Belvedere House provides accommodation, nursing and personal care for up to 68 people, some living with dementia. At the time of our inspection, there were 67 people living in the service, one person was in hospital. The home is arranged over two floors and is set in its own grounds on the outskirts of Banstead in Surrey. The service supports elderly, sick or disabled seafarers, their widows and dependants.

At the last inspection in December 2013 the service met all the regulations it was inspected against.

There was a registered manager 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.

People who use the service describe the best thing about the service as the “excellent staff”. Relatives described the expertise and exceptional ability of staff in caring for people with dementia as a key strength of this service. People complimented the home, the manager and staff; they had great confidence in the service in that it provided outstanding care. People had complete confidence their relatives were safe and well cared for. A relative reviewing the service wrote on the website, “A totally lovely place, Belvedere House is always a welcoming environment to any visitor or relative staying there.”

The service only employed suitably vetted staff who demonstrated the right attributes and values. Valuing and respecting people were practices promoted throughout the service. Staff felt valued by the organisation and staff morale was excellent, they were a highly motivated team who spoke passionately about their job. They understood the importance of providing high quality care to people and reflected this in practice. People spoke about the positive impact this had on the way they were cared for.

They were well supported and supervised in their role, staff retention was excellent, and as a result staff had a great knowledge about the people they cared for and clearly understood how to meet their needs. The stability in the staff team had great benefits and resulted in meaningful relationships and trust being established between people and all the staff. Feedback from people and their relatives was very complimentary acknowledging the exemplary approach of staff.

Staff confidently made use of the Mental Capacity Act 2005 and used innovative ways to make sure that people were involved in decisions about their care so that their human and legal rights were sustained. There were champions within the service who actively supported staff to make sure people experienced good healthcare outcomes leading to an outstanding quality of life. The registered manager was following legal requirements in relation to DoLS. At the time of the inspection, applications had been made to the local authority in relation to people living at the service to protect people’s legal rights.

One person visiting relatives over many years said, “This home has a great reputation and justly deserves it".

Staff worked very well as a team, the team included nurses and care staff, but also maintenance and housekeeping, as well as catering staff, each one playing an important role in delivering a consistently high quality service. The staffing levels fully considered individual needs and allowed staff to focus on the individual thus delivering person centred care, and these arrangements were regularly reviewed.

Staff were well trained, skilled and experienced due to the excellent training and development programme. They were inspirational in their attentiveness to people’s changing needs. Staff demonstrated important qualities such as affection and warmth in their relationships with people.

People’s care and support was planned proactively and in partnership with them. Staf

We spoke with four people who lived at the home. They were all satisfied with the care and support they received and were happy living at Belvedere House. One person told us, "I feel safe, happy and well looked after". Another said, "You couldn't fault the staff. They are ever so nice. I could ask for anything, anytime". A visitor told us, "This place has a very good reputation. and it deserves it". We noted that the home provided a wide variety of social events and activities in both group and individual settings; the people we spoke with were happy with the number and types of opportunities on offer.

We saw that people's consent was obtained where possible before care and treatment was undertaken. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from the risks associated with poor medication management. We noted that medicines were properly handled and administered in line with the provider's policy. We noted that there were adequate numbers of skilled and experienced staff to deliver safe and appropriate care. We also found that systems were in place for people and relatives to make a complaint about the service if necessary. We saw that complaints were handled in an appropriate and timely fashion.

We spoke with five people who used the service and we spoke with two relatives of people who used the service.

People we spoke said that they were happy with the care that they received. They said "we have lots of help to keep us as independent as possible but the staff were always willing to help if we need it",they continued to say that they visited the home on "quite a few occasions before they decided to move in".

When we asked them about the staff people told us that the staff were, "very caring and sweet to all of us". Another said, "The staff appear to take a genuine interest in our care and always try their level best to make our days bright".

People said that they thought there was always enough staff on duty. We observed staff interacting with people in a friendly and caring manner.

People who use the service told us that they have experienced a good level of respect they stated that staff always knock on their door before they come into the room and always ask her permission before undertaking her care.

They were respected by staff, treated with dignity when receiving care, allowed privacy and supported to be more independent or to maintain their independence.

Staff were described as being very patient and understanding and would work at the pace of the person they were providing care for.

The staff always ask permission before assisting in all aspects of care.

One person who uses the service told us that the a member of staff had asked him if he wanted any relative to be involved in planning his care package and if they wanted anyone else involved outside the family members.

They receive care that meets their needs and said that the staff were "always busy but never to busy to help, always willing to listen and are very kind" when providing care.

One person who recently moved into the service told us that before they moved in someone from the service came and had a long chat with her and her family to make sure that Belvedere House could meet her needs. The care plan that was developed included the needs assessed during their chat and other information the service received from the GP and after a recent hospital discharge.

People who uses the service told us that the food is "very nice and there is always something I like" and "always looks and tastes very nice" and that they were looking forward to their Christmas lunch.