This inspection took place on 21 March 2017 and was unannounced. This meant the registered provider and staff did not know we would be visiting. A second day of inspection took place on 22 March 2017 and was announced.

Belmont View is a residential care home situated in Guisborough. The home can accommodate up to a 50 people over two floors and offers care for older people and individuals who are living with a dementia. At the time of the inspection 49 people were using the service.

The service had a registered manager in place and they had been in post since January 2012. 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 the last inspection in January 2015 the service was rated Good. At this inspection we found the service remained Good.

Risks to people using the service were assessed and plans put in place to reduce the chances of them occurring. Plans were in place to support people in emergency situations. People’s medicines were managed safely. Procedures were in place to safeguard people from the types of abuse that can occur in care settings. There were enough staff deployed to keep people safe and the registered provider’s recruitment processes minimised the risk of unsuitable staff being employed.

Staff received training considered mandatory by the registered provider in a number of areas to help them provide effective support and were supported with regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 were protected. People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health.

People spoke positively about staff at the service, describing the support they provided as kind and caring. Relatives also spoke positively about the support people received at the service. Staff treated people with dignity and respect. Throughout our visit we saw numerous examples of kind and caring support being delivered. People were supported to access advocacy services where needed. Procedures were in place to plan and support people with end of life care.

People and their relatives told us the service provided personalised care and support and care plans reflected people’s needs and preferences. People were supported to access activities they enjoyed. Procedures were in place to investigate and respond to complaints.

Staff spoke very positively about the culture and values of the service. People and relatives spoke very highly of the service, speaking positively about the registered manager and registered providers. The registered provider and registered manager placed great emphasis on developing links with other care agencies and community groups to help improve care delivery at Belmont View. People using the service were empowered to maintain their own links with community bodies and agencies. The registered manager and registered provider carried out a number of quality assurance audits to monitor and improve standards at the service. Feedback from people and their relatives was sought and acted on. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications.

During the inspection we spoke with ten people who used the service and three relatives. We also spoke with the manager, operations manager and a care assistant. People who used the service and relatives told us that they were happy with the care and service received. One person said, “The building is excellent, the staff are excellent and the food is very, very good.” Another person said, “This is a place where everything is provided for me. I am happy here.”

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that people had their needs assessed and that care plans were in place.

People’s health, safety and welfare were protected when more than one provider was involved in their care and treatment, or when they moved between different services.

We saw that people lived in a homely environment that promoted their wellbeing.

We saw that the service had appropriate equipment. We saw that regular checks and servicing of equipment was undertaken to ensure that it was safe.

We saw that comments and complaints were listened to and acted on effectively.

We found that people who used the services had their privacy, dignity and independence respected. Their views and experiences were taken into account in the way the service was provided and delivered in relation to their care. We found that the people who use the service experienced care, treatment and support that met their needs and protected their rights. People were protected from the risks of inadequate nutrition and dehydration and were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found that there were enough qualified, skilled and experienced staff to meet people’s needs and that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

One relative told us, "They have more than met my expectations, not just mine but my family and friends aswell."

One person who used the service told us, "It is like home from home."

We inspected Belmont View on 23 and 26 January 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Belmont View is a residential care home situated in Guisborough. The home can accommodate up to a 50 people over two floors and offers a care service for older people and individuals who are living with dementia. At the time of the inspection 49 people used the service.

The home had a registered manager in place and they had been in post since January 2012. 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 we spoke with told us they felt the staff did a wonderful job and made sure their needs were met. We found that people were encouraged and supported to take responsible risks and positive risk-taking practices were followed. Those people who were able to were encouraged and supported to go out independently and others routinely went out with staff.

We saw that on the units for people, who experienced dementia, staff matched their behaviour to people’s lived histories (the time of the person’s life they best recall) and this enabled individuals to retain skills and work to their full potential.

People told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice. We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff that were jovial and supportive. Staff were kind and respectful, we saw that they were aware of how to respect people’s privacy and dignity.

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training and understood the requirements of the Act. Where people had difficulty making decisions we saw that staff gently worked with them to work out what they felt was best. We saw that when people lacked the capacity to make decisions staff routinely used the ‘Best Interests’ framework to ensure the support they provided was appropriate. This meant staff worked within the law to support people who may lack capacity to make their own decisions.

People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained comprehensive and detailed information about how each person should be supported. We found that risk assessments were very detailed. They contained person specific actions to reduce or prevent the highlighted risk.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. They found the staff worked very hard and were always busy supporting people. Two senior care staff and six care staff were on duty during the day and two senior care staff and four staff on duty overnight. We found information about people’s needs had been used to determine that this number of staff could meet people’s needs.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff had received a wide range of training, which covered mandatory courses such as basic food hygiene as well as condition specific training such as working with people who lived with dementia. We found that the provider not only ensured staff received refresher training on all training on an annual basis but offered staff regular access to a wide range of course and educational material. They worked closely with local colleges, accessed a variety of distance learning courses and provided an educational library in the home. The home offered apprenticeships and placements for students. The registered manager completed a staff training session on a quarterly basis and these covered various topics with the latest being the change in the Health and Social Care Act 2008 regulations. We found that the staff had the skills and knowledge to provide support to the people who lived at the home.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. A designated infection control champion was in post and we found that all relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.

The provider had developed a range of systems to monitor and improve the quality of the service provided. We saw that the registered manager had implemented these and used them to critically review the service. This had led to the systems being extremely effective and the service being well-led.

The registered manager had enrolled the home in a number of pilots for encouraging best practice in care and the home had won several awards for instance an award of supporting people with oral hygiene and a food award. Plus the provider had been achieved ‘Investors in People’ award over consecutive years. They were completing the ISO award (which is an accredited scheme for ensuring quality assurance processes are effective) and staff were part way through completing the Gold Standard Framework (which promotes good end of life care). The provider supported the local college and sponsored awards.

We saw that the provider had a system in place for dealing with people’s concerns and complaints. The registered manager had ensured people were supported to access independent advocates when needed. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

Regular surveys, resident and relative meetings were held. We found that the analysis of the surveys showed the majority of people believed the home delivered an excellent service and this view was echoed in our discussions with people during the visit.