The Belfry Residential Home is a ‘care home’. People in care homes receive accommodation and personal care under a contractual agreement. CQC regulates both the premise and the care provided and both were looked at during this inspection. The Belfry Residential Home accommodates up to 12 people in one adapted building. At the time of our inspection, 10 people were using the service. The service is a converted home and bedrooms are available for people on both the ground and first floor.

This inspection took place on 15 March 2018. The inspection was unannounced, this meant the staff and provider did not know we would be visiting. At the last inspection on 10 January 2017, the service was rated ‘requires improvement’. Following the last inspection, we asked the provider to complete an action plan to show, what they would do and by when to improve the key questions to at least good. At this inspection, we found that the service had made improvements and this was now good.

Covert surveillance in the lounge and communal areas was being used and the provider had obtained people’s consent to do this. The security of people was maintained. People were supported to have maximum choice and control of their lives and the systems in the service supported this practice.

Medicines were managed safely and people got them on time and in the correct way. There were enough staff on shift to meet people’s needs and people could access activities of their choice and these included trips out of the service.

People, staff and visitors had been asked about their experiences and this information was being used to look at the ways the service could be improved.

Staff knew how to recognise and report any suspicions of abuse, and people told us they felt safe and cared for. The registered manager had a robust recruitment process, and supported staff to develop their skills and knowledge. Staff told us they enjoyed their work and worked well as a team.

Accidents and incidents were appropriately recorded and when these had occurred investigations had been carried out. Risk assessments were in place for people who used the service. Staff worked well with health care professionals, to ensure people maximised their health and wellbeing and had access to medical services when this was needed. People and their relatives told us they were aware of how to make a complaint and that the registered manager listened to them.

The registered manager carried out audits to look at the quality of the service people received. They asked for people’s feedback and used this information to look at ways the service could be improved.

The Belfry is a residential care home for up to 12 older people with care needs. The service is a converted home and bedrooms are available for people on both the ground and first floor.

At the last inspection, the service was rated good, however we have found that the service requires improvement in some areas. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People were not supported to have maximum choice and control of their lives and the systems in the service did not support this practice.

People’s consent had not been obtained to film them using covert surveillance in the lounge and communal areas. There were no signs telling people that they were being covertly filmed. Consent to provide care was verbally obtained but formal consent forms had not been signed as part of the assessment process.

We could not be assured that the security of people would always be maintained. On arrival, the front door was unlocked and we could freely access parts of the home undetected.

Activities arranged for people were limited and focused on activities that took place in the home. Some people told us they would like to do more activities based on their likes and interests and to have more trips out of the home in order to meet their social needs.

People’s medicines were not always managed safely and there were was not always enough staff on shift. Increasing staffing levels would help ensure that people were supported to follow their interests and take part in activities that are meaningful to them.

Information was not used to continuously improve the service. People, staff and visitors had not been asked about their experiences of using the service, so any changes made had had not been directed by the people who were living there.

Food met people’s nutritional needs, but people told us the menu choices and the quality of the meals could be improved.

Staff knew how to recognise and report any suspicions of abuse, and people told us they felt safe and cared for. The registered manager had a robust recruitment process, and supported staff to develop their skills and knowledge. Staff told us they enjoyed their work and told us they worked well as a team.

Accidents and incidents were appropriately recorded and investigated, and risk assessments were in place for people who used the service.

Relatives and visiting health professionals told us there was a positive atmosphere and staff were approachable and knowledgeable.

Staff worked well with health care professionals, to ensure people maximised their health and wellbeing and had access to medical services when this was needed and people and their relatives told us they were aware of how to make a complaint and felt that they were listened to by the registered manager.

Further information is in the detailed findings below.

The Inspection took place on 27 October and was unannounced.

When we inspected this service on 09 June 2014. We found the service was in breach of regulation 13 - Management of medicines and regulation 10 - Assessing and monitoring the quality of service. The provider provided us with an action plan, dated 22/07/14, which detailed the measures they had taken, or planned to take to address the areas of non-compliance. We found during our current inspection, that the provider had made the required improvements and was now meeting the regulations.

The Belfry provides accommodation for up to 12 older people mostly for those living with dementia. The service is not registered to provide nursing care. On the day of the inspection there were 12 people living at the home. There was a registered manager in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We saw that there were policies, procedures and information available in relation to the MCA and DoLS to ensure that

people who could not make decisions for themselves were protected. We also saw evidence that staff training had been provided in respect of the MCA. We saw from the records we looked at that the service was applying these safeguards appropriately.

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.

The provider had systems in place to protect people from abuse. These included guidance to staff about recognising the signs of abuse, and policies linking to the local authorities reporting and investigating procedures. People’s care plans contained individual assessments in which risks to their health, such as developing pressure ulcers and malnutrition, were being assessed and managed appropriately. Care plans included individualised guidance for staff where people displayed behaviour that was challenging to others. These provided guidance to staff so that they managed behaviour that was challenging in a consistent and positive way, which protected people’s dignity and rights. We saw examples of staff responding to people who displayed behaviour which challenged in a calm and supportive way during the course of our inspection.

Thorough recruitment process were in place that ensured staff had the right skills and experience and were safe to work with people who used the service. Staffing levels were based on the assessed needs of the people who used the service and this was kept under review. People who used the service, visiting professionals and staff told us that there was enough staff available to meet people’s needs. We observed staff supporting people in a timely way when, for example, people expressed a desire to use the toilet. Staff confirmed they received training and support which kept their knowledge up to date and gave them the skills, knowledge and confidence to carry out their duties and responsibilities effectively.

