The inspection took place on the 17 October 2017 and was unannounced. The inspection continued on the 18 October 2017 and was announced. Belmore Lodge is a residential nursing home in Lymington and registered to provide accommodation for up to 55 people. There were 52 people using the service on the days of our inspection. Rooms are over three floors, single occupancy and all have an ensuite with a wash basin and toilet. Specialist bathrooms are available on each level of the home. There are a range of public areas including a lounge on each floor, dining room, and café. There are communal secure gardens with good access from the building.

The home had a registered manager. 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 and their families described the care as safe. Staff had been trained to recognise signs of abuse and knew the actions they needed to take if abuse was suspected. People were protected from avoidable harm as risk assessments had been carried out, were regularly reviewed and staff understood the actions needed to minimise identified risks. People were involved in decisions about how their risks were managed and had their freedoms and choices respected.

There were enough staff to meet people’s needs and they had been recruited safely which included obtaining employment references and carrying out a criminal record check. People were supported by staff who had completed an induction and on-going training to enable them to carry out their roles effectively. Staff were supported and received regular supervision and had opportunities for professional development. Nurses received training than kept their clinical skills up to date.

Medicine had been ordered, stored and administered safely by trained staff. Staff understood the actions needed if a medicine error occurred. When people self-administered their medicine risk assessments were reviewed monthly with them to ensure theirs and other peoples safety. People had access to healthcare when it was needed.

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 service supported this practice.

People and their families described staff as caring, kind and patient and we observed relaxed, friendly interactions between people and the staff. Staff demonstrated a good understanding of people’s individual communication needs and supported people in ways that enabled them to be involved in decisions and express their wishes. People were involved in decisions about their day to day life’s and had their independence, privacy and dignity respected. People who needed an independent representative to speak on their behalf had access to an advocacy service a complaints procedure was in place and people felt if they used it they would be listened to and actions taken.

People had been involved in decisions about how they would like their care needs met and these were regularly reviewed. Care and support plans provided clear information about people’s care needs and staff understood the actions needed to support people and had been kept up dated with changes. People had their eating and drinking needs met and were offered choices of meals and snacks throughout the day. Information about likes, dislikes, allergies and special diets had been shared with the catering team.

People had opportunities to follow hobbies, interests and keep in touch with family and friends. A monthly activity planner provided details of several activities and reflected peoples hobbies and interests. Links had been made with the local community and people and t

Belmore Lodge is registered to provide accommodation for persons who require nursing or personal care for up to 55 older people some of who may be living with dementia. On the day of our visit 55 people were living at the home. The home is located approximately one mile from the town of Lymington, Hampshire. The home is purpose built and accommodation is on three floors. There is a passenger lift to all floors. The home has a well maintained garden area that people are actively encouraged to use.

The inspection on 23 March 2015 was unannounced.

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 and associated Regulations about how the service is run.

Staff understood the needs of the people and care was provided with kindness and compassion. People, relatives and health care professionals told us they were very happy with the care and described the service as excellent. A visiting GP told us, “I have no concerns at all regarding anyone living there. The home look after people very well indeed. Things have become significantly better all-round since the new manager has been in post”.

People were supported to take part in activities they had chosen. One person said, “There is always lots to do. It’s a very busy and social place to live. Everyone gets on so well with each other and we have a good old laugh”.

Staff were appropriately trained and skilled to ensure the care delivered to people was safe and effective. They all received a thorough induction when they started work at the home and fully understood their roles and responsibilities.

The registered manager assessed and monitored the quality of care consistently involving people, relatives and professionals. Care plans were reviewed regularly and people’s support was personalised and tailored to their individual needs. Each person and every relative told us they were asked for feedback and encouraged to voice their opinions about the quality of care provided.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. One person living at the home was currently subject to a DoLS. The manager understood when an application should be made and how to submit one and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

Staff talked to people in a friendly and respectful manner. People told us staff had developed good relationships with them and were attentive to their individual needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring and professional manner. People told us they felt staff were always kind and respectful to them.

Staff were encouraged to raise any concerns about possible abuse. One member of staff said, “We all know how to recognise abuse or bad practice and what to do if we thought someone was being abused. I know if we have concerns we can speak to the manager and she would report it”.

People and relatives knew how to make a complaint if they needed to. The complaints procedure was displayed in the home. It included information about how to contact the ombudsman, if they were not satisfied with how the service responded to any complaint. There was also information about how to contact the Care Quality Commission (CQC).

The home routinely listened and learned from people and visitor experiences through annual resident/ relatives’ survey. The surveys gained the views of people living at the home, their relatives and visiting health and social care professionals and were used to monitor and where necessary improve the service.

During our inspection on 13 September 2012 we judged that although people received the care they needed, staff were not able to respond to requests for assistance and care in a timely manner. The provider provided an action plan and at this inspection we found that improvements had been made.

Care plans and daily records demonstrated how the delivery of care matched people's assessed needs. One person told us: "It's nice and friendly here. The staff are all very charming".

People's food and drink met their religious or cultural needs. We saw that people were offered a choice of food. The home displayed a menu showing varied and nutritious meals. One person who used the service said: "The food is very good, well prepared and very tasty"

Appropriate arrangements were in place in relation to the recording of medicine. Medicine administration records (MAR) were in use for each person and documented prescribed medicines administered by staff. We saw that staff completed records after medicines were administered.

