About the service

The Belmar Nursing Home is registered to provide care for up to 44 people with a mental health condition, dementia or substance misuse. At the time of our inspection 36 people were receiving care and support at the home.

People’s experience of using this service

Although people told us they felt safe living at the home, we found people were not always safe. Risk was not always appropriately managed and addressed.

We could not be assured people received their medicines safely. Medicines were not managed in line with good practice guidance.

The environment was not always appropriately maintained to ensure infection control processes could be carried out to a high standard

Care records were incomplete, inaccurate and not always reflective of people’s needs. Consent to care and treatment had not been formally gained and documented.

Care records were not always person-centred and did not reflect the needs of people living with mental health conditions. We saw people were not encouraged to set and work towards person-centred goals. Additionally, care plans did not include information to manage behaviours which could sometimes be considered challenging to the service.

People were not always consistently supported to have their health needs met in a timely manner. We saw when advice and guidance had been provided by health professionals this wasn’t always followed up as requested.

We found the service was not always well-led. Paperwork within the service was not always accurate and complete. Additionally, records were not always secure and stored appropriately in line with statutory guidance.

Leadership at the home was inconsistent. The registered manager had completed audits and had identified concerns within processes and systems and had highlighted these to the senior management team. Not all identified concerns had been addressed in a timely manner to ensure actions were identified and addressed to reduce risk.

The home was not always appropriately maintained to ensure the comfort of people. We have made a recommendation about this.

Processes were in place to report and respond to abusive practice but these were not always followed. We have made a recommendation about this.

Records had been developed and implemented for people who were at risk of dehydration. However, we found the records implemented lacked good practice guidance and instruction and had not always been completed. We have made a recommendation about this.

We found dignity was not always considered and promoted. We have made a recommendation about this.

Good practice guidance was not always considered and implemented. For example, good practice guidance for the safe management of medicines and management of some health conditions had not been considered.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service did support this practice.

At the time of the inspection visit, the service was relying on agency staff to ensure shifts at the home were covered. The registered manager was looking at ways of recruiting and retaining staff.

Safe recruitment processes had consistently applied to demonstrate suitable checks had taken place before staff were employed.

People told us they were happy living at The Belmar Nursing Home. They told us the quality and availability of food was good.

During our inspection, we observed activities taking place. The home had recently recruited a new activities coordinator and people and relatives told us this had started making a difference in people’s lives.

We observed positive interactions between people who lived at the home and staff. We saw staff had a good rapport with people and there was a light-hearted atmosphere within the home.

Rating at last inspection:

At the last inspection the service was rated good (published 10 August 2018).

Why we inspected:

This ins

This inspection took place on 31 May 2017 and was unannounced.

The Belmar Nursing Home is registered to provide care for up to 44 people with a mental health condition, dementia or substance misuse. The home is situated in a residential area of Lytham St Annes close to local shops and public transport. Bedrooms were of single occupancy and spanned three floors. The home provides a number of lounges plus a conservatory. There are gardens to the front, side and rear of the home, plus space for car parking. At the time of our inspection there were 33 people lived at the home.

The service had a registered manager. 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 the last inspection on 20 January 2016, we found the provider was not meeting the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 The breaches related to safe care and treatment, consent, recruitment of staff, person centred care and good governance. Following that inspection, the provider sent us an action plan which told us how they planned to make improvements for people who used the service. During this inspection we checked to see what improvements had been made. We found the provider had made positive changes and the service was now meeting legal requirements.

Environmental risks and risks to individuals were assessed and measures put in place to reduce or remove them, in order for care and support to be provided safely.

We saw staff operated safe systems when administering medicines. Medicines were safely and appropriately stored and secured safely when not in use. We checked how staff stored and stock checked controlled drugs. We noted this followed current National Institute for Health and Care Excellence (NICE) guidelines.

We found staffing levels were regularly reviewed to ensure people were safe. There was an appropriate skill mix of staff to ensure the needs of people who used the service were met.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff had received safeguarding vulnerable adults training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

People and told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

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 supported this practice.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met. We saw staff responded promptly when people had experienced health problems..

