in line with professional guidance.

Staff were caring, compassionate and attentive in their approach to meeting people's needs. Staff used different ways of enhancing communication and used their knowledge of people to develop positive relationships. People and relatives were involved in making decisions about their care.

Experienced staff knew people well and used the knowledge they had to tailor their care and support. Care plans did not always include the information staff who were new to the service needed to provide personalised care that reflected people's preferences.

People had opportunity to be involved in a range of one-to-one and group activities. People were supported to go out into the wider community through day trips and events.

People and their relatives were confident to raise concerns and complaints about their care. The registered manager

This inspection took place on 1 July 2015 and was unannounced.

Accommodation for up to 59 people is provided in the home in six separate units over four floors. There were 55 people using the service on the day of our inspection. The service is designed to meet the needs of older people living with dementia and provides nursing care.

At a previous inspection on 30 and 31 July 2014, we asked the provider to take action to make improvements in the areas of cleanliness and infection control and assessing and monitoring the quality of service provision. We received an action plan in which the provider told us the actions they had taken to meet the relevant legal requirements. At this inspection we found that improvements had been made in both areas.

There is a registered manager and she was available during the inspection. 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.

People felt safe in the home and staff knew how to identify potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. The premises were managed to keep people safe.

Sufficient staff were on duty to meet people’s needs and they were recruited through safe recruitment practices. Medicines were safely managed and the risk of infection was minimised.

People’s rights were not fully protected under the Mental Capacity Act 2005. People’s mealtime experiences were varied and documentation was not always fully completed to monitor that people were receiving sufficient to eat and drink.

Staff received appropriate induction, training, supervision and appraisal. External professionals were involved in people’s care as appropriate and adaptations had been made to the design of the home to support people living with dementia.

Staff were caring and treated people with dignity and respect. People and their relatives were involved in decisions about their care.

People’s needs were promptly responded to. Care records provided sufficient information for staff to provide personalised care. Activities were available in the home. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident raising any concerns with the management and that the registered manager would take action. There were systems in place to monitor and improve the quality of the service provided.

We spoke with eight people using the service. One person said, “I make my own decisions what to do, how I spend my time.” One person said, “They’re very good to me. They look after me.” Another person said, “I’m happy with the care and I like the food.”

We found that there were processes in place to ensure that people were able to give informed consent to their treatment and care. However, we also found that people’s care and treatment was not fully planned and delivered in a way that ensured people's safety and welfare.

We found that people were supported to be able to eat and drink sufficient amounts to meet their needs. However, we also found that appropriate checks were not always undertaken before staff began work.

We found that there were sufficient staffing to meet people’s needs and the provider assessed the quality of the service provided.

We carried out this inspection to follow up on concerns identified at our previous visit on 29 August 2012. These concerns were that the provider had not taken adequate steps to protect people against the risks of unsafe premises and not all staff received regular training, supervision and appraisal.

We spoke with four people who use the service. The feedback we received from people who used the service indicated they were pleased with the quality of the accommodation and had no concerns about maintenance issues. One person said, “I love my room,” which was highly personalised. Another person said, “There’s no problem with the building as far as I’m aware.”

People using the service were not happy with the temperature of one part of the home on the day of our inspection. We received confirmation from the service the following day that the heating issue had been resolved.

We found that people, staff and visitors were protected against the risks of unsafe and unsuitable premises. We also found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We carried out this inspection to follow up on concerns identified at our previous visit on 29 August 2012.

We spoke with three people who use the service. They were happy with the care provided by the service and raised no issues of concern regarding any of the outcomes inspected.

We found people were treated with dignity and respect and received care that met their needs. We found that there were sufficient staff to meet people’s needs and that records were kept securely and were fit for purpose.

One person who uses services said, “I’m happy enough here, I’d prefer to be at home but my memory’s failing.” Another person told us that staff were kind and supportive and worked hard to meet people’s needs. However, other people who use services made negative comments regarding living at the service.

One person told us they were tired of the noise and of people shouting at the home. Another person told us their breakfast was cold, including their cup of tea. Another person, who was at the home for respite care, was concerned about their catheter care and told us they had asked staff to order a replacement part but had not received it.

Two people who use services told us they thought the home was clean and safe. However, other evidence did not support these comments.

Two people told us they didn’t think there were enough staff on duty. They told us there was only one member of staff on their unit and they didn’t know where she was or how to get help if they needed it. Another person said, “There’s never enough staff.”

