We carried out this unannounced comprehensive inspection on 30 and 31 January 2018. At our last inspection on 07 March 2017 we found three breaches of regulations and rated the service as requires improvement. The breaches found on 07 March 2017 related to safe care and treatment, staffing and good governance. This was because some staff had been unsure about operating equipment to keep people safe, some emergency pull cords were not accessible in line with the regulations. Some people’s personal emergency evacuation plans (PEEPS) were not up to date. People did not always feel reassured after a fire drill. There was insufficient staffing at certain times and we were concerned that the provider’s quality assurance systems did not always identify issues of concern so was not effective.

At this inspection we found improvements had been made in all areas. Staff were confident with the equipment they used. Emergency pull cords were checked regularly to ensure they were within easy reach should someone need them. People’s PEEPS were up to date and relevant. Systems had been put into place to give people reassurance both before and after fire drills. Staffing levels had improved and we found adequate staffing in place to keep people safe. The quality assurance systems in place allowed the registered manager to identify when things went wrong so they were able to improve the quality of care.

Belmont House Nursing Home is a three storey purpose built residential nursing home in Sutton that provides nursing, support and personal care for up to 60 people. At the time of our inspection the second floor was not in use and 32 people were using the service using the ground and first floor accommodation. The service had dining and lounge areas on each floor with a hairdressing salon, a coffee area, cinema room and a dedicated activities room on the ground floor. There were secure well maintained gardens with planting and seating areas. The laundry, catering, staff room and training area were located in the basement. The environment appeared light, clean and well maintained.

People told us they felt safe at Belmont House Nursing Home. There were appropriate safeguarding policies and procedures in place and staff were all trained in safeguarding adults and had a good knowledge and understanding of how to identify if people were at risk of abuse and knew what to do in these circumstances. Risks were identified and plans were in place to monitor and reduce risks to help keep people safe.

There were systems in place for the safe storage, administration and recording of medicines. Each person’s medicine was stored securely and only senior competent staff were authorised to administer medicines. During the inspection all medicine records we observed had been filled out correctly and medicine audits were completed to ensure medicine procedures were robust.

Staff had been recruited safely with appropriate checks on their backgrounds completed. We saw all the staff had completed an induction programme and on-going training was provided to ensure skills and knowledge were kept up to date.

We observed positive and appropriate interactions between the staff and people who used the service. Staff were caring and treated people with kindness, dignity and respect. People who used the service and their relatives were complimentary about the permanent staff and the quality and standard of care received. There were nominated dignity champions within the staff team.

The home employed two activity coordinators and this had a positive impact on the quality of life people experienced. People we spoke with enjoyed the variety of activities available, the activity schedule catered for all interests. The provider was looking at ways to further encourage engagement for those people living with dementia.

There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People were encouraged and suppo

We carried out this unannounced comprehensive inspection on 7 March 2017. At our last inspection on 29 September and 4 October 2016 we found seven breaches of regulations and rated the service as 'Inadequate' and the service was placed in 'special measures'. Special measures provide a framework for services rated as inadequate to make the necessary improvements within a determined timescale. If they do not make the necessary improvements, the CQC can take further action against the provider, including cancelling its registration.

The breaches of regulations we found at the inspection on the 29 September and 4 October 2016 were in relation to person centred care, dignity and respect, need for consent, safe care and treatment, good governance, staffing and fit and proper persons employed. This was because the provider did not have effective systems to assess, review and manage risks to ensure the safety of people and they did not have suitable arrangements to protect people against the risks that can arise from the unsafe management of medicines. We also found that staff’s recruitment processes were not carried out safely, staff did not receive appropriate training and support and the provider had not followed processes to ensure that any restrictions on people's liberty were kept to a minimum. In addition, people were not supported by caring staff, who respected their privacy and dignity and the provider had not ensured that people always receive care from staff of a gender of their choosing. Our findings also showed that care plans had not been updated to take into account people’s changing needs and the provider did not have adequate quality assurance systems and we found care records including food charts; fluid balance charts and turning charts were not completed properly to monitor people's health.

Following our inspection in September 2016 and as part of our decision making process for urgent enforcement action against the provider, we wrote to them requesting a plan outlining what actions they had taken since our inspection and what further action they planned to take in order to meet the breaches of regulations summarised above. We received an action plan within the timescale requested which provided some assurance that the provider had addressed or was in the process of addressing our most urgent concerns and that they would make all the necessary improvements by the end of December 2016.

We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Belmont House Nursing Home on our website at www.cqc.org.uk”

Belmont House Nursing Home provides accommodation, personal and nursing care for up to 60 older people. There were 23 people using the service when we visited. The home is divided into three units, one on each of the three floors of the home. The ground floor is for people with nursing needs and the first floor accommodates people with dementia. The third floor was not being used at the time of our inspection.

The home had a registered manager but they were no longer in post at the time of the inspection and had not yet deregistered. There was a peripatetic manager in place on the day of the inspection. 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 this inspection we found that whilst there had been some improvements in the quality of the service, there were still some areas that needed to be further improved. For example some staff were still not sure how to operate the movement sensors and sensory mats in people’s bedrooms. These devi

This unannounced inspection took place on 29 September and 4 October 2016. The home was registered on 13 July 2016 this was the first inspection of this home. The inspection was brought forward because of the number of concerns about the quality of the service provided to people that the CQC had received from the London Borough of Sutton, Sutton Clinical Commissioning Group and on many occasions from relatives of people who use the service and anonymous callers.

Belmont House Nursing Home provides accommodation, personal and nursing care for up to 60 older people. There were 19 people using the service when we visited. The home is divided into three units, one on each of the three floors of the home. The ground floor is for people with nursing needs and the first floor accommodates people with dementia. The third floor was not being used at the time of our inspection.

The home had a registered manager but they were no longer in post at the time of the inspection and had not yet deregistered. There was a newly appointed manager who was registered with CQC at another home within the Caring Homes Health Care Group. They had submitted an application to CQC to register as the manager of Belmont House.

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.

We found the provider did not have effective systems to assess, review and manage risks to ensure the safety of people. For example staff were not using the right lancing device to test for blood sugar levels increasing the risks of cross infection. Suction machines were not prepared and set so these could be used in an emergency, to clear a person’s airway if they choked. These issues were addressed when we pointed them out but the provider’s own systems had not identified those issues.

People’s risk assessments and management plans were not always updated when their needs changed. Risk assessment for falls had not been updated after people had had falls. This meant people were not being adequately protected against further risks of falls. The provider had a strategy to manage falls but this was not disseminated within the home so staff were aware of this strategy to reduce the risks of falls. Staff did not fully understand how to operate the sensor mat that was linked to the call bell system so these could be used effectively, to help prevent falls.

The provider did not have suitable arrangements to protect people against the risks that can arise from the unsafe management of medicines. Among the concerns we found, we noted that the quantity of medicines were not always recorded when received into the home or carried forward to provide an audit trail about how medicines were managed. On a few occasions we could not correlate the amount of medicines in stock with what had been received and given; therefore we could not confirm people had received their medicines as prescribed. On at least three occasions on one day staff had signed the MAR sheet that medicines had been given to people but we found the medicines were still in their blister packs.

People had personal emergency evacuation plans (PEEP) in their care records but we found that these had not been reviewed when their needs had changed.

Staff recruitment procedures were not safe. Records did not show a current photograph of the staff member and none of the records we looked at had a current criminal record check. There was no evidence of any assessment of their suitability to work with people who used the service.

People were not supported as well as they could have been by staff who were knowledgeable in understanding their needs because they did not receive appropriate training and support. Records and feedback from staff showe