This inspection took place on 18 December 2018 and was unannounced. Belvedere Lodge is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual arrangement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to accommodate up to 20 people and at the time of the inspection there were 15 people residing in the home. The home is a converted Victorian property with facilities over four floors. There is a stair lift in situ which means there is access to all bedrooms apart from the two bedrooms in the basement. A number of bedrooms had en-suite facilities.

When we inspected the service in November 2016 there were no breaches of legal requirements and we gave the service a quality rating of Good.

There was a registered manager in post (registered in July 2018). There had been a change in registered manager since the last 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.

Improvements were required with the management of medicines to ensure people were completely safe. There had been a significant number of medicine errors (no harm to people), where the care staff were either not signing to say they had administered medicines, were not checking records correctly or were administering medicines at the wrong time of day. Regular audits were taking place and staff were being spoken with but this was not improving practice.

Improvements were also required with the care records for each person. Each person had a care plan but this was not person centred. The information contained in the care plans was computer generated and not always relevant to the person’s specific care and support needs. The recordings in people’s daily notes was of a poor quality and did not reflect the care and support they received.

Staff received safeguarding vulnerable adult training as part of the provider’s mandatory training plan. Staff would report any concerns about a person’s welfare to the registered manager, the deputy, ‘head office’ or the Care Quality Commission. Safe recruitment procedures were in place to ensure only suitable staff were employed. The appropriate steps were in place to protect people from being harmed.

Any risks to people’s health and welfare were assessed and people’s care plans detailed how these risks were managed to reduce or eliminate the risk. The premises were well maintained with regular maintenance checks being completed. Checks were also made of the fire safety systems, the hot and cold-water temperatures and any equipment to make sure it was safe for staff and people to use.

The number of staff on duty for each shift was based on the number of people in residence at any given time. Consideration was also given to the dependency level of each person and any social activities that were taking place in, or outside of the home. Staffing levels were adjusted as and when necessary. Staffing levels were appropriate at the time of the inspection.

People received an effective service. The staff team received training to ensure they had the necessary skills. New staff had an induction training programme to complete. Staff were well supported by the registered manager and the deputy although improvements were necessary to ensure improvements were made in work performance.

People’s capacity to make decisions was part of the care planning process. People were always asked to consent before receiving care. They were encouraged to make their own choices about aspects of their daily life. We found the service to be meeting the requirements of the Mental

We carried out a comprehensive inspection of Belvedere Lodge on 22 November 2016. Following a previous inspection undertaken in May 2015, we served Warning Notices for a breach of one regulation of the Health and Social Care Act 2008 relating to good governance. Complete and accurate records were not being maintained in respect of each person using the service. Compliance with these Warning Notices was followed up in October 2015 and the provider had undertaken sufficient action to meet the standard.

In addition to this, at the inspection in May 2015 we served requirement actions for two other regulations. We found there were not always enough staff on duty to meet people’s needs and care records did not always include full information about people. The provider wrote to us following this inspection in May 2015 and told us how they would achieve compliance with the standard. During this inspection in November 2016, we found that sufficient improvements had been made.

Belvedere Lodge provides accommodation and personal care for up to 20 people. The service mainly provides support for older people who are living with dementia. At the time of this inspection in November 2016, there were 18 people living at Belvedere Lodge.

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 felt safe and we observed they were at ease with the staff that supported them. There were sufficient staff on duty to support people and recruitment procedures operated by the provider were safe. People received their medicines when they needed them. However we highlighted to the registered manager that the depth and robustness of the current audit system may need to be reviewed. Staff understood their responsibilities in relation to safeguarding people from abuse and care plans contained risk management guidance. People were cared for in a clean and maintained environment.

Staff understood the Mental Capacity Act 2005 and how it impacted on their work. The service had complied with the Deprivation of Liberty Safeguards (DoLS), however it was highlighted to the registered manager that staff knowledge varied. People living in care homes can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). The application procedure for this is called the Deprivation of Liberty Safeguards (DoLS).

