This inspection took place on 3 July 2017 and was unannounced.

Belamacanda provides accommodation and personal care for up to 22 people who may have physical or mental health needs. At the time of our inspection there were nineteen people living in the service.

At the last inspection, the service was rated good and at this inspection we found the service remains good.

There was 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.

People received a safe service and were protected from the risk of harm. There were enough staff who had been safely recruited to help keep people safe and to meet their needs. Medicines management was good and people received their medicines as prescribed.

The service supported people to have as much choice and control over their lives in the least restrictive way possible.

People had a choice of balanced, healthy and nutritious meals and were able to eat their meal where and when they wanted. Nutritional assessments were in place which identified what food and drink people needed to keep them well and what they liked to eat.

People received support that was personalised to them and met their individual needs and wishes. They ere encouraged to be as independent as possible. Additional support was provided respectfully. Staff respected people's privacy and dignity and interacted with people in a caring, compassionate and professional manner.

Care plans had been regularly reviewed to reflect people’s changing needs and people were involved in the review process. People were encouraged and supported to participate in a range of activities to suit their individual interests. Complaints were dealt with appropriately in a timely way.

People were positive about the quality of the service. The registered manager and the staff team were committed to providing people with good quality person centred care that met their needs and preferences.

There were effective systems in place to monitor the quality of the service and to drive improvements.

Further information is in the detailed findings below.

The inspection took place on 20 May 2015 and was unannounced. Belamacanda provides accommodation and personal care and support for up to 22 people who predominantly have physical disabilities and may have mental health needs. At the time of our inspection there were 21 people who lived in the service.

The home had a registered manager in post. 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 and associated Regulations about how the service is run.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals.

The service had appropriate systems in place to keep people safe, and staff followed these guidelines when they supported people. There were sufficient numbers of care staff available to meet people’s care needs and people received their medication as prescribed and on time. The provider also had a robust recruitment process in place to protect people from the risk of avoidable harm.

People’s health needs were managed by staff with input from relevant health care professionals. Staff supported people to have sufficient food and drink that met their individual needs. People’s privacy and dignity was respected at all times.

People and their relatives were involved in making decisions about their care and support. Care plans reflected people’s care and support requirements accurately and people’s healthcare needs were well managed. Staff interacted with people in a caring, respectful and professional manner, and responded well to people’s care and support needs.

People were encouraged to take part in interests and hobbies that they enjoyed. They were supported to keep in contact with family and develop new friendships so that they could enjoy social activities outside the service. The manager and staff provided people with opportunities to express their views and there were systems in place to manage concerns and complaints.

There was an open culture and the management team demonstrated good leadership skills. Staff were enthusiastic about their roles and they were able to express their views. The management team had systems in place to check and audit the quality of the service. The views of people and their relatives were sought and feedback was used to make improvements and develop the service.

Some of the people who lived at Belamacanda had complex needs but most were able to speak with us. We spoke with people who used the service on the day of our inspection. We gathered evidence of people's experiences of the service by observing how they spent their time and we noted how they interacted with other people who lived in the home and with staff. We also spoke with staff members. We looked at four people's care records. Other records viewed included staff rotas, training and supervision records, health and safety checks, staff and resident meeting minutes, medication records and records which related to the quality assurance of the service.

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?

This is a summary of what we found;

Is the service safe?

When we arrived at the service we were asked for our identification and asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service was aware of new changes in the law with regard to DoLS. Where applications had needed to be submitted, appropriate policies and procedures were in place and had been followed. Relevant staff had been trained to understand when an application should be made and how to submit one.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns. We saw the service had processes in place which ensured that staff had the skills and knowledge to support people safely.

We saw that people's personal records including medical records were accurate and that staff records and other records relevant to the management of the service were accurate and fit for purpose.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information.

We found that there were enough trained, skilled and experienced staff to meet people's needs. Staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the specific needs of the people who used the service and how those needs were to be met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, and respectful manner. We saw that staff treated people with respect.

Staff had a good knowledge and understanding of people's care and support needs, including recognising and supporting them as an individual. Where people required assistance, staff provided this in a timely manner and at a relaxed pace. This ensured people received care and support consistently and in ways that they preferred.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. People's choices were taken into account and listened to.

People told us that they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns appropriate action had been taken to address them. People could therefore be assured that complaints are investigated and action is taken as necessary.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

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.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good service at all times.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

The service had a quality assurance system in place and records seen by us showed that identified shortfalls were addressed promptly. The service had processes in place to collate the information they had gathered, identify the service's strengths and weaknesses, and plan the actions required to improve the experiences of people who used the service. This ensured continued improvement in the areas identified.

We used a number of different methods to help us understand the experiences of people who used the service, as some of the people using the service had complex needs which meant they were not fully able to tell us their experiences. Where people were unable to provide a response or tell us about their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at Belamacanda to be positive.

We observed that staff members were polite and attentive towards people who used the service, in particular those people with no or limited verbal communication. We saw that staff made good eye contact with people.

People told us they were satisfied with the level of care and support they received at Belamacanda. One person told us: "It's very nice here they look after you, and you are well looked after."

Feedback about the service from the people we spoke with was positive and the comments they made to us during the inspection were relayed back to the manager. They told us that staff were kind, approachable, listened to their views, provided good care and were always available.

We used a number of different methods to help us understand the experiences of people who used the service. Some of the people using the service had complex needs which meant they were not able to tell us about their experiences. Where people were unable to provide a response or tell us about their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at Belamacanda to be positive.

We observed that staff members were polite and attentive towards people who used the service, in particular those people with no or limited verbal communication. We saw that staff made good eye contact with people that were unable to communicate and used touch, such as holding people's hands or stroking their upper arm to reassure them when they reached out to staff.

People told us they were satisfied with the level of care and support they received at Belamacanda. One person told us "I love the staff they are my family"

Feedback about the service from the relatives we spoke with was positive. They told us that staff were kind, approachable, listened to their views, provided good care and were always available. One relative said "My (relative) has been here many years and we have had no problems".

People with whom we spoke told us that their privacy, dignity and independence are

respected and that their views on the support and care they receive are taken into

account.

people also told us that generally they were able to make choices about aspects of their

care. For example, we spoke with three people about how they are supported to

choose what to eat each day. They told us that staff offer them a choice of meals each

day and they can choose where they have these. They are also able to make a

decision as to whether or not they participate in social activities.

One relative with whom we spoke confirmed they were happy with their relative's care

and support and found staff to be kind and caring.

One person said, in relation to personal care, "I can do most things myself but if I need help I can ask for it."

People told us that they were satisfied with the level of care and support they received

at Belamacanda. One person with whom we spoke told us "They look after me well here."

Those people with whom we spoke said they could choose whether or not to join in activities and could spend time alone in their room pursuing their own interests if they

preferred.

People using the service told us that staff helped them with their medication when they needed it.

People told us when we visited that they liked the home and the improvements that had been made.

People told us that they liked their rooms, found them comfortable and liked the way the home was presented.

Everyone with whom we spoke told us that the staff at the home were very good and they felt comfortable talking with the staff about any issues that they had and that the manager was also always available for them to talk to. One person said, "They have lovely staff here."

People told us that they experience good care and are happy with the service they receive. One person told us “It’s very good here I find staff always helpful and friendly." People told us that they feel well looked after by the staff at Belamacanda. One person with whom we spoke said, "This is my home and they are lovely and they will always help you." Where people were unable to provide a verbal response or tell us their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at Belamacanda to be positive.