This inspection took place on 31 May and was unannounced. A second day of inspection took place on 1 June 2017 and was announced. The last inspection of this service was carried out in March 2016.

Belle Vue House is a residential home which provides personal care for up to 27 people, with dementia or general care needs. There were 24 people living there at the time of our inspection. The accommodation is over three floors, with lounges and dining rooms on the ground and first floors.

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 our last inspection of this service in March 2016, we gave the service a rating of 'requires improvement' and asked the provider to take action to make improvements. This was because we found the provider had breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to medicines. At this inspection we found significant improvements had been made in relation to medicines.

The arrangements for managing people's medicines were safe. Medicines were stored securely and there were clear policies in place for supporting people with their medicines. Medicine records were up to date with no gaps or inaccuracies.

The service was exceptionally responsive as people had access to a fantastic range of activities. People and relatives spoke extremely positively about the range of themed events and day to day activities on offer. The service had excellent links with the local community and people from the local community were regularly invited to events. Staff knew people's needs exceptionally well.

Some of the people who used the service had complex needs which limited their communication. This meant they could not always tell us their views of the service, so we asked their relatives for their views. All the relatives we spoke with said they thought Belle Vue House was safe. Staff had completed training in how to protect people from harm and abuse and understood the different forms and potential signs of abuse. Staff told us they had confidence in the management team to deal with safeguarding issues promptly and effectively. Records showed safeguarding concerns were recorded and dealt with appropriately and promptly. A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service.

There was a pleasant and homely atmosphere at the service. The accommodation was comfortable, clean and decorated to a good standard. Alterations had been made to communal areas since our last inspection which gave people more choices about where to have their meals. All relatives we spoke with said they were happy with the premises.

Staff received relevant training to support people in the right way. Staff received regular supervisions and appraisals, and told us they felt supported.

People were supported to maintain a balanced diet and to have enough to eat and drink. The chef knew people and their food preferences well. People told us they enjoyed the food.

There was a welcoming atmosphere and people who used the service were comfortable with staff. Staff encouraged people to be independent and supported people to do the things that mattered to them. Staff talked about people who used the service with affection and respect.

Staff had a clear understanding of people and how they liked to be supported. People's independence was encouraged without unnecessary risks to their safety. Staff were responsive to people's needs and acted promptly and appropriately when needs changed. Support plans were well written and specific to people's individual needs. Record

The inspection took place on 1and 2 March 2016. This was an unannounced inspection. The last inspection of this service was carried out in May 2014. The service met the regulations we inspected against at that time.

Belle Vue House is a residential home which provides personal care for up to 27 people, with dementia or general care needs. There were 25 people living there at the time of our inspection. The accommodation is over three floors, with a lounge and dining room on the ground and first floors.

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.

We found the provider had breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered provider did not have accurate records to support and evidence the safe administration of medicines. We found that some records relating to 'when required' medicines were not accurate and prescribed creams and ointments were not being recorded as administered, so it was unknown if this had taken place in the right way or at the right frequency.

You can see what action we told the provider to take at the back of the full version of the report.

People spoke positively about the service. Comments included, “It’s lovely here”, “The girls are great” and “Staff couldn’t do more.” People and their relatives told us the service was safe as people were well looked after.

Staff told us they were confident any concerns they raised would be listened to and investigated thoroughly to ensure people were protected. Staff had completed up to date training on safeguarding adults, and could describe different types of abuse and signs to look out for.

People were happy with the quality of the food which looked appetising and nutritious. People’s dietary needs and preferences were catered for by a chef who knew people well.

People and their relatives made many positive comments about staff being caring, respectful and kind. The service had a homely atmosphere and there were positive interactions between staff, people who lived there and their relatives.

People had access to important information about the service, including how to complain, make a compliment or make a suggestion. Nobody we spoke to had needed to complain.

The service had a registered manager who had worked there for a significant period of time. People, relatives and staff told us the service was well run and the registered manager was approachable. The registered manager said they felt supported by the provider.

We carried our this inspection to check that improvements had been made in respect of shortfalls in medicines management and record keeping identified on our previous visit on 14 January 2014. During our inspection on 7 May 2014, we also checked that other essential standards of quality and safety were being met. We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service responsive?

• Is the service caring?

• Is the service well led?

Below is a summary of what we found.

Is the service safe?

We spoke with six people who used the service and three relatives, as well as a health professional to find out their opinions of the service. We also sought the opinions of the local authority team which commissioned services from the home. All spoke positively about the service.

People were treated with respect by the staff. Appropriate arrangements were in place to manage medicines and we considered that people were protected from the risks associated with their use.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst no applications had needed to be submitted, we found proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

We saw that risks to people’s safety had been identified and assessed to ensure that appropriate care and support was provided to keep people safe.