Comments we received demonstrated people were satisfied with their care. The management and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people who lived at the home.

Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect peo

The Belmar Nursing Home is registered to provide care for up to 44 people with a mental health condition, dementia or substance misuse. The home is situated in a residential area of Lytham St Annes close to local shops and public transport. The home provides a number of lounges plus a conservatory. There are gardens to the front, side and rear of the home, plus space for parking. The lead adult social care inspector for the service undertook an unannounced inspection at the service on 20 January 2016. A specialist professional advisor with a background in adult mental health also took part in the inspection.

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.

The company that operated the home described Belmar Nursing Home as providing rehabilitation services. Although we found some written evidence and personal testimony from service users that the home was involved in rehabilitation, we found this to be very limited. Staff at the home were not able to clearly demonstrate how the worked with individuals on interventions to help them to recover from their mental health problems, or maintain their mental health, and to (re)gain their skills and confidence to live successfully in the community. We recommend that the service provider revisit the admission criteria for the home, in order to ensure that the service is clear about who they want to target their resources at, thus ensuring that people receive more specialised care and support linked to recovery and rehabilitation, as stated in their advertising literature.

Care was provided to people on an individual basis, however, the registered person did not always fully complete risk assessments based on the needs of individuals living at the home. Where risks are identified, then risks assessments must always be robustly completed so as to ensure people's health and welfare are protected and promoted. The registered person had not ensured that individualised assessments reflected people's needs and preferences, and that in designing services, these needs and preferences were taken into account. Opportunities had not always been created to ensure that both short term and long term goals, based on these needs and preferences, were created and acted upon.

Staff levels were seen to meet the day to day needs of people living at the home; however, some of the personnel records relating to staff were incomplete. The registered person did not operate robust recruitment procedures, including the undertaking of any relevant employment checks. This must include checking on the professional status of qualified staff such as nurses, in order that they have assurances that individuals are fit to practice.

Although there were systems in place to ensure staff received training and support, we recommend that the service provider undertake more frequent supervision and analyse the training needs of the staff team and link them to the assessed needs of people living at the home. Tis would assist in determining if any specialised training is required, and ensure that the assessed needs of people could be more effectively met. The building is a large and spacious one, with a range of facilities, however, we recommend that an environmental assessment is undertaken in the home, to identify which areas of the home require renewal or refurbishment as some of the carpets in people’s rooms appeared to be in need of replacing. The registered person had not ensured that there were appropriate systems in place to ensure that people's capacity to undertake individual tasks was clearly assessed. When assessments are undertaken, then they must be properly considered and acted u

At our last inspection in December 2013, we found this service to be ineffectual in relation to record keeping, care planning and some aspects of care delivery. The building was in need of essential maintenance and staff training needed improvement. Improvements have taken place. At our last inspection in December 2013, we found this service to be ineffectual in relation to record keeping, care planning and some aspects of care delivery. The building was in need of essential maintenance and staff training needed improvement. Improvements have taken place.

Our inspection team was made up of an inspector, and we looked for evidence to answer the following questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? 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. If you want to see the evidence supporting our summary please read the full report.

Is the service safe? People are treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures are in place and staff understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted.. Relevant staff had been trained to understand when an application should be made, and in how to submit one. The service was safe, clean and hygienic. Equipment was maintained and serviced regularly therefore not putting people at unnecessary risk. The registered manager sets the staff rotas, they take people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. Recruitment practice is safe. Policies and procedures are in place to make sure that unsafe practice is identified and people are protected.

Is the service effective? There was an advocacy service available if people needed it, this meant that when required people could access additional support. People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs. People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

Is the service caring? People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, “I like the staff. They are very helpful, and give me support when I need it.” People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes, and where resources allowed.