During our visit we found no instances where people had to wait for unacceptable periods of time before they received assistance from staff. We saw that staff responded quickly to call bells and requests for help.

People told us that the manager regularly asked them if they were happy with their care at the home. They told us that they were also asked if there were ways in which their care could be improved.

During the visit we spoke with eight people who used the service. Most people told us they were well treated by staff. Comments included “staff have the right skills and treat me well”, “staff are kind” and that staff are “very good generally speaking”.

People told us staff provided the care and support that they needed, although some people said this was not always at the time that they would prefer.

Six of the eight people we spoke with said they sometimes had to wait for a long time for their call bell to be answered. Five people gave examples of waiting between 15 and 30 minutes for their call bell to be answered. One person told us this was “horrible when waiting to go to the loo”. Another person, who was in bed when we spoke to them at approximately 10.30am said they liked to get up early, adding “I will get up today but I’m not sure what time”.

Three people told us they would like to have a bath more frequently than they were able to. One person said they would like to have a bath twice a week, but only had one once a fortnight. Another person said they had not had a bath for 10 days, but would like to have one once a week. People told us staff did help them to have a thorough wash each day and they felt clean, but they would like to have more frequent baths.

We found that the provider needed to take action to ensure that staffing levels and the way staff were deployed ensured that people's needs were met.

During the visit we spoke with seven people who use the service. Five of the seven people we spoke with said they received good care and that staff had the right skills to meet their needs. People told us staff listened to their requests and provided care in the way they wanted it. Two people said they received the care they needed and staff were very good, but were concerned about the way the service was managed. They did not give specific examples about any impact this had on the care they received.

Everyone we spoke with in their room had a jug of water or cordial available and within reach. People had also received hot drinks during the morning. Most people told us they were able to have drinks when they wanted and said the food was generally good. People said there was a choice of meals and they were able to request something different if they wanted to. Once person told us staff ensured their drink was placed in the right place to enable them to reach it and said they received the support they needed.

People told us they received support to take their medicine at the right time. Two people told us they preferred to manage their own medicines and were provided with a lockable cabinet in their room where they could keep it.

Two people said there were generally enough staff available, although there was sometimes a problem when staff were absent due to sickness. One person said they felt there were sufficient staff, who came quickly when they used their call bell. One person said staff answered the call bell quickly, but said they would like to get out of bed earlier. Two people said they didn’t think there were enough staff available, but said this did not have an impact on them as they didn’t require much assistance. These two people did say staff answered the call bell “relatively quickly”. The seventh person we spoke with did not comment on staff availability, but said they received all the care they needed and were satisfied with the home.

During the visit we spoke with five people who use the service. People said they felt they were well treated by staff. We were told staff were respectful of them and listened to their requests. Comments from people included that they were “happy with they care I receive”, “they ask me how I want care provided” and “staff are very respectful”. One person told us she had been involved in developing her care plans and said she was able to make decisions about the care she received.

People said they received the care they needed in the way that they wanted it to be provided. Most people told us staff responded promptly, giving examples of staff answering the call bell and responding to requests for information.

People we spoke with said they felt safe in the home and were confident that staff would respond appropriately to any concerns they raised.

During the visit we spoke with six people who use the service. We received mixed feedback about the care that people receive, with most people saying they receive very good care from staff who have the right skills and approach. Two people told us they did not feel that they received the right care and support, and one person said “they make you feel a nuisance”. One person told us that staff had dressed them in odd socks on the morning of our visit.

We also received mixed feedback from people about how they were treated. Two people said they were not happy about the way some staff spoke to them and responded to their requests. Comments included that ‘some staff are very rude and dismissive’ and ‘staff don’t listen to requests to do things in the way I want’. One person told us ‘certain staff are excellent, but some leave a lot to be desired’. Another comment was that staff don’t always cover the person appropriately when they are using the commode.

Other people told us they were treated well and that staff listen to requests about how care should be provided. One person told us staff are ‘quite good, although sometimes very busy’.

Four people said they thought there were generally sufficient staff members on duty at any one time to meet their needs. One person said they felt a little rushed whilst receiving personal care because the home was sometimes short staffed. One person said the home seemed short staffed, but that staff responded quickly to the call bell in an emergency.

Most people we spoke with said their privacy and dignity was respected and that staff treated them well.

Of the nine people we spoke with, six expressed satisfaction with the care they received, with comments including “staff know what they’re doing”, “I feel safe and well treated”, and “staff follow my care plan”. Other people we spoke with said their needs were not always met because of staff shortages at some times. Examples people gave included waiting for assistance to go to the toilet for up to half an hour, staff saying they will return but this not happening and staff being very rushed.

People told us they feel safe in the home and well treated.

Six of the people we spoke with said there were sometimes problems with staffing levels. People’s views of the frequency of staffing problems varied, with one person reporting shortages were the “exception rather than the rule”, whilst another person said staff shortages were regular, particularly in the mornings. People’s views about the impact of staffing shortages also varied, with two people reporting that they had to wait a long time when they used the call bell, whilst other said that although staff were rushed they answered the call bells quickly.

People told us they were confident that any complaints they made would be taken seriously and investigated. People were aware of the complaints procedure and who to speak to if they needed to make a complaint.