This inspection was undertaken on 1 and 2 March 2017.

Belmont Lodge provides accommodation and personal care to up to 46 people. People living in the service may have care needs associated with dementia. There were 36 people living at the service on the day of our inspection.

A registered manager was 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.

At this inspection we found significant improvements had been achieved across most areas of the service. However, additional work was needed to some records and evaluation arrangements to ensure ongoing progress.

There were processes in place to manage risks in the service. Staff practice and use of equipment for people was notably safer. Medicines were safely managed to ensure people received their prescribed medicines. People were supported by staff who knew them well and were available in sufficient numbers to meet people's needs effectively. Recruitment procedures were more comprehensive. Staff knew about identifying abuse and how to report it to promote people’s safety and well-being. Action had been taken as needed to ensure people were safeguarded.

Staff were more confident and had received additional training and support needed to enable them to improve their practice. One exception to this had already been identified and action was being implemented to address this. People’s dining experience was notably enhanced. People had choices of food and drinks that supported their nutritional or health care needs and their personal preferences. Arrangements were in place to support people to gain access to health professionals and services.

People overall were cared for by kind and caring staff. People’s dignity and privacy were respected and this was another area of staff practice much improved since our last inspection. Visitors were welcomed and relationships were supported.

People had opportunity to participate in their care planning and to have input into the way their care was provided. People were supported to participate in social activities of their choice. People felt able to raise any complaints and felt that the provider would listen to them. Information to help them to make a complaint was readily available.

Staff morale was higher and staff worked as a team to provide care in a friendly and calm environment. The provider had used their staff performance systems to effect positive changes in staff culture and responsibility.

Systems were in place to offer people ways of expressing their views and influencing their everyday experience of the service. The provider had listened to people’s views and ensured that actions were taken in response to people’s comments.

There was clearer leadership and accountability in the service. The registered manager, with the support of the provider, had worked to stabilise the service and implement positive changes.

This inspection took place on 20, 21, 22 July and 3 August 2016.

Belmont Lodge is registered to provide accommodation with personal care to up to 46 older people. People may also have needs associated with dementia. There were 40 people receiving a service at the time of our inspection.

A registered manager was 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.

At our inspection of August and September 2015 we found that the provider was not meeting the requirements of the law in relation to the training, support and deployment of staff, people’s nutrition and hydration, care planning and good governance.

At our inspection of July and August 2016 we established that sufficient improvements had been made in some areas and further progression was still needed in others. The need for further improvements and the identified areas of risk were of concern because the management of the service had not used the quality assurance systems effectively to continually improve the service for people. Further failings had been identified in areas that were not failing at our 2015 inspection.

The provider’s quality assurance system, although improved needed further development to ensure that all aspects of shortfalls in the service were captured and addressed on an on-going and sustained basis. The provider responded promptly where we identified concerns in the service. However, our concern remains that the improvements were not identified and actioned by the provider’s own systems. As part of this inspection process, we met with the provider to discuss their retrospective action and to get their assurances on continued compliance. We were assured that action was being taken swiftly to address shortfalls in the service to ensure people’s safety and wellbeing.

Systems to manage medicines and risk for people living and working in the service needed improvement. While staff support systems had improved, areas of staff practice were not always safe, respectful and person centered. Records, both in relation to the quality of the information they contained and to their secure storage, needed further attention. Improvements were needed to ensure that all aspects of people’s care needs were documented to provide guidance for staff on meeting people’s needs.

Improvements were noted to the management of risks to the environment and the running of the business so as to ensure people’s safety since the last inspection. People were supported by increased numbers of staff who were more effectively deployed to meet people's needs. People were supported to participate in a wider range of social activities that interested them and met their needs. Improved information on available activities and meal choices in an accessible format was arranged for people during the inspection.

People’s care was planned and reviewed with them or the person acting on their behalf. Arrangements were in place to support people to gain access to health professionals and services. Visitors were welcomed and relationships were supported.

