This inspection took place on 27 January 2017 and was unannounced. This meant the staff and registered provider did not know we would be visiting.

Belmont Grange Nursing and Residential Home provides care and accommodation for up to 30 older people. On the day of our inspection there were 23 people using the service.

The service had a registered manager in place. 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.

Belmont Grange Nursing and Residential Home was last inspected by CQC on 7 December 2015 and was rated Requires Improvement overall and in four areas; Safe, Effective, Responsive and Well-led. Following the last inspection, the registered provider sent us an action plan. During this inspection we checked to see whether these actions had been completed and improvements made.

Accidents and incidents were recorded and analysed. Risk assessments were in place for people who used the service and described potential risks and the safeguards in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Belmont Grange Nursing and Residential Home. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care plans were in place that recorded people’s plans and wishes for their end of life care.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person centred way.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs. The service had links with the local community.

The registered provider had an effective complaints policy and procedure in place and people who used the service and visitors were aware of how to make a complaint.

Staff felt supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service. People and visitors told us the management team were approachable and accommodating.

The inspection was carried out by a single inspector. This was the first inspection of this location since it was registered by the provider, Perfect Care in December 2013. During our inspection we asked the provider, staff and people who used the service specific 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 and speaking with people using the service, and 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 told us they were treated with respect and dignity by the staff. They said they felt safe. We found safeguarding procedures to be robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We also found relevant staff had been trained to understand when an application should be made, and how to submit one. This meant people were safeguarded as required.

The service was safe, clean and hygienic. This was confirmed by the Infection Control Team who had recently visited the home. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

The registered manager set the staff rotas, they told us they took people’s care needs into account when making decisions about the staffing numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were met.

Is the service effective?

There was an advocacy service available if people needed it, this meant people could access additional support when required.

People’s health and care needs were fully assessed with them, and they or their representatives were fully involved in writing their plans of care. We saw people's care plans and risk assessments had been signed by people who used the service or their relatives/representatives.

Specialist dietary, social, mobility, equipment and dementia care needs had been identified in care plans where required.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical, memory and mental health impairments.The provider was planning to extend the existing conservatory in order to create additional communal space for people using the service.

People who used the service confirmed they were able to see people in private and that visiting times were flexible.

Is the service caring?

People told us they were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. People commented, “The staff are very good. They put me first,” “This is a really nice place to live. They look after me very well, there is a good choice of meals available each day. It’s a very friendly place." and “They the staff are very good. I feel safe here.” A relative told us that the care at Belmont Grange was excellent. Another told us, “I couldn’t fault the care my relative receives, they have been in two previous homes and this is by far much better, my relative is so much happier here.”

The provider told us they will be asking people using the service, their relatives, friends and other professionals involved with the service to complete an annual satisfaction survey. Where any shortfalls or concerns are raised, the provider will use this information to put things right.

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

Is the service responsive?

People completed a range of activities in and outside the service regularly.

People we spoke with knew how to make a complaint if they were unhappy.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. The records we looked at showed any shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. This helped to ensure that people received a good quality service.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

This inspection took place on 4 and 7 December 2015 and was unannounced. This meant the staff and provider did not know we would be visiting.

Belmont Grange Nursing and Residential Home provides personal and nursing care for up to 30 older people. On the day of our inspection there were 27 people using the service. This was made up of 22 permanent residents, one respite and four Intermediate Care Plus clients. Intermediate Care Plus (ICP) is

a range of health and social care services. The benefits of ICP include preventing inappropriate hospital admissions, promoting faster recovery from illness or injury and providing care at, or close to, home.

The registered manager told us permanent beds at the home were full and there was a waiting list for permanent admissions.

The home had a registered manager in place. 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.

Belmont Grange Nursing and Residential Home was last inspected by CQC on 2 June 2014 and was compliant.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Thorough investigations had been carried out in response to safeguarding incidents or allegations.

People were not protected against the risks associated with the unsafe use and management of medicines.

Staff training was not up to date and staff did not receive regular supervisions and appraisals.

The home was clean and suitable for the people who used the service.

People were protected from the risk of poor nutrition.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. The provider was working within the principles of the MCA.

People who used the service, and family members, were complimentary about the standard of care at Belmont Grange Nursing and Residential Home.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

We saw that the home had a full programme of activities in place for people who used the service.

Care records showed that people’s needs were assessed before they moved into Belmont Grange Nursing and Residential Home however care plans were not written in a person centred way and some care records were inconsistently completed.

The provider had a complaints policy and procedure in place and complaints were fully investigated.

The provider did not have a robust quality assurance system in place.

The service had good links with the local community.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.