Belle Vue is registered to provide accommodation for up to 52 people aged 65 and over who require residential or nursing care. At the time of our inspection there were 42 people living at the home. Some people who lived at the home were living with dementia.

People’s experience of using this service: The managers and staff demonstrated a commitment to providing person centred, high-quality care. The management told us they aspired to deliver outstanding care and support to their residents and provide a specialised inclusive dementia community for the people of Torbay.

People and their relatives were complimentary about the care they received. People told us staff had an excellent understanding of their individual needs which resulted in them receiving personalised care. People said staff knew what their preferences were and how they liked to be supported. The dedication and team working at Belle Vue had a positive impact on people’s health, wellbeing and quality of life.

We observed staff were very gentle, caring and treated people with compassion and kindness. People's privacy and dignity was respected and promoted, and people were supported to maintain their independence. This provided them with a sense of purpose and wellbeing.

The managers and staff were passionate about ensuring people and their loved ones experienced positive end of life care that was delivered with tenderness, sensitivity and effective communication between staff, the person and their family.

People told us they felt safe living at Belle Vue. Staff had a good understanding of how to safeguard adults from abuse. Safeguarding training had been provided and refreshed in line with the providers policy to ensure knowledge remained up to date.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice.

People's needs, and choices were assessed and their care and support delivered to achieve effective outcomes. Care plans provided staff with information and guidance about how to meet people's needs in the way they preferred. Risk assessments covered areas such as, moving and handling, falls, nutrition and hydration. Not all care plans and risk assessments were as detailed as they could be or contained information about how risks to people were being mitigated. We made recommendations to the provider about this.

There were sufficient staff to meet people's needs in a timely manner and ensure that care was person centred. The provider completed relevant pre-employment checks to ensure staff were safe to work with older people. The manager analysed staffing needs to ensure staff had the right mix of skills to meet people's needs safely.

Staff received training suitable to meet the needs of the people they were supporting and received regular supervision. Staff told us they felt supported in their roles.

People told us they knew what to do if they had any concerns or complaints about the home and the management team had resolved them. The home used learning from complaints to improve future practice.

People told us they thought the home was well led. People and their relatives were very complimentary about the management team and told us they knew them well. One person told us, “The managers know everything about me which makes me feel good.”

The provider had an effective system of governance in place to monitor and improve the quality and safety of the service. Feedback was regularly obtained from those who lived at the home and their relatives. Regular team meetings had been conducted and staff members felt able to approach the managers with any concerns, should they need to do so.

Rating at last inspection: On 20 March 2018 (report published 25 May 2018), the service was rated ‘Requires Improvement’ because the service was not always safe, responsive or well-led. At this inspection, we found these issues w

This inspection took place on 20, 21 March and 11, 12 April 2018 and the first day was unannounced. This was the first inspection since the service was taken over by Harbour Healthcare 1 Ltd in November 2017.

Belle Vue is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Belle Vue accommodates 49 people in one adapted building, over two floors and is split in to a ground floor nursing unit and first floor dementia care unit. At the time of our inspection there were 32 people living at the home. The home supported older people, some with physical disabilities and long term medical conditions. Some people at the home were living with dementia.

There was no registered manager in post at the time of the inspection. We were supported on the first two days of the inspection by the interim manager and the newly recruited manager on the last two days of the 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.

People told us they felt safe living at Belle Vue. One person said, “I certainly feel as though I am safe here.” However, we did not find that all of the provider’s processes ensured people’s safety.

The provider's recruitment processes were not fully effective and some pre-employment checks were incomplete.

Some risks to people's safety and well-being were assessed and care plans guided staff on how to meet people's care needs and manage risks. However, risk assessments were not always in place to support staff to understand and support people with their health. Where risks had been identified, records did not always show that care had been delivered as it should. Records did not always demonstrate staff were maintaining effective oversight of some people's fluid intake to manage their risk of dehydration. People were not always being protected from the risk of malnutrition.

Since the provider took over the home in November 2017 they had been working hard to improve standards of care quality for people living at Belle Vue. They recognised they were still in the early stages of improving the quality of care were implementing improved care planning, monitoring and auditing processes. There were systems in place to monitor the quality of the service but these were not effective in identifying all areas where improvements were needed.

We received mixed views from people, relatives and staff about whether there were sufficient numbers of staff deployed at Belle Vue. Some people told us they had to wait for care as staff were busy with other people. Staff told us they felt that some days were busier than others and an extra member of staff would be beneficial. They were aware people were having to wait for support, especially at mealtimes. We observed there were enough staff on the ground floor to meet people's needs. However, on the first floor dementia unit, we observed that some people had to wait for staff to help them. We made a recommendation that the provider reviews staffing levels within the home to ensure they meet the needs of the people.

People told us they would benefit from more activities at the home. One person commented, “There’s not much to do here.” Another said, “In some ways it’s absolutely wonderful, all of the attention we get, but there is nothing going on in the afternoons. You need something to stimulate you.” the home had a programme of activities and the management were looking at how they could enhance the provision of activities available to people.

People's medicines were managed and administered safely. There wer