People received the appropriate support from healthcare professionals when required and staff received training relevant to their roles. Staff confirmed they received supervision and were able to develop themselves through additional training. The provider had an induction aligned to the Care Certificate. People in the service received the support they required in relation to eating and drinking sufficient amounts.

People spoke positively of the staff and we saw good relationships between people and staff. Staff understood the people they cared for and knew how to meet their needs. The service had created personalised care plans for people that reflected their needs and showed their life history. People’s communication preferences were noted and where needed the service had translated people’s care plans into their first language to allow them to be involved in their care more. There were activities for people to partake in and the provider had a complaints procedure.

People were positive about the management of the service. Staff also spoke positively about the management of the service and expressed satisfaction in their employment. There were systems that monitored the quality of service provided. The registered manager

We carried out a focused inspection of Belvedere Lodge on 14 May 2015. Following this inspection, we served a Warning Notice for a breach of one regulation of the Health and Social Care Act 2008 relating to good governance. Complete and accurate records were not being maintained in respect of each person using the service. The Warning Notice required the provider to be compliant with this specific regulation by 5 August 2015.

We undertook a focused inspection on 14 October 2015 to check the provider was meeting the legal requirements of the regulation they had breached and had complied with the Warning Notice. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive and focussed inspections, by selecting the 'All reports' link for ‘Belvedere Lodge’ on our website at www.cqc.org.uk

Belvedere Lodge is a care home without nursing for up to 20 people. The home mainly provides support for older people who are living with dementia. There were 17 people living at Belvedere Lodge at the time of our inspection.

There was a not 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. The listed registered manager was no longer employed at the service, and the provider had recently employed a new manager who told us they would be registering with us soon.

At this inspection, we found the provider had taken sufficient action to achieve compliance with the Warning Notice and the regulation. New documentation had been produced to record people’s food and fluid intake. Nutritional risk assessments had been completed to ensure only people’s current needs were reflected and no conflicting information was held within people’s records. The provider’s quality assurance and training manager had completed audits to monitor staff completion of these records to ensure they were accurate. This meant that the provider now held accurate and complete records in respect of each person’s hydration and nutritional needs.

The ratings we gave for the service at the inspection on 14 May 2015 have not changed as some regulations continue not to be met and we would require a record of consistent good practice over time. You can see what action we told the provider to take at the back of the full version of the report.

We carried out a comprehensive inspection of Belvedere Lodge on 28 October 2014. Four breaches of the legal requirements were found at that time. These related to the management of medicines, record keeping and quality assurance. After the inspection, the provider sent us a report of the actions they would take to meet the legal requirements.

We undertook a focused inspection on 14 May 2015. This was to check the provider had followed their plan and to confirm they now met the legal requirements. We also looked at the staffing arrangements at the home. This was because we had received information since the last inspection which raised concerns about the support people received.

This report only covers our findings in relation to these specific areas. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for ‘Belvedere Lodge’ on our website at www.cqc.org.uk

Belvedere Lodge is a care home without nursing for up to 20 people. The home mainly provides support for older people who are living with dementia. There were 18 people living at Belvedere Lodge at the time of our inspection.

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.

At our focused inspection on 14 May 2015, we found the provider was not meeting the legal requirements in all areas. People’s care records were not being fully completed. There was a risk that people would not receive the right support because accurate information about their care had not been recorded.

The provider had taken a number of the actions they had planned following the last inspection. This had resulted in some improvements, for example in the way people’s medicines were being managed. Some new checks had also been started to help identify where improvements were needed. However the actions taken were not effective in ensuring that good standards were maintained in all areas.

We found shortcomings in the staffing arrangements. Staff did not always have the time to meet people’s needs in a personalised and timely way.

The ratings we gave for the service at the inspection on 28 October 2015 have not changed. Regulations continue not to be met. You can see what action we told the provider to take at the back of the full version of the report.

Overall summary The inspection was unannounced. The previous inspection was carried out 25 September 2013 and there had been no breaches of legal requirements at that time.

