The inspection was unannounced and took place on 12 and 13 June 2017.

The last inspection took place on 4 and 10 May 2016. At that inspection we identified breaches of the relevant regulations in respect of sufficient numbers of staff, the need for safe care and treatment of service users, person centred care and the need for good governance. At this inspection, we found that improvements had been made and the provider was no longer in breach of any of the regulations.

The Belvedere is a purpose built care home located close to Alderley Edge. It offers permanent or respite nursing and dementia care for up 41 older people. All bedrooms have ensuite facilities. Lounges and dining rooms are accessible to all residents and there is a garden which they can also use. The home is divided into three units; Silk unit which caters for older people with nursing needs, Mulberry unit which is for people living with dementia with additional nursing needs and Weaver unit for people living with dementia and with complex needs. On the day of our inspection there were 41 people living in the home.

The home has a registered manager who had been in post since September 2016. 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.

We found through our observations that there were sufficient numbers of suitably qualified, competent, skilled and experienced persons deployed within the service to meet the needs of the people living there.

We found that the arrangements for the administration, storage and disposal of medication were safe.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

We asked staff members about training and supervision. They all confirmed that they received regular training and supervision throughout the year.

We observed caring relationships between staff members and the people living in the home.

There was a flexible menu in place which provided a good variety of food to the people using the service.

We found that that there had been improvements in the care plans and these were being updated regularly and the provider was now consistently keeping contemporaneous records in respect of fluid intake, however there was scope for further improvement.

The provider had a quality assurance system in place and regular audits were being completed, and issues identified were addressed in a timely manner. This system included audits on medication, weight losses, accidents and incidents. In addition to the above, there were also a number of maintenance checks being carried out weekly and monthly. These included checks on fire alarms and emergency lighting and equipment such as hoists and electric profiling beds, as well as checks on water temperatures.

Staff members and relatives we spoke with were very positive about how the home was being managed. Everyone spoke of the improvements observed since the current registered manager had been in post.

The inspection was unannounced and took place on 4 May 2016. An arranged visit to complete the inspection was then undertaken on the 10 May 2016.

The last inspection took place on 13 October 2014. At that time the service was not in breach of any of the regulations, however some recommendations were made regarding record keeping in relation to Deprivation of Liberty Safeguards (DoLS) applications and adaptation of the physical environment for people living with dementia. We saw that the service now had a system in place for recording DoLS applications and whether they had been granted and when they needed updating. Improvements had been made to the physical environment and these were ongoing as the building was undergoing a refurbishment during the days of our inspection.

The Belvedere is a purpose built care home located close to Alderley Edge. It offers permanent or respite nursing and dementia care for up 41 older people. All bedrooms have ensuite facilities. Lounges and dining rooms are accessible to all residents and there is a garden which they can also use. The home is divided into three units; Silk unit which caters for older people with nursing needs, Mulberry unit which is for people living with dementia with additional nursing needs and Weaver unit for people living with dementia and with complex needs. On the day of our inspection there were 38 people living in the home.

The home has a registered manager who had been in post since September 2015. 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 this inspection we identified breaches of the relevant regulations in respect of sufficient numbers of staff, the need for safe care and treatment of service users, person centred care and the need for good governance. You can see what action we told the provider to take at the back of the full version of the report.

We found through our observations that there were insufficient numbers of suitably qualified, competent, skilled and experienced persons deployed within the service.

We found that whilst the administration, storage and disposal of medication were safe, the provider did not have the correct protocols in place for the administration of covert medication and PRN (when required) medication.

We found that the provider was not consistently keeping contemporaneous records in respect of fluid intake and some of the care plans were not being kept up to date. Records were not kept securely to ensure people’s confidentiality was maintained.

Although the provider had a quality assurance system in place and regular audits were being completed, some of the issues that we identified during the inspection had not been identified by these systems. This system included audits on medication, weight losses, accidents and incidents. In addition to the above, there were also a number of maintenance checks being carried out weekly and monthly. These included checks on fire alarms and emergency lighting, the proper operation of window restrictors and equipment such as hoists and mattresses, as well as checks on water temperatures.

Staff members we spoke with were not always positive about how the home was being managed. All of the staff members that we spoke with voiced concerns about the numbers of staff employed to provide support to the people within the service.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns.

