Belsfield House in Blackpool is a purpose-built nursing home providing residential and nursing care for up to 40 people. At the time of our inspection the home was fully occupied. Accommodation is provided over three floors, each one providing communal lounges and dining areas. Bedrooms are for single occupancy, spacious and include an en-suite facility.

At the last inspection on 17 and 18 March 2016, the service was rated outstanding in all areas except safe, which was rated good. At this inspection we found the evidence continued to support the rating of outstanding and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. Additionally, we found the management of people’s safety had improved to outstanding. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

During this inspection visit, when we discussed safety with people and relatives, we received highly complimentary comments. A relative said, “I would recommend it to anyone. They are definitely excellent.” A display board in the foyer demonstrated the manager’s commitment to maintain everyone’s safety. It showed how safety systems affected people and helped everyone to understand their responsibilities. They told us, “We direct people to it to show different risks, how we monitor this and what we are doing about them.”

Care records we saw showed each area of risk was assessed in line with limiting factors, benefits and burdens. When we discussed procedures, we found staff had an excellent working knowledge. A staff member told us, “My job is about making sure people are safe. We have a lot of training on preventing falls and we review their care plan to make sure they are as safe as possible.” Staff used advanced systems to show hazards to people, which helped them to keep safe.

We found Belsfield had exceptionally high levels of staffing and skill mixes, which were deployed in innovative ways. One person said, “They are here straight away if you need them.” It was clear the provider invested heavily in care delivery and ensured required resources went beyond the norm. A visiting professional said what made a difference between this provider and others was how much they funded staffing levels and training.

Medication administration followed evidence-based tools to immediately and continuously assess, manage and comfort individuals. We saw multiple systems showed the provider’s commitment to invest in staff solely to benefit and improve their lives. A visiting professional said staff discussed concerns about medication, but they had never had an error because of their excellent procedures.

Staff demonstrated a very good understanding of their duty to report unsafe or inappropriate care. One staff member explained their priority was, “Making the residents’ lives better no matter in how small a way that might be.” Multiple environmental procedures and auditing systems ensured the continued safety of those who lived at Belsfield.

Recently employed staff we spoke with told us their recruitment was intensive. Their induction included a full day experiential training session to assess their suitability. We found the provider continued to invest heavily in their personnel through a wide-ranging, rigorous package of training. Additional training since our last inspection included bespoke training over and above the vast array of regular provision. This was tailored to the home’s delivery of care and practices.

Belsfield was exceptional at providing a range of choice and portion size at mealtimes. A relative said, “They have a good choice and always get offered more.” Outstanding support for people’s nutritional needs included inventive systems to reduce risk and enhance meal experiences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way

The inspection visit at Belsfield was undertaken on 17 March 2016 and was unannounced.

Belsfield provides nursing care and support for a maximum of 40 people who live with dementia, physical disability or mental health conditions. At the time of our inspection there were 39 people living at the home. Belsfield is situated in a residential area of Blackpool. Accommodation is provided over three floors. There is also a swimming pool in the basement area. Each floor is provided with communal lounges and dining areas. Bedrooms are for single occupancy, spacious and include an en-suite facility. A passenger lift is provided for ease of access.

A registered manager was in place. 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’. 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 the last inspection on 20 August 2014, we found the provider was meeting all the requirements of the regulations inspected.

During this inspection, we observed Belsfield had exceptional leadership. This steered staff to provide outstanding care that was highly responsive to people’s requirements. Without exception, one person and relatives told us they experienced compassionate staff who consistently aimed to provide excellence in care. One relative said, “Belsfield was recommended to us, but it was some distance and we weren’t thinking this far away. It has exceeded our expectations.”

The management team had control measures in place to maintain people’s environmental safety. This included a variety of risk assessments and tools to safeguard them from potential hazards. Staff demonstrated a good awareness of how to protect people from potential harm or abuse.