Systems were in place to make sure that lessons were learnt from events such as accidents and incidents. This reduced any risk to the people and helped the service to continually improve. For instance, bed rails had been removed from one person’s bed as they were identified as a risk to the person because they moved about their bed and could become trapped in the rails. A crash mat (a thick spongy mattress placed on the floor) and a lower bed had been provided to reduce the risk of harm to the person, should they fall from their bed.

The provider had implemented effective audit processes to ensure the service was safe and to identify ways to improve.

Is the service effective?

We found that people who were using the service received the care and support they needed. The staff we spoke with could describe how they met people’s needs. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. A visitor told us, “My relative has settled quite well. She needs help and she gets it here.” People were happy with the care that was delivered, and particularly the social stimulation provided by staff. A relative commented, “The improvement in my mother’s mind is great. She is noticing more around her.” A health professional told us she had observed regular and interesting social activities taking place.

We found that people were supported to be able to eat and drink sufficient amounts to meet their needs. They were provided with a choice of suitable and nutritious food and drink which helped ensure their wellbeing. Relatives were confident that their relatives’ nutritional needs were being met and their weight was carefully monitored. One told us, “My mother weighed 40 kg on arrival and now she is 59 kg.”

Relatives we spoke with told us they were confident about the way staff managed people’s medicines. One told us, “The staff are good with my relative’s tablets.” Records showed that people were given their medication when they needed it.

We found that people’s personal records and those records which related to staff and the management of the service were accurate and fit for purpose. Staff told us they found the care records helpful to them in their work and a health professional commented, “They keep me informed about people’s weight. They do know what is happening with each patient, which is good.”

Is the service responsive?

We observed that staff provided personalised care and support and they respected people’s wishes and their agreed plan of care. People and their families were encouraged to be involved in making decisions about their care and treatment.

Relatives participated in regular reviews of their relative’s care and felt that the service responded to any concerns or issues. Relatives also told us the management and staff were open and friendly and they felt confident about raising any issues or concerns with them. One relative commented, “I know I can come and speak to them (the management) anytime I want. We often have a bit talk anyway.” People and their families were encouraged to be involved in making decisions about their care and treatment. Another relative commented, “It feels so nice here. The staff are incessantly cheerful and helpful. There’s a lovely atmosphere. The staff are very supportive. The staff are very special.”

Is the service caring?

We saw that people were treated with dignity and respect by staff, who were friendly and considerate at all times. They were attentive to people and spent time talking with them to reassure and occupy them. There was a pleasant, welcoming atmosphere in the lounges and dining rooms where people spent time. We received the following comments from people using the service: “It’s good here, everything”, “It’s nice. We all look after each other”, “It’s nice. Everyone is alright”, and “They’re extremely kind. I’m happy here.”

We spoke with three relatives who were all impressed with the quality of care. One commented, “My relative is in a good place. It’s small and caring. Staff are approachable and caring.” Another told us, “My relative is loved by the people here and cared for.”

A health care professional told us, “This is one of the homes I recommend to families. There are a lot of activities going on. People are happy.”

Local authority commissioners told us they were happy with the care that was delivered at Belle Vue.

The provider carried out checks to ensure people were treated well. Relatives were asked for their feedback and felt confident their views were listened to.

Is the service well led?

The service had been managed effectively for a considerable number of years by the same registered manager. Staff felt supported by her and people we spoke with felt they were regularly involved and consulted about the service, which helps drive improvement. A relative commented, “The manager is always here out of hours and she is very conscientious. She would take (any concerns) on board and do something about it.”

Quality assurance systems were effective. Audits were carried out to check people were cared for appropriately, for instance in respect of their physical wellbeing and nutritional status. Appropriate action had been taken where any incident affecting people’s wellbeing or safety had occurred, which helped keep people safe.

Medication systems were audited to ensure staff were following safe practice.

Management had provided staff with up to date and comprehensive policy and procedural guidance.

We spoke to people, relatives, visitors and staff at the home and they all had positive things to say about Belle Vue House. One health professional told us that they would live at Belle Vue if they needed to go to a care home to live.

We found records to show how people's health needs had been assessed before they came to live in the home. Care plans and risk assessments were then completed once the person was in residence. We spoke to one relative and they said, “I am kept fully informed both on the phone and when I come in and I have been fully involved with care records.”

We found the home to be clean, tidy and homely and one person told said, “The cleaner has such a hard job looking after us, but she does it very well.”

We found that people living in the home were not protected by appropriate management of medication, including for example; storage and recording.

We asked staff if they felt supported and from the seven staff that we spoke to they all confirmed that they enjoyed working at the home and that they felt very much supported.

There were no complaints logged at the service since our last visit and people and relatives knew how to complain. One person told us, “I would never need to complain as I am cared for here.”

There was a shortfall in administration of records at Belle Vue which meant people were not protected from the risks of unsafe or inappropriate care and treatment because inaccurate and inappropriate records were maintained.