The provider had introduced a number of measures to improve the safety of its procedures for the safe administration of medicines, such as daily audits completed by staff and new medication recording records. During the course of our visit we saw evidence of these measures being used effectively.

People who used the service and their relatives were complimentary about the staff and told us that they were caring at all times and respected their privacy and dignity. Staff were motivated and demonstrated that they knew people’s needs well. Staff turnover was identified as low by people we spoke with during our inspection. The interaction between staff and people was warm, caring and friendly.

People told us they were able to discuss their health needs with staff and had contact with the GP and other health professionals, as needed. Relatives told us staff were good at keeping them informed about their relative’s health and welfare. People were protected from the risks associated with eating and drinking. People spoke positively about the choice and quality of food available. Where people were at risk of malnutrition, referrals had been made to the dietician and speech and language team for specialist advice (SALT).

People, and those that mattered to them, were able to have a say on how they wanted their care and support provided. Information in three people’s care plans confirmed that their personal preference on how they wanted their care and support provided had been sought, and acted on. A customer satisfaction survey had been completed in October 2013 providing positive feedback about the service.

People we spoke with, including visiting professionals and staff praised the registered manager for their values, such as openness, compassion and respect for people who used the service. Staff told us that the manager was very knowledgeable and inspired confidence in the staff team and led by example.

Systems were in place which continuously assessed and monitored the quality of the service, including obtaining feedback from people who used the service and their relatives. Systems for recording and managing complaints, safeguarding concerns and incidents and accidents were monitored and management took steps to learn from such events and put measures in place which meant they were less likely to happen again.

The registered manager and senior staff accessed local training initiatives and meetings to keep themselves up to date with new ways of working and changes in legislation. The provider was also a member of several good practice initiatives, such as Dignity in Care and the Dementia Pledge, working towards developing good quality care for people living with dementia.

On the day of this inspection there were 12 people living at The Belfry.

This inspection was conducted by a single inspector. Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary, please read the full report.

We spoke with five people who lived at the home. The manager was not present in the home, although we spoke with them on the telephone. We also spoke with three members of care staff. We looked at written records, which included people's care records, medication systems and quality assurance documentation.

Is the service safe?

We found the accommodation to be warm and clean and the provider had taken steps to ensure it was suitably maintained. There were sufficient skilled and experienced care staff on duty. There were proper processes in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

The provider ensured that medicines were stored safely within the home. However, the provider did not have a sufficiently robust system for the safe receipt of medicines into the home and the administration of medicines to people. The provider could not always demonstrate that people had received their prescribed medicines and could not always account for the amount of medicines stored in the home. This meant that people were not always protected by safe and effective medication administration systems.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring safe and robust medication administration systems.

Is the service effective?

People we spoke with were satisfied with the care and support they received. No one raised any concerns with us.

People were treated with dignity and respect. People were given information and support to help them understand the care and support available to them. Care plans and risk assessments were informative, up to date and regularly reviewed. All of the staff we spoke with were knowledgeable about individual people's care needs, and this knowledge was consistent with the care plans in place.

Is the service caring?

We spoke with five people who lived at the home. One person said to us, "I've lived here a long time. The staff are very kind and can't do enough for you." Another person said, "The home suits me well. You can have a laugh and a joke with the staff. I'm very happy."

We witnessed the care and attention people received from staff. All interactions we saw were respectful, kind and friendly. There was a good rapport between staff and the people who lived there.

Is the service responsive?

People were consulted about and involved in their own care planning and the provider acted in accordance with their wishes. Where people did not have the capacity to give consent, we found the provider acted in accordance with legal requirements.

Three staff members told us that the manager was approachable and they would have no difficulty speaking to them if they had any concerns about the service.

Is the service well led?

Staff said that they felt well supported by the manager, there was a good team ethic and they were able do their jobs safely. People who lived at the home and their representatives were asked for their views about their care and support, and their views were acted upon by the manager.

To enable us to assess people’s wellbeing we talked with three people who used the service and one person’s relative. We also spent time sitting with people, observing the care they received and the level of staff interaction.

We saw that there was enough staff on duty to keep people safe and that staff were attentive to their needs. We observed that staff respected people’s privacy and dignity and sought their agreement before providing any support or assistance. The people we saw were relaxed, engaged with their surroundings and interacted with each other.

People told us they were comfortable and liked living at the service. One person told us, “It’s not so bad here, they (the staff) are good and work very hard.” Another person told us, “I have lived here four years now and wouldn’t want to go anywhere else.” People told us that staff always asked their consent before they supported them, one person told us, “They (the staff) take their time and don’t rush me.”

One person’s relative we spoke with was complimentary about the service and found that the staff were caring and supportive. They told us that, “They are marvellous here, I have no worries and no complaints.”

We saw that the service had taken precautions to protect people from infection and that staff had received training in infection control and food hygiene.

We saw that the provider had an effective system in place to enable people to make complaints and that they were managed properly.

People who lived at The Belfry had a range of complex needs including needs associated with dementia. People who were able to speak with us told us that they felt cared for, were given choices about every day activities and encouraged to be as independent as possible. One person said “It is nice here; I am comfortable and I like the company.”

A number of people were not able to tell us directly about their experiences. However, we observed that they were relaxed and comfortable with the staff. Staff interaction was positive and respectful. For example staff knocked on bedroom doors before entering and assisted people to eat their lunch in a patient and gentle way.

The Belfry had all the necessary policy and procedures, records, quality assurance and monitoring systems in place for the protection of people who used the service. Staff were recruited appropriately, carried out their caring responsibilities well and people and their families were involved in their care arrangements.