The provider had ensured Belsfield House was well resourced with high staffing levels. For example, staffing ratios exceeded one staff member for every two people. Additional staff were deployed, at cost to the provider, to meet extra care requirements. We observed the registered manager was incredibly resourceful in how they trained their staff and had provided comprehensive levels of guidance. One relative told us, “I am absolutely confident about leaving [my relative] in their experienced hands.” The management team followed correct recruitment procedures to ensure suitable staff were employed.

We noted responsible staff dispensed medicines, without interruption, in a focused, knowledgeable way. They utilised evidence-based tools to monitor pain and when required medicines for individuals who could not verbalise their needs. The management team monitored related processes to check people’s medicines were managed safely.

Care files we looked at held detailed nutritional risk assessments to protect people from the risk of malnutrition. We observed lunch was well organised, very enjoyable and promoted as a social occasion. The cook stated, “There are no restrictions on the food budget, [the registered manager] is good like that. Whatever the residents want we get.”

Staff demonstrated an in-depth awareness of the principles of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards. We observed they had positive, strong relationships with people to support them to have as much freedom as possible. Additionally, we found people’s consent to care and treatment was sought with an ongoing and fluid approach.

We observed staff demonstrated an exceptionally caring, compassionate and kind attitude towards people who lived at the home. A staff member stated, “You have to have a heart and be passionate to give residents the best care they deserve.” When we discussed care with staff, they demonstrated an enthusiastic desire to understand individuals and their preferences. One person and relatives told us their care was excellent. A relat

Summary

We considered our inspection findings to answer questions we always ask: -

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People were comfortable and relaxed during our inspection. A relative told us, “I’m fully confident my mother-in-law is safe in their hands. She is well looked after”.

Belsfield House had several policies and procedures in place designed to maintain people’s safety. Our discussions with staff demonstrated they had a good understanding of how to safeguard people against potential abuse.

Our discussions with staff demonstrated they understood the needs of people they supported. Information we found in people's care records was in-depth and regularly updated. This meant the provider had protected people from unsafe care by ensuring care planning and risk assessment was appropriate.

We found Belsfield House recruited people in an appropriate and safe way. The home showed good practice in having systems to retain staff. This showed people were protected against inappropriate care because staff were properly recruited.

Is the service effective?

Belsfield House had appropriate systems in place to ensure people’s preferences were met. We observed that staff had a good understanding of consent and related principals. One staff member told us, "It’s always about finding different ways of giving people choice”. This meant care provision was effective and based on individual choice because the service gained people's consent prior to giving support.

A relative told us the home was efficient in meeting the needs of their family member. They explained, “The staff communicate with my mother-in-law very effectively and she is properly stimulated and well-occupied”.

Documents we reviewed showed support plans and risk assessments were individualised and regularly updated. Support planning matched people's assessed needs. This meant people were protected against ineffective care provision because people's needs were adequately assessed.

Is the service caring?

We observed staff interacting with people in a respectful and compassionate manner. A relative told us, “The staff are brilliant. They are so caring and patient”.

People were comfortable and relaxed during our inspection. Staff engaged with people in a friendly manner and had a good understanding of quality care. One staff member told us, “I look at good care as how I would like to be cared for. I want to make sure people are happy and comfortable”.

Is the service responsive?

Care files we reviewed recorded where people’s health needs had changed. Documents included reports and outcomes of visits by external professionals, such as GPs, district nurses and social workers.

One staff member told us, “If you care about people as we do, you notice changes in them. If we notice any changes in people's weight, for example, we would discuss this as a team. We would inform the cook to look at their diet and refer to the GP. Their care plan would also be amended”. This meant people were safeguarded against inappropriate care because their changing health needs were assessed and responded to.

Is the service well-led?

There were a range of quality audits in place to monitor service delivery. Appropriate policies and other regular processes underpinned this, such as satisfaction surveys and staff meetings. This meant people were protected against inappropriate support because the manager had systems to check the quality of care.

Care delivery was well-led and there were clear lines of responsibility. Care planning was in-depth and personalised. This was reflected in our observations during our inspection. One staff member told us, “I love working here. The managers are inspiring and there’s a really nice vibe around the place”. This meant care delivery was appropriate and safe because the home was well-led.