We looked at recruitment files for the most recently appointed staff

When we visited the Belvedere we talked to the people living in the home and some of the relatives who were visiting. A relative told us “The level of care (my relative) receives is very good and I attend the residents’/relatives’ meetings”. Another relative told us that their spouse was well cared for and that there were “no problems”. One person who lived in the home told us “We are well looked after. We are well fed and the carers take us for walks. What more do we want?”

We talked to the staff and found that they had a good understanding of issues around consent in a home where some people might not be able to express this very easily. We observed staff caring for people and found that they did so with respect. We looked at the arrangements for meals and found that people’s nutritional requirements were taken into account.

We checked that the provider took steps to make sure that the people they employed to provide care were suitable to do so and that there were adequate arrangements for people to make complaints.

At the time of our inspection visit, 39 people lived in the home. We were not able to speak to people who used the service because people who lived at the home had dementia and so found it difficult to communicate verbally in a meaningful way. We gathered evidence of people’s experiences of the service by speaking with relatives and reviewing a relative’s survey undertaken by the provider in April 2012. Additionally, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

All relatives who responded to the April 2012 survey said their family member was happy living in the home and that their needs were being met. The two relatives we spoke with told us their family members were looked after well and treated in a caring way with dignity and respect. They also said their views were taken into account in the planning of the care and support their relative required. For example, one relative said; “We have been able to input fully into decisions about how care needs are met and have regular meetings with the lead nurse.”

The relatives we spoke with also told us their family members were happy living at the home. They spoke highly of the staff, and said they were kind and caring, looked after them well and helped them when necessary. They also told us there were enough staff to meet their care and welfare needs. For example, one relative said; “There are enough staff. The atmosphere is nice and peaceful. The staff know the people who live here and how to look after them.” The other said; “There is good nursing and good care here. The staff know what they are doing and have a positive, caring attitude.” They also said; “When I leave I know they will be looked after properly and be safe.”

We used SOFI to observe care on Weaver unit on the top floor of the home whilst several people who lived in the home were in the lounge after breakfast and on Silk unit on the ground floor of the home whilst people had lunch. During our observations we saw that staff were respectful, kind and patient when addressing people or offering assistance. People looked comfortable and confident when in the company of staff. The atmosphere was friendly and relaxed. Staff did not appear to be rushed and were seen to have good relationships with people. They demonstrated that they had a good understanding of people's individual needs and personal preferences. We also saw people were being supported in an appropriate and sensitive manner.

The relatives we spoke to during our visit were very positive about the care their relative receives. They all said that staff are very caring and professional and responsive to meeting their relative's needs. They said they are happy to leave after a visit as they know their relative will be looked after properly and be safe. They also find staff knowledgeable about their relatives and what has been happening to them between visits.

The health and social care professionals we spoke to prior to our visit gave equally positive feedback about how well the care and welfare needs of residents are being met. They also commented on the range of activities available to keep them stimulated and busy. They see the staff at the home to be very caring and professional. For example, treating the people who live there with respect and as an individual, with flexible solutions used to meet their needs or solve their problems.

This inspection was unannounced and took place on 13 October 2014. A second day of the inspection took place on 20 October in order to gather additional information. The home was previously inspected in November 2013 when it was found to be meeting all the regulatory requirements which were inspected at that time.

The Belvedere is a purpose built care home located close to Alderley Edge. It offers permanent or respite nursing and dementia care for up 41 older people. All bedrooms have en-suite facilities.

Lounges and dining rooms are accessible to all residents and there is a garden which they can also use.

At the time of the inspection there was a registered manager at the Belvedere. 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.

We found that people felt safe at The Belvedere and that staff had a good understanding of how to protect people and would take action to do this if it was required. There were good arrangements for recruiting staff who were well-trained in most of the required areas. Although there were enough staff working at the Belvedere we found on a few occasions that the layout of the building meant that people were sometimes left alone for short periods of time.

Records were kept which would allow staff to provide the care that people needed and there was good access to health and other care services. More attention was needed to the arrangements for recording people’s agreement to their care and for Deprivation of Liberty Safeguards.

Some people who lived in the home and relatives told us that the food was not very good and we found that there was not enough choice. The home was taking action to improve this. The Belvedere was well-led with a proactive management that was keen to listen to the relatives and people who lived in the home.