People felt able to raise any complaints and felt that the provider would listen to them. Information to help them to make a complaint was readily available.

People knew the registered manager and found them to be approachable and available in the home. People living and working in the service had the opportunity to say how they felt about the home and the service it provided and be listened to.

We looked at four care plans for people who lived at Belmont Lodge Care Centre, all of which had consent for care that had been signed by the person it involved or their relative. However, there were no Mental Capacity Assessments to establish whether people had mental capacity to give consent or to make a decision.

We observed that all staff spoke kindly and respectfully to people who lived in the home.

Belmont Lodge Care Centre was clean, although in need of refurbishment, which the manager told us was due to commence shortly. All the staff we spoke with were aware of their role in preventing cross infection.

We observed staff managing medication and saw that medicines were stored, handled and administered appropriately. There was a system in place which was followed to ensure that if people declined their medication, they were referred to the prescriber for advice on further management.

Staff received training and support to ensure they were fully competent and confident in their jobs.

One person, who had been living at Belmont Lodge Care Centre for some time said to us, "It's really very nice here. The staff are very kind. They all know me and my family really well" Another told us, "I really like my room and I can go there if I want to be quiet. Otherwise I can choose to sit in one of the lounges and chat."

We spoke with the relatives of three people during our visit to the service on 31 August 2012. They all told us that they were very happy with the care and support provided by the service. One relative told us, “I wanted them to be safe. There is always someone there to take them to the toilet. I feel they are safe here.” We spoke with seven people living at the home. One person told us when they first came to the home, “The manager and staff were extraordinarily welcoming”. They told us that they liked to spend time in their room and this was respected. Another person told us, “They respect my privacy. I have a key to my own door and I can go out when I like.”

We spent time listening to interactions between staff and people living at the home. We took time to observe the daily routines to help us determine what it was like for people living there. We saw that people looked happy and relaxed in their surroundings and that they responded positively to staff during our visit. We saw that people were given a choice in the time they got up and how they spent their day. One person told us, “I‘m quite happy. Staff are all very, very good. They look after me like a daughter.”

People living at the home told us that their care needs were met and that they had choice in their day to day lives. They said that the staff team were kind, caring and chatty.

This inspection took place on 27 August and 1 September 2015.

Belmont Lodge Care Centre provides accommodation for up to 46 older people who require personal care. People may also have needs associated with dementia. There were 38 people living at the service on the day of our inspection, including two people who were in hospital.

A registered manager was in post but was on leave 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.

Staff were not available in sufficient numbers to meet people's needs safely and staff were rushed at times. Improvements were needed to staff deployment.

People’s nutrition and hydration needs were not always properly assessed and met.

Staff did not receive suitable training and support to enable them to meet people’s needs effectively. Staff performance was not suitably monitored and appraised to ensure good practice was in place.

Records were not always available to guide staff on how to meet people's assessed care needs. People did not always receive the support required to meet their identified individual needs. People had varied levels of opportunity to participate in social activities and engage in positive interactions.

The provider’s systems to check on the quality and safety of the service provided were not effective in identifying and acting on areas that required improvement. People did not always feel their views were listened to positively.

Medicines were not consistently stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines safely. Risks to people’s health and well-being were not always assessed or were not sufficiently detailed to ensure people’s safety. People received varied support in the way their healthcare needs were met.

The provider had a clear complaints procedure in place. Improvements were needed to ensure everybody felt their concerns were listened to.

Appropriate assessments had been carried out where people living at the service were not able to make decisions for themselves and to help ensure their rights were protected.

Staff had attended training on safeguarding people and were knowledgeable about identifying abuse and how to report it. Recruitment procedures were thorough.

People were supported by staff who knew them well. People’s dignity and privacy was respected and staff were kind and caring. Visitors were welcomed and people were supported to maintain positive relationships with others.

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