We received information that some people’s care and nursing needs were not being met having the potential to affect their wellbeing. Other information we received suggested staffing levels may be inappropriate to meet the needs of people living at Belsfield House. Also, other information showed there may be lapses in staff training and how records were being completed which had the potential to affect the health and safety of those using the service.

We shared this information with commissioning organisations. They told us they did not have any concerns in respect of services Belsfield House were providing to people whose placement they were funding.

When we visited Belsfield House we looked at records and spoke with members of the management team, nine staff members and some people who lived at the home. In addition we took time to walk around the home and make observations.

Records demonstrated the management team were in the process of reviewing all care planning records and making a number of changes in individual cases. We found routines were flexible and we witnessed staff treating people with dignity and sensitivity.

Staff told us staffing levels were generally suitable to meet people’s needs. One person told us, “It is a busy home but we work well as a team and changes are made where staff are needed most”. Staff were responding to call bells in a timely manner, so that people were not waiting for the support they needed. Staff were seen to have time to spend assisting people with their breakfast meal, in a dignified way by sitting with them and communicating with them. The home was observed to be relaxed with a staffing presence on all four floors of the home.

In instances where people required one to one care, this was being provided by support staff. Records were being maintained to record a range of observations including behaviour management, incidents, general care and support. This enabled commissioning teams to monitor the level of need and identify any changes necessary in the persons best interest.

Systems were in place to ensure control measures were in place for the prevention of infection. In one instance information was limited, however staff were able to demonstrate effective measures in place and the management team were addressing the issue of recording.

During the course of the visit we spoke individually with three people living at the home. We also spoke with several other small groups of people in various lounges throughout the day. However the conversation was somewhat restricted because of the effects of dementia. Discussion also took place with two relatives who were visiting, the senior management team, the chef and catering manager and seven members of staff.

People appeared to be comfortable and relaxed in their surroundings. The relationship observed between staff and people living at the home was supportive and encouraging. One person told us he was happy to be living at the home and that he always enjoyed his meals. Another person was pleased with his bedroom accommodation and confirmed that staff checked on him regularly during the night.

A relative who visited most days commented, “They are absolutely fantastic I am very pleased with the care. He is being well looked after, I cannot find fault”.

People spoke positively of the meals served. Although one person could not recall the meals actually served, he said that he always enjoyed everything he ate. A relative said, “The food is always good and fresh, he never refuses food, he has put weight on”.

Another relative told us that she felt that peoples’ privacy and dignity were well respected and that she was often asked if she was happy with the level of care and support provided to her relative. We were told “She could not be in a better place”.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. People also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes were treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience and a practicing professional. An Expert by Experience is a person who has experience of using services and who can provide a different perspective. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

In addition to using SOFI, we spent periods of time observing staff and residents in communal areas of the home and spoke with some relatives. We also spoke individually with five people living at the home and two relatives who were visiting.

We found that people experienced some good care and support. However we observed some practices which did not effectively promote peoples’ dignity, privacy or right to make choices.

The main criticism of one relative spoken with was simply that the home did not have enough activity to keep the person living there actively doing things in the day. This person told us that her relative really enjoyed a song because they could remember the words even if other things were forgotten and they would even get up and enjoy a dance.

However people living at the home and the relatives spoken with all spoke positively of the staff team. One person said he found the staff to be polite and respectful. Another person said that they really liked the staff that treated them with dignity and respect, were kind to them and used the name they were happy to be called.

We observed that people who used the service were supported to eat and that people enjoyed their meals. Consideration was given to peoples’ individual nutritional needs. People consistently told us that the meals were good and that they enjoyed the foods served. We were also told that meals were served hot, that they were appetising and that there was always enough to eat. People confirmed that there was no choice of meals with one person telling us, “You get what you are given, but it is good.” Another person said that the food was basic but good and that they enjoyed their meals.

People spoke positively of the care and support provided at Belsfield House and the qualities of the staff team. We saw that people were treated with kindness. People appeared comfortable enough to speak with staff about any concerns. One person told us that they felt completely safe and at ease in the home and said that if anything happened to concern them, they would go straight to the manager.