We observed the routine at Belle Vue Lodge to see how people were involved in the care and support they received. In one unit people were watching television and appeared content with this. One person was not interested in the television and walked up and down the corridor opening and closing doors. In another unit two people told us they were bored and did not know what they could do. One person repeatedly asked to go out, but had to wait until there were sufficient care workers available. Two others walked around and went to the door several times. In a third unit we saw that one person wanted to go outside to smoke and was waiting for another member of staff to accompany them.

There were games, cards and books available, but we did not see anyone involved in any of these activities during the day. Care workers told us there had been an activities person working at Bell Vue Lodge until two weeks before our visit.

We saw people were encouraged to maintain existing links in the community. We saw in one person’s care record they had regularly attended a church service prior to moving into Belle Vue Lodge. We were told that these visits had continued as the person's family visited and took them to church.

We observed people were given a choice of main course at lunch time. In one unit each meal was shown so that people could choose. In another they were asked verbally. Some people did not understand what broccoli quiche was and the staff had no actual meals or pictures to show them. They opted for the alternative pork casserole. We did not see any pictures in use to aid communication and choice in any area.

We spoke with people who used the service and relatives. One relative told us they visit most days and are always informed about the daily care of their relative. They had no concerns about the care and felt needs were “Well met by these very caring staff.” One relative stated that the care workers always seem to know how to handle people and were very compassionate. We observed that care workers knew individuals’ needs well and knew how to speak to them.

We observed staff interacting respectfully both with people living there and their relatives. They explained carefully what they were going to do. We saw that when one person became aggressive staff requested assistance and continued to interact respectfully and maintained the person’s dignity at all times.

We asked people about whether they felt safe at Belle Vue Lodge. The majority of people we spoke with were unable to comment on this due to their care needs. One person did tell us “It’s ok here but I would rather be at home.” One relative told us, “They are well looked after here and much safer than at home.”

We spoke with two people using the service who had capacity. Both of the people confirmed they were happy living in the home. One person said “There is nothing to grumble about, if I ask staff it is done.”

We were also told “I can’t lock my bedroom door and sometimes things go missing.” We observed that there no locks on any bedroom doors.

On one floor we observed people with dementia who appeared to be anxious and wandering around the unit. We didn’t see any meaningful activity provided for these people during our visit, with the exception of one person who had been provided with an appropriate activity.

We observed some positive interactions between staff and people using the service. We saw that one person who was being cared for in their bed had appropriate documentation in their bedroom.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. This was an unannounced inspection.

On 19 November 2013, our inspection found that the care home provider had breached regulations relating to care and welfare of people who use services and requirements relating to workers. Following the inspection the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made. We saw that improvements had been made in both the areas of care and welfare of people who use services and requirements relating to workers.

Belle Vue Lodge is a care home providing accommodation and nursing care for up to 59 adults. There were 57 people living there when we visited. The care home provides a service for people with physical nursing needs and for people living with dementia. A registered manager was in post at the time of our visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm, however, we saw some examples of people being put at risk of avoidable harm. Suitable arrangements for staff to respond appropriately to people with behaviours which might challenge other people were not always being followed.

Staff were recruited through safe recruitment practices; however, effective infection control and medicines management procedures were not always being followed. The premises were not safely maintained.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The DoLS are a code of practice to supplement the main Mental Capacity Act 2005 Code of Practice. We looked at whether the service was applying the DoLS appropriately. These safeguards protect the rights of adults using services by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who are trained to assess whether the restriction is needed.

We checked the records of one person who we were told had a DoLS in place. The DoLS documentation showed that the DoLS had expired and no application to extend the DoLS had been made. We found the location was not fully meeting the requirements of the DoLS.

Staff received supervision, appraisal and training. Records showed that people who used the service were not always fully protected from the risks of inadequate nutrition and dehydration. We saw that limited adaptations had been made to the design of the home to support people with dementia. However, the home did involve outside professionals in people’s care as appropriate and people told us that staff knew what they were doing.

We observed interactions between staff and people living in the home and staff were kind and respectful to people when they supported them. However, people were not always involved in their care where appropriate.

Staff mostly responded appropriately to people’s needs but additional detail was required in some care plans to provide guidance to staff to respond to people’s deteriorating condition. People who used the service told us they had no complaints and knew who to complain to if they needed to.

There were systems in place to monitor and improve the quality of the service provided; however, the provider had not identified some of the issues that we found at this inspection. Staff told us they would be confident raising any concerns with the management and that the registered manager would take action. People told us that the registered manager was approachable and had taken action to improve the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.