This unannounced inspection took place on the 30 May 2018.

Bellamy’s Cottage is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Bellamy’s Cottage accommodates up to eight adults who have a learning disability and or autistic spectrum disorder related conditions. At the time of the inspection there were eight people living there, all male. The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. The service is purpose built and situated within the grounds of the Linkage college campus, close to local amenities. It provides eight single bedrooms and four have en-suite facilities. The accommodation includes a bathroom, shower room, toilets, laundry, kitchen, two sitting rooms, kitchen and a dining room.

The service had a registered manager in post. A registered manager is a person who has registered with 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 29 and 30 March 2017, we rated the service as ‘Requires Improvement’ and we found concerns in relation to care records, consent and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Responsive and Well-Led to at least good. At this current inspection we found significant improvements had been made in all areas.

People, their relatives and visiting professionals provided only positive feedback about the service. The registered manager had received regular peer and senior management support and we found the management and organisation of the home had improved. Quality assurance reviews were completed more thoroughly and we saw action had been taken when issues had been identified.

The service was operating within the principles of the Mental Capacity Act 2005 (MCA). People were supported to make their own decisions and choices. The registered manager had a much improved understanding of mental capacity legislation. People had assessments of capacity and best interest decisions made on their behalf if they lacked capacity; documentation regarding best interest decisions had been completed. Appropriate applications had been made to the local authority when people’s liberty was deprived due to their lack of capacity and need for continual supervision. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People’s care plans had improved, with new assessments of need completed for each person. The provider had implemented a new recording format and information was easily accessible. This meant they could better assess and manage risks to people’s health and safety.

The organisation’s new recording format had been fully implemented and information was easily accessible. Risks to people’s health and safety were better assessed and managed. Care plans were detailed, person centred and updated when people’s needs changed.

The management of medicines was safe and people received their medicines as prescribed. The medicine administration procedures were more person-centred.

The provider had policies to guide staff in safeguarding people from the risk of harm and abuse. Staff knew how to raise safeguarding alerts if they had concerns.

The environment was s

Bellamy's Cottage provides accommodation and personal care for up to eight people. At the time of the inspection there were eight people living there.

The service 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 2008 and associated Regulations about how the service is run.

At the first rated comprehensive inspection on 3 and 4 December 2014, we rated the service as ‘Good’. This inspection took place on 29 and 30 March 2017 and we found shortfalls in a number of areas. The rating of four of the five domains has changed to ‘Requires Improvement’ and the service has been rated ‘Requires Improvement’ overall.

We found there was inconsistency regarding the application of the Mental Capacity Act 2005. The registered provider and registered manager had not always followed best practice regarding assessing people’s capacity and discussing and recording decisions made in their best interests.

We found not everyone had a full and up to date care plan and risk assessment to guide staff in how to meet their needs.

The quality monitoring system had not been effective in highlighting areas to improve such as the care records, consent to care and aspects of safety monitoring. We found action had not been consistently taken in order to address these.

The above areas breached regulations in relation to consent to care and monitoring the quality and safety of the service, including the maintenance of complete and accurate care records. You can see what action we have asked the registered provider to take at the back of the full version of the report.

The CQC had not received all notifications for incidents which affected the safety and wellbeing of people who used the service as required by registration regulations. This had been an error by the registered provider and registered manager and they told us they would forward all required notifications in future. We have written to the registered provider to remind them of their responsibilities in this area.

Staff had completed safeguarding training and knew how to protect people from the risk of harm and abuse. We found some inconsistencies in the reporting procedures to the local safeguarding team, which the nominated individual [registered provider's representative] confirmed would be addressed with improved oversight by the senior management team.

We saw there were sufficient staff on duty to meet people’s needs. Staff had been recruited using a robust system that made sure they were suitable to work with vulnerable people. They had received a structured induction and essential training at the beginning of their employment. This had been followed by regular refresher training to update their knowledge and skills.

People’s health needs were met. Medicines were ordered, stored and administered safely and people received their medicines as prescribed. We found staff contacted health professionals in a timely way for advice and treatment.

People’s nutritional needs were met. The menus provided people with a varied and nutritional diet. People told us they liked the meals and we observed they enjoyed a positive mealtime experience.

