About the service: Belmont Castle is a residential care home that is registered to provide accommodation and personal care for up to 40 people. At the time of the inspection 32 people were living at the home. People living at the home had a range of care needs, including people living with dementia.

People’s experience of using this service:

Risks to people and the environment were not always effectively managed though robust assessments to ensure people were appropriately protected.

Medicines were not always safety managed in line with best practice guidance. Medicines administration timings were not always recorded accurately.

We received mixed feedback from people and their relatives about being involved in the planning and reviewing of their care.

People’s rights and freedoms were not always protected. Where people were considered to lack capacity, systems and processes did not always reflect compliance with the principles of The Mental Capacity Act 2005.

Care records and daily recordings were not always consistently completed to reflect that people’s needs were always met.

There were clear systems and processes in place to protect people from the risk of abuse, and the home promoted an open and transparent culture.

People and relatives told us they were happy with the care and support provided. People told us staff were caring and they felt comfortable in the home.

We received positive feedback from people that they enjoyed the quality and choice of meals provided.

The environment was suitable to meet people’s needs and the design and layout was supportive of people living with dementia.

The home ethos promoted people to be treated with dignity and respect and people were supported to maintain their privacy.

People were encouraged to make their own choices and decisions as appropriate, and staff supported people to have control over their day to day routines.

People had access to an extensive range of activities to meet their interests, which were flexible to meet their individual needs.

There was a clear management structure in place, and the registered manager had established positive relationships with people and their relatives.

Rating at last inspection: This service was previously rated as Good at the last comprehensive inspection. That report was published on 21 February 2017.

Why we inspected: This was a planned inspection based on the previous inspection rating.

Enforcement: We found three breaches of Regulations. For actions we told provider to take, please refer to the end of this report.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 18 January 2017 and was unannounced. Belmont Castle provides accommodation and personal care for up to 40 older people, including people with dementia and physical disabilities, who do not require nursing care. There were 36 people living at the home when we visited.

There was a registered manager at the home. 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 the last inspection in November 2015, we asked the provider to take action to make improvements in relation to record keeping and ensure people’s legal rights to make decisions were assured and the Mental Capacity Act 2005 was fully implemented. The registered manager sent us an action plan and at this inspection we found this action has been completed.

People, visitors and external health and social care professionals were positive about the service people received. People were positive about meals and the support they received to ensure they had a nutritious diet. People were supported and encouraged to be as independent as possible and their dignity was promoted. Staff followed legislation designed to protect people’s rights and freedoms.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. Reviews of care involving people were conducted regularly. People had access to healthcare services and were referred to doctors and specialists when needed. Medicines were managed safely and people received these as prescribed. At the end of their life people received appropriate care to have a comfortable, dignified and pain free death.

People felt safe and staff knew how to identify, prevent and report abuse. Legislation designed to protect people's legal rights was followed correctly. Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible and their dignity was promoted.

There were enough staff to meet people's needs. The recruitment process helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work. Staff worked well together, which created a relaxed and happy atmosphere that was reflected in people's care.

The home and gardens had been decorated and accessorised to provide a positive and suitable environment for people living with dementia. People were offered an extensive range of activities suited to their individual needs and interests providing both mental and physical stimulation.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

The registered manager and provider were aware of key strengths and areas for development of the service. Quality assurance systems were in place using formal audits and through regular contact by the provider and registered manager with people, relatives and staff.

We spoke to three people who lived at the home and to a relative of someone who lived at the home. We also spoke someone who regularly visited people and to two health and social professionals.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We saw people had positive experiences. Staff were observed to help people who needed it. People were observed enjoying the meal and the conversation they had with other people during the meal. We noticed that one person would have benefitted from additional support.

We saw each person’s needs were assessed and that there were care plans outlining how staff should safely support each person.

We saw the home involved people in a range of activities and that people had a direct input into how activities were organised as well as other ways the home ran.

The home was found to be clean and hygienic with policies and procedures regarding the prevention and control of infections.

Staff were aware of the principles of safeguarding vulnerable adults and had received training in this.

Staff were provided at suitable levels to meet people’s needs.

The home consulted people and their relatives about the home’s performance. A number of audits were used to check the home was safe and effective at providing care.

We spoke with five people who use the service who told us that their support and care needs were met and they were satisfied how members of staff looked after them. One person said: “We are very looked after here. They treat us well.” Another person told us how a member of staff supported them in a way that made them feel better and less anxious about a forthcoming dental appointment. People we spoke with told us that they enjoyed the activities planned at the home including visits to a local pub, shopping and a local zoo.

This inspection took place on 4 and 5 November 2015 and was unannounced.

Belmont Castle Care Home is registered to provide accommodation and personal care services for up to 40 older people and people who may be living with dementia or a physical disability. At the time of our inspection there were 35 people living at the home. They were accommodated in a converted and expanded historic building and grounds. There was a variety of shared sitting and dining areas. People had single rooms except for one couple who had a double room.

There was a registered manager in place. 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.

It was clear from our discussion with them that people living at Belmont Castle Care Home and their families were very happy with the quality of service they received. We saw examples of care and support that were very good. The registered manager and staff were motivated to make sure people had a positive experience of care. However, we found areas for improvement were needed in record keeping and legal requirements around mental capacity assessments.

The provider had arrangements in place to protect people from risks to their safety and welfare, including the risk of avoidable harm and abuse. Staffing levels were sufficient to support people safely and in a calm, professional manner. Recruitment processes were in place to make sure only staff who were suitable to work in a care setting were employed. Arrangements were in place to store and administer medicines safely.

Staff received suitable training and support, although training records were not complete. Staff sought people’s consent for their care and support. However records of mental capacity assessments did not show that the service always acted according to the legal requirements where people lacked capacity.

The provider had made substantial changes to the décor and fabric of the building to help meet the needs of people living with dementia and to provide an interesting, vibrant atmosphere. Staff made efforts to make meal times an enjoyable experience, and encouraged people to eat and drink enough. Visiting healthcare professionals were complimentary about the service and records showed people had access to healthcare services when they needed them.

Staff had established caring relationships with people. They respected their individuality and dignity. Staff encouraged people to participate in decisions about their care and support.

People’s care and support were based on assessments and plans which took into account their needs, preferences and wishes. The provider had processes in place to review people’s care and check they received care according to their plans. There was a varied programme of activities and leisure interests which took into account people’s individual interests and preferences. There was a complaints process and complaints were followed up and investigated.

There was an open, friendly and positive atmosphere in the home. The registered manager encouraged team work and motivated their staff. Staff responded to their management style and felt empowered to make suggestions. The management system operated effectively apart from in the area of records management where we found inaccurate, incomplete and unnecessary records which meant people were at risk of inappropriate care. Systems were in place to monitor, assess and improve the quality of the service.

We found two 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 end of the full version of the report.