Ada Belfield House Care Home provides accommodation and personal care for up to 25 older people. This included people living with dementia. At our inspection visit, 19 people were receiving care.

The inspection visit took place on 7 March 2017 and was unannounced. The service was last inspected on 29 July 2014 and was rated 'Good' overall. At this inspection we found the service remained 'Good' in five questions which gives a rating of 'Good’ overall.

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 told us they felt safe. Staff understood what could constitute abuse and knew how, and who, to report to should they have any concerns. The provider had a safe recruitment process, which ensured new staff were suitable to work with people. Pre-employment checks had been carried out. There were enough staff on duty to meet people's needs.

Systems and processes were in place to ensure people received their medicines in a safe manner. Risks to people were assessed and identified and included in their care plans. Procedures were in place for emergencies and untoward incidents.

Staff understood the key principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with dignity and respect; staff were kind, caring and compassionate. People were supported to maintain relationships with family and friends. People had to access healthcare professionals when needed; they were supported to maintain good health.

People told us there was plenty of choice and variety around meals; personal preferences, as well as special diets, were catered for. Drinks were freely available as well as being offered periodically throughout the day.

Care plans were reflective of people and their individual needs; people had been asked to contribute to their care plans. People and relatives felt there were enough activities to keep people occupied; staff supported people to take part in activities.

People and relatives were involved in the service and their views had been sought. Auditing procedures were in place to assess, monitor and evaluate the quality of the service being provided. People and relatives felt able to approach the staff or members of the management team and discuss any worries; people and relatives felt listened to.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by the Care Quality Commission, which looks at the overall quality of the service.

Accommodation and personal care is provided at Ada Belfield for up to 25 older adults. At this inspection there were 22 people living at the home. The inspection was unannounced.

At our last inspection on 8 July 2013, we found that the care provider was meeting the essential standards of quality and safety in all five outcomes we inspected against.

There is a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.

People felt safe in the home and were protected against harm and abuse by staff who knew how to report concerns about any poor practice. People were happy living in the home and were particularly pleased with the way the home was being managed and run. They were also satisfied with their care and the meals provided, which met their assessed needs and choices. People told us that staff, were caring and that they treated them with respect and promoted their dignity and privacy. People’s views about their care and those of their relatives and representatives were regularly sought and acted on.

Care staff understood and followed the Mental Capacity Act 2005 (MCA) to ensure that people’s rights and best interests were being protected. The MCA is a law providing a system of assessment and decision making to protect people who do not have the capacity to always consent to or make specific decisions about their care. Where people’s medical conditions affected their capacity to make some important decisions about their care, staff ensured that decisions were being made in their best interests.

Care staff demonstrated an awareness of the Deprivation of Liberty Safeguards (DoLS). This is a law that requires assessment and authorisation if a person lacks mental capacity and needs to have their freedom restricted to keep them safe. People were protected against the risk of unlawful or excessive control and restraint that may restrict their liberty or human rights. Where any person was subject to DoLS, these were legally authorised in their best interests, by the relevant authority; and the provider told us when this occurred.

People received care from staff who, understood and were trained to meet their personal, safety and health needs, which were reflected in people’s care plans. Staff sought advice support from relevant health care professionals when required. Instructions and advice received were included in people’s written care plans, which staff followed. People’s care plans were kept under review and revised with people when required and reflected people’s needs and wishes.

Staff, were well led and understood their roles and responsibilities and the service aims and values for people’s care. Management strategies meant that ways to improve people’s care were being continuously sought. Improvements in progress included staff planning and deployment, infection control and prevention, promoting dignity in care and to further enable people’s participation in hobbies and interests.

As part of this inspection we spoke to seven people who used the service and one relative that were present on the day we inspected. We also spoke to five members of staff and three visiting health professionals.

People we spoke with were happy with the care provided. We found that each person had a care plan in place and that these had been reviewed on a regular basis helping to ensure that they reflected people’s needs. People had access to health services such as GP’s.

Staff where able to tell us about the different types of abuse and what they would do if they had concerns. All staff had been booked on to refresher training in safeguarding vulnerable adults.

Audits were carried out on the building and we saw that appropriate checks had been made to ensure that the building was safe.

The provider had quality assurance systems in place to help monitor the service provided.

Records were reviewed regularly and staff understood the importance of detailed and accurate records.

This was a follow up inspection. Please see our previous reports for full comments.

Care plans were detailed and had been reviewed regularly. Where risks had been identified the provider had taken appropriate action.

We spoke with three people on the day of this inspection. All were happy with the care provided.

We spoke to three people who used the service about the specific outcomes in this report. They all told us that staff were good but that there were often not enough staff on shift.

Please see our previous inspection report for full comments.

During our visit we spoke with four people who used the service, one relative, seven members of staff including the registered manager and one volunteer who had contact with the service.

A person using the service told us “I’m glad I’ve come to live here”. Another person stated “it’s very nice here”.

One thank you card read “a big thank you for all the kindness and care you gave to our mum”.

The staff we spoke with all enjoyed working at the home. They felt that there was a friendly environment and that management were approachable.

People told us that they liked using the service and that they felt well cared for and staff were ‘kind’ ‘loving’ and ‘very caring’. They told us they received medical attention when needed.

Most people enjoyed the meals and described the food as ‘good’.

People told us they felt able to make a complaint.

People visiting the service spoke positively about the staff and said they were ‘pleased’ with the care provided and that they had ‘no complaints’.