We found people were supported to live as independently as possible and be active and healthy. Staff encouraged people to participate in activities of daily living such as laundry, cleaning, shopping and meal preparation. They also assisted people to access community facilities such as day services and leisure activities. Staff provided a range of activities for people to participate in within the service.

People who used the service and their relatives told us they were supported by kind and caring staff who knew them well and understood their preferences for how their care and support sho

We saw that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Care records gave details of people’s preferences and we saw they decided things, like how they spent their day and what meals they ate. If people could not tell staff what they wanted systems were in place to help them do so or other people were involved.

There were clear care plans for staff to follow about how to support people safely and promote their independence.

People who used the service were provided with a balanced and varied diet. Health professionals provided guidance and treatment when required.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Throughout our inspection we observed good interactions and found people who used the service were relaxed and happy in the care of the staff. People described the staff as, “Nice and friendly” and “Good, they help me.”

We found people’s comments and complaints were acted on. Staff told us how they would support people to raise concerns if they could not do so themselves. One person who used the service told us, “We talk about complaints at the meeting. I would speak with my key worker if I was upset about something.”

People told us they were happy with the care and support that Bellamys Cottage provided.

People's comments included: "I really like it here in this house. They do respect me." One person told us about the weekly meeting to decide menus, leisure activities and allocation of tasks which promoted independent living skills: “We have meetings to talk about the house and what we all want.”

People and their relatives spoke positively about their care and support. People's comments included: "Care is to a very high standard," "The care is good. The food is good; it is what I would want for myself if my circumstances were different," and, "This place is superb and the staff with it. We are always involved in everything to do with our relative.” Another person told us, "We couldn’t have a better place for him, the staff have worked hard to learn everything about him and they know him really well now and fully understand his needs and how these are best met for him.”

People spoke positively about the staff that worked with them. They said: "Staff are very helpful, understanding, friendly and warm.” and "The staff are very nice to me and I have not a bad word to say about them." A visitor said, "When we come it is solely about our relative. Every staff member gives me a breakdown of what he has done. It has been an absolute dream for us for him to live here.”

We carried out an unannounced inspection of the service on 3 and 4 December 2014. Bellamy’s Cottage provides accommodation and personal care for up to eight people with learning disability, male only. At the time of our inspection six people were using the service. The last inspection took place on 6 December 2013 during which we found there were no breaches in the regulations.

The service had a registered manager in place at the time of our 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’s human rights were protected by staff who had received training in the Mental Capacity Act 2005. We saw where a person may not have the ability to make a certain decision, an assessment was completed to see if they understood the choice they were asked to make. Where people were not able to make a decision we saw these had been made in their best interest by family members and professionals involved in their care.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered provider had followed the correct process to submit applications for a DoLS where it was identified a person needed to have their liberty restricted in order to care for them safely, and that this was in their best interest. At the time of the inspection six people who used the service had their freedom restricted and the registered provider had acted in accordance with the Mental Capacity Act, 2005 DoLS to seek authorisation.

People were supported by sufficient numbers of staff who knew and respected them as individuals. There were systems in place to protect people from the risk of abuse.

We found the registered manager and staff put the care and welfare of people who used the service at the centre of what they do. We found they encouraged people to be as independent as possible and ensured that everyone who was important in people’s lives were involved in their care and support and able to contribute to the development of the services they provided.

We saw the care people were provided with met their needs and was delivered in a way which was intended to keep people safe. People received their medicines as prescribed.

Staff made referrals to health and social care professionals when people’s needs changed and people who used the service were supported to attend health appointments. We found staff were knowledgeable about people’s health and social care needs.

People were treated as individuals. Staff knew them well and understood their individual preferences and respected their choices. We saw examples of people being supported with kindness, respect and dignity throughout the inspection.

People had access to sufficient quantities of food and drink. Staff monitored their nutrition and hydration requirements regularly.

The service’s training records showed the courses staff had undertaken and when they were due to be refreshed. The majority of training was up-to-date and the outstanding training had been scheduled. Staff told us they had regular supervision meetings and the registered manager was supportive and approachable at any time.

The registered provider had a set of corporate values and staff we spoke with demonstrated how they were used to provide a quality service to people. We saw there were systems in place to continually review and improve the quality of service people received.

We saw the registered provider had systems in place to capture the views and concerns of people who used the service to see if any improvements were needed. There was a complaints policy in place and people and relatives we spoke with told us they knew how to complain.