This inspection took place on 20 February 2018. Belvoir Vale Care Home is registered to provide accommodation and personal care for up to 62 people, who have needs associated with dementia and a broad range of medical conditions. On the day of our inspection there were 43 people were using the service, housed in three different units.

At our last inspection we rated the service Good. At this inspection, we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to feel safe and staff ensured that risks to their health and safety were reduced. Although there were some concerns around staffing levels, the management team had already begun to address this just prior to the inspection using the company’s staff monitoring tools. That allowed them to re-evaluate staffing levels. Following our inspection, the registered manager informed us the levels had been increased to meet the needs of people at the service.

People were protected from the risks of infection as the service provided sufficient cleaning hours to ensure the environment was clean. Staff had received appropriate training to ensure they had the knowledge to protect people whilst providing care. Systems were in place to support people to take their medicines.

Staff received relevant training and felt well supported. People were asked for their consent and appropriate steps were taken to support people who lacked capacity to make particular decisions. People were supported to eat and drink enough to maintain good health.

There were positive and caring relationships between people and the staff who cared for them. Staff promoted people’s right to make their own decisions and respected the choices they made. People were treated with dignity and respect by staff who understood the importance of this.

People received person-centred and responsive care from staff who had a clear understanding of their current support needs. Care plans were in place, which provided information about the care people required. People knew how to make a complaint and there was a clear complaints procedure in place.

When people were at the end of their life the service had effective measures in place to support them and ensure their wishes and needs were met.

An open and transparent culture enabled people and staff to speak up if they wished to. The management team provided strong leadership and a clear direction to staff. The service worked to ensure lessons were learned from adverse incidents. There were robust quality monitoring procedures in place.

Further information is in the detailed findings below.

We spoke with five people and observed two others who lived at the service. We spoke with five staff during the course of the inspection including the manager and deputy manager to help us assess compliance.

All of the people we spoke with told us they received good quality care when they needed it. They all told us they received care that met their needs. One person said, "I get the care I need, they are excellent here, the carers." People we spoke with all said their health care needs were met well at the service and we observed care being delivered to people in line with the plan of care ensuring people's needs were met.

We looked at the premises and the safety and suitability of equipment and we found the home was comfortable and odour free. The people we spoke with all told us the home was well maintained. One person commented, "Any repairs are done quickly."

We observed that people had the equipment they needed to meet their needs and to keep them safe and there were records to show that equipment was serviced regularly to make sure it was safe for use.

None of the people we spoke with had complained but they all said they felt any concerns would be investigated and responded to. One person told us, "I would complain if I needed to, but the staff seem very kind, I have never seen any of them misbehaving." We saw that any complaints were recorded and responded to in line with the company policy.

We undertook this inspection to follow up on a compliance action we set about making sure people's capacity was assessed before do not attempt resuscitation orders were put into place.

We haven’t spoken to people using the service because the compliance action was to do with making sure the right records were in place. However, we saw evidence in the files we looked at to show both staff and the doctor had spoken with people living at the service about their resuscitation wishes. These were clearly recorded and provided evidence of consultation and involvement in decision making where this was possible. We found that the compliance action had been met.

Some of the people who live at Belvoir Vale care home would find it difficult to help us understand their views about the quality of the care being provided to them. We used a special tool, called a short observational framework inspection (SOFI) which was designed to help us understand how people who have dementia experience the care being provided to support them. We observed ten people who lived at the service in two of the units over two hours including the lunchtime period. We looked at how staff interacted with people and how care was being provided to support people with their needs. We looked for clear and observable signs which would show us how people felt about the care they were receiving. We also spoke with two people who lived at the service and a relative to ask them for their views on the care being provided at the home.

All of the people we spoke with said the staff treated people who lived at the home with respect. They said the staff were patient and kind. One person told us, "I have had very loving care, I feel very comfortable with the carers." A relative told us her loved one was always nicely dressed when she visited. We observed that there was a calm and pleasant atmosphere at the home and that staff were kind and attentive towards people living at the service.

One person told us they received they care they needed and a relative also confirmed they were very satisfied with the care being provided. We observed three members of staff support people to eat their meal. They were patient with people and allowed them to eat their meal at their own pace. The people we spoke with told us their health care needs were met well. One person told us, "The staff know me very well, if I don't feel very well they ask my permission to get the GP." The people we spoke with told us there were activities provided at the home and in the local community. We found people's rights to make decisions may not always be assessed in line with the law.

Both of the people we spoke with told us they felt safe living at the home. A relative we spoke with told us, "I feel (my relative) is safe and well cared for here. I have seen people who live here being very aggressive with the staff, but they are calm and patient and incidents are handled well."

We found mixed evidence in respect of whether the staffing numbers were sufficient to meet people's needs. A person living at the service told us that the staff were competent and well trained but they said they did not feel there were always enough staff in the morning to assist people to get up or at night to assist people into bed.

One person told us that there were regular relative and residents' meetings. They told us representatives of the provider attended these meetings so they could hear people's views.

We performed this unannounced inspection on 21 and 22 September 2015. Belvoir Vale Care Home provides care and support for 62 older adults, including people living with dementia. On the day of our inspection 55 people were using the service. The service is provided across three buildings, six people lived in the Gatehouse, 25 people lived in Gramby House and 24 people lived in Rutland House.

The service had a registered manager in place 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.

During this inspection we found there were suitable arrangements in place to ensure people who used the service were safe. They were protected from abuse and medicines were managed safely. There were appropriate risk assessments in place and the registered manager shared information with the local authority when needed. The staffing levels were sufficient and staff underwent appropriate pre-employment checks.

People were supported by staff who had the knowledge and training to provide safe care and support. They were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. People who lived at the home did not have unnecessary restrictions placed upon them.

People were protected from the risks of inadequate nutrition. Specialist diets were provided if needed. Referrals were made to health care professionals when needed.

People who used the service, or their representatives, were encouraged to contribute to the planning of their care. They were cared for in a respectful manner by staff who behaved in an inclusive and open way.

People who used the service, or their representatives, were encouraged to be involved in decisions about their care and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.