Is the service responsive? People completed a range of activities in and outside the service regularly. People knew how to make a complaint if they were unhappy. We looked at how these complaints had been dealt with, and found that the responses had been open, thorough, and timely. The manager was looking at ways in which evidence could be collected to show how, from time to time, meeting people's short and long term goals could be improved if extra resources were available from Commissioning bodies.

Is the service well-led? The service worked well with other agencies and services to make sure people received their care in a joined up way. The service now has a better quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Staff told us they were now clearer about their roles and responsibilities. Staff had a good understanding of the ethos of the home and wanted to ensure it was implemented.

We spoke with a range of people about the home. They included the registered manager, staff members and people who lived at the home. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced living at the Belmar.

We were able to speak with people during the day of the inspection about their care and support. We spent time in areas of the home, including lounges and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed.

We observed staff assisting people who required care and support. We saw staff talking to people respectfully. We saw they spent time with people on an individual basis and were patient when required.

People we spoke with told us they could express their views and were involved in decision making about their care. They told us they felt listened to when discussing their care needs. We spoke with people about the care and support they received. One person told us, "The staff are very good." Also, "The staff are very polite and respectful.”

We spoke with a range of people about the home. They included the registered manager, staff members and people who lived at the home. In addition we had responses from external agencies such as Lancashire County Council in order to gain a balanced overview of what people experienced living at the Belmar.

We were able to speak with seven people during the day of the inspection about their care and support. People we spoke with told us they could express their views and were involved in talking about their care. They told us they felt listened to when discussing their care needs.

We spent time in areas of the home, including lounges and the dining areas. This helped us to observe the daily routines and gain an insight into how residents care and support was being managed. We observed staff treated people with respect and provided support or attention as people requested it. We spoke with one person about the care and support they received. They said, "Staff really cared for me when I was unwell.” And, “There is nothing I don’t like about living here.”

We spoke to service users about the support they receive at the Belmar. We were told that staff will arrange health appointments and will provide support to attend appointments where needed. One person told us about a recent health problem and how staff had arranged appointments for him. The problem was still not resolved but he was confident that a follow up appointment would be made.

Another person told us that he was in better health since moving into the home, describing how the nurses made appointments with his GP, that he had been very anxious but this had now improved, that he had gained weight, was now able to attend to his own personal hygiene and that staff had helped him to build up his confidence when going out.

An individual told us about his admission into the home, saying that he had been fully involved in his assessment and had visited the home and chosen his bedroom.

The people we spoke to told us that they were satisfied with the meals provided. Comments included; “I like all the meals”, “no complaints” and “the food is alright”. Service users also said that they were happy with the refurbishment of the home and made positive comments about their upgraded bedrooms and the new conservatory.

We saw that service users are supported to make informed choices, such as what to eat and what activities to take part in, as part of day to day life at the home. Some service users do not want to go out and this decision is respected. One person told us;” ” I’m happy to watch a bit of TV and potter around.” Another person, who does not regularly join in activities, told us how he had enjoyed a trip to the theatre to see a ballet performance screened live from a theatre in London, saying that, “it was great, really good; I haven’t seen proper ballet since I was young.”

The service users we spoke to told us that they like the staff at the home and feel able to raise concerns or suggestions.

We looked at a number of outcome areas and found non-compliance. We found that the system relating to the ways in which care plans were developed did not always reflect the assessed needs of people living at the home. Risk assessments were not completed, and behaviour management plans were not in place. The service did not have suitable arrangements in place to ensure people were safeguarded when the staff used any form of control or restraint when involved in the de-escalation of violent or aggressive incidents. Although control or restraint may only be used infrequently, suitable arrangements were not in place to protect people against the risk of such practices. We found errors in the ways in which medication was managed. The records were not accurate and some descrepancies in the qualities of medication held at the home were found. Staff training was on-going, however specialist training based on the assessed needs of people living at the home was not taking place. The quality assurance system operated at the home was found to be ineffectual in some areas as areas of non-compliance had not be identified by the manager and management team. Some of the records relating to people living at the home, and relating to the management systems were not accurate and up to date.