Belvedere Lodge is registered to provide accommodation for up to a maximum of 20 people. The service cares for people who are living with a form of dementia. At the time of our inspection there were 18 people living in the care home. Belvedere Lodge is a large semi-detached property and accommodation is spread across three floors. Access to upper levels is provided by means of a stair lift.

A registered manager was in post at the time of 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 and associated Regulations about how the service is run.

People in the home were not always safe. We found several errors in the recording and auditing of medicines and some people’s risk assessments were not comprehensive to reflect their needs. The procedures for managing people’s medicines were not safe in all areas. This was around the maintaining of stock levels and lack of a robust auditing process.

Improvements needed to be made with risk assessment processes. This is to ensure people, and the staff who support them, were kept safe and protected from harm. Some people’s risk assessments lacked detailed guidance for staff to follow as they were not always comprehensively completed.

Not all records were completed fully. Some people’s care files lacked recordings in relation to their care and treatment. This included nutritional recording charts. This posed a risk to people’s individual needs not being met effectively.

Quality and safety in the home was monitored to support the registered manager in identifying any issues of concern. However they were not robust in respect of medicines and safeguarding audits and had not identified the shortfalls found during this inspection.

Staff had training and awareness of the Mental Capacity Act 2005, however not all staff understood who to report safeguarding concerns to in the absence of the registered manager or the provider.

People were happy with the food and drink they received in the home. We observed mealtime activities where people’s needs were being met. We found that some people did not have personalised dedicated one to one support time during the lunchtime activity. For example we saw one member of staff was stood up assisting three people with their meal.

People we spoke with were positive and felt well cared for and that their needs were met. Staff showed a caring attitude towards people they were supporting. People told us; "I love the staff" and "They’re kind yes." One person said, "They haven’t got a regime in here, not like being in the services."

People were supported to use the healthcare services they needed and staff arranged for healthcare professionals to visit the home as required.

Staff meetings and registered manager meetings were scheduled regularly and staff were encouraged to express their views. Meetings were held with people and their relatives to ensure that they could express their views and opinions about the service they received. People could also raise any complaints at these meetings.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

At the time of our inspection 16 people were living in Belvedere Lodge. During our inspection we spoke with people living in the home, visiting relatives, staff, the registered manager, the provider and examined the care records for people living in the home.

Not all people were able to verbally tell us about the care they received or if they were happy. This was because some people were living with a form of dementia. Therefore we observed how staff interacted and supported people in communal areas and crossed referenced this with their individual care plans. This enabled us to make a judgement on how their needs were being met.

Overall people we spoke with who used the service were happy with the care they received. Comments included; “it’s lovely here”. “The nicest people in the world”. “they are kind to me”.

One visiting relative told us “first class care is given. Anything I need to know they tell me. Staff are very good and my X is contented here”.

The provider had systems in place to monitor and review the quality of the service provided.

We visited the home on the 19 July 2012 and found the provider was not meeting all of the essential standards.

We found non compliance in outcome 4; there was insufficient individual stimulation for meeting the needs of people with dementia, and limited staffing to support this. Therefore people did not receive care and support that fully met their psychological and social needs.

Outcome 13; There were not enough skilled and experienced staff to meet the psychological and social needs of people that use the service.

Outcome 16; the provider did not have an effective system to regularly assess and monitor the quality of service that people received. When we visited again on the 26 September 2012 we found the required improvements had been made.

Belvedere Lodge provides care to people with dementia therefore not all of the people we spoke with were able to tell us whether the care and support they received was to their satisfaction because of dementia or ill health. However we observed how people were being cared for, examined records and talked to staff.

One person told us “Its very nice here staff are kind”. One member of staff told us the improvements have been positive for the people that use the service and for the staff team.

Belvedere Lodge provides care to people with dementia therefore not all of the people we spoke with were able to tell us whether the care and support they received was to their satisfaction because of dementia or ill health. However we observed how people were being cared for and talked to staff.

We spoke with seven people who use the service and comments included “its value for money that’s what I can expect” “It’s ok” “its lovely staff are as good as gold if they weren’t I would cause trouble” “they look after me but the first twelve months was the worse then you just get used to it”.