CQC report explained · a residential care home
What the CQC found at Belmont Lodge Care Centre
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Safe was not assessed during this focused inspection. The rating from the previous comprehensive inspection was carried forward.
- Effective?
- Good
- Staff understood the Mental Capacity Act and Deprivation of Liberty Safeguards. People's nutritional, healthcare and oral health needs were supported, and the environment was suitable and maintained.
- Caring?
- Good
- People were treated with kindness, dignity and respect. Staff knew people well and involved them in choices about their care.
- Responsive?
- Good
- Care plans were personalised and included people's preferences and communication needs. Activities were meaningful and complaints were investigated, although relatives gave mixed feedback about communication.
- Well-led?
- Good
- Well-led was not assessed during this focused inspection. The rating from the previous comprehensive inspection was carried forward.
What inspectors found, July 2021
Belmont Lodge Care Centre was rated Good; inspectors found kind, personalised care and improvements since the previous inspection, with communication between staff and relatives sometimes uneven.
This was an unannounced focused inspection on 15 June 2021. Inspectors spoke with five people living in the home, four relatives, nine staff members and a visiting professional. They also observed care and reviewed care and staff records.
The inspection found Good ratings for Effective, Caring and Responsive. People were supported to make choices, eat and drink well, access healthcare and receive personalised care. Staff treated people kindly and activities reflected their interests.
The previous rating was Requires Improvement, with two breaches of regulations. Inspectors found enough improvement had been made and the home was no longer in breach. The overall rating changed to Good, but Safe and Well-led were not assessed during this inspection and their earlier ratings were carried forward.
Respectful, kind staff
People had positive relationships with staff. Inspectors saw staff taking time with people, not rushing them and supporting their dignity.
“People had developed positive relationships with the staff, who treated them with respect and kindness.” from the report
Personalised care
Care plans recorded people's likes, dislikes, communication needs and daily preferences. Staff knew people well and delivered care in line with their wishes.
“Care plans were personalised, and people's needs and wishes were considered and planned for.” from the report
Meaningful activities
Activities were adapted to people's interests, cultural needs and abilities. Inspectors saw activities involving food, reminiscence and social events.
“The activity organiser and staff had worked hard to ensure activities were personalised and meaningful.” from the report
Improvement since the last inspection
The home had addressed the earlier problems involving consent and staff training. It was no longer in breach of the regulations identified at the previous inspection.
“At this inspection enough improvements had been made and the provider was no longer in breach of Regulation 11.” from the report
Communication was not always consistent
minorRelatives gave mixed feedback about communication. One relative said communication depended on which staff were working, and inspectors fed this back to the manager.
“The communication could vary dependent on what staff were on, some staff were very good but others it was more difficult.” from the report
- 01How will you make communication consistent when different staff members are on duty?
- 02How will relatives be updated about changes to their family member's care?
- 03What were the Safe and Well-led ratings at the previous comprehensive inspection?
- 04How are care plans reviewed when a person's needs or preferences change?
- 05How are activities matched to each resident's interests and communication needs?
This was a focused inspection of Effective, Caring and Responsive; Safe and Well-led were not assessed and their previous ratings were carried forward. This explanation was written from the published report of 1 July 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2021
Rated Requires Improvement; inspectors found safer care and stronger management, but breaches relating to consent and person-centred care remained.
The inspection was unannounced and took place on 19 November 2020. One inspector spoke with four people, six staff members and four relatives. They reviewed care records, medicines records, recruitment information, training data and quality checks.
The home was rated Good for Safe and Good for Well-led. Inspectors found improved risk assessments, suitable staffing, safe medicines systems, infection controls and checks on staff recruitment. People and relatives spoke positively about the care and said staff knew people well.
The overall rating was Requires Improvement because Effective and Responsive were not reviewed, and breaches relating to consent and person-centred care remained from the previous inspection. The home had improved from Inadequate and was no longer in special measures.
Improved risk management
The home had introduced a new care-planning and risk-assessment system. Records were regularly reviewed and gave staff information needed to support people safely.
“Care plans were detailed and contained all the information staff needed to support people safely.” from the report
Safe staffing and recruitment
Inspectors found a consistent staff team, staffing levels based on people's needs and appropriate recruitment checks.
“The acting manager used a dependency tool to calculate staffing numbers and staffed above these needs to ensure there was enough staff to cover absence such as, sickness.” from the report
Safer medicines and infection control
Medicines were given by trained staff, with systems for storage, ordering and monitoring. Inspectors were assured that infection risks, including coronavirus risks, were being managed.
“There were suitable systems in place for the storage, ordering, administering, monitoring and disposal of medicines.” from the report
Stronger leadership
The acting manager and deputy manager had improved oversight and created systems to monitor quality, learn from incidents and involve people and relatives.
“This encouraged continual learning and improvement of the service to improve outcomes for people.” from the report
Consent and person-centred care breaches remained
seriousThe report says the Effective and Responsive areas were not reviewed. It also says the previous breaches relating to consent and person-centred care remained in place, so the overall rating was still Requires Improvement.
“However, Effective and Responsive were not reviewed at this inspection breaches of regulation 11(Consent) and 9 (Person centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 remain in place.” from the report
- 01What has the home done to address the remaining breach relating to consent under Regulation 11?
- 02What has changed to make care more person-centred and address Regulation 9?
- 03When were Effective and Responsive last fully assessed, and what were the findings?
- 04How does the home check that risk assessments and care plans remain accurate as people's needs change?
- 05How will you keep our relative and family updated about care reviews, activities and any concerns?
This was a planned, unannounced inspection focused on Safe, including infection prevention and control, and Well-led; Effective, Caring and Responsive were not rated at this inspection. This explanation was written from the published report of 13 January 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Belmont Lodge Care Centre
6 rated inspections over 5 years: the service has improved, from Requires improvement to Good.
- July 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2021Requires improvementup from Inadequate
- January 2020Inadequatedown from GoodSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- April 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- November 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Inadequate
- September 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 2 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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