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Inspection carried out on 10 December 2018

During a routine inspection

About the service: Belvedere is a small care home for people who are experiencing severe and enduring mental health conditions. The home provides accommodation and support for a maximum of four people. Belvedere belongs to a group of homes owned by The Community of St Antony and St Elias. The homes act as a community with group activities and group management meetings and oversight. At the time of the inspection there were four people living at the home.

What life is like for people using this service:

People continued to receive care that was safe, effective, caring, responsive to their needs and well-led.

People told us they felt safe and were happy living at the home. The registered manager and staff were aware of how to keep people safe. Staff had received safeguarding training and could describe signs that may indicate someone was at risk of abuse or harm.

Risks associated with people’s complex care needs had been appropriately assessed and staff had been provided with information on how to support people safely. People’s medicines were managed, stored and administered safely and appropriately by staff who had been trained and assessed as competent to do so.

Staff were recruited safely and there were sufficient numbers of staff deployed to meet people's needs. Staff told us they felt supported and we saw evidence staff had received an induction, training and ongoing supervision.

Care and support was personalised to each person which ensured they could make choices about their day to day lives. People knew how to make a complaint and felt confident they would be listened to if they needed to raise concerns.

People's healthcare needs were monitored by staff and people had access to healthcare professionals according to their individual needs. 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 benefitted from a home that was well led by a registered manager who was open and approachable. The provider had systems in place to review, monitor and improve the quality of service provided. This included a programme of audits and checks, such as reviewing medicines management, quality of care records, support to staff and environmental health and safety checks.

The home was clean, well maintained and people were protected from the risk and/or spread of infection as staff had access to personal protective equipment (PPE).

Rating at last inspection: The home was previously rated as Good. The report was published on the 19 July 2016.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

Follow up: We will continue to monitor intelligence we receive about the home until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Inspection carried out on 19 April 2016

During a routine inspection

Belvedere is a small care home for people who are experiencing severe and enduring mental health conditions. The home provides accommodation and support for a maximum of four people. Belvedere belongs to a group of homes owned by The Community of St Antony and St Elias, which is known locally as the Community. The homes all act as one community, with group activities and group management meetings which provided oversight. This inspection took place on the 19 and 27 April 2016 and was unannounced. The inspection team consisted of two adult social care inspectors on the first day and one on the second day. The service was previously inspected on the 24 September 2015, when we found the provider did not have effective systems in place to regularly assess and monitor the quality of the service provided. Following this inspection the provider sent us an action plan telling us how they were going to meet this regulation. At this inspection, we found that improvements had been made. There were good systems in place for staff to communicate any changes in people health or care needs and regular team meetings facilitated the sharing of information on all aspects of people’s care and support and allowed staff to discuss specific issues or raise concerns.

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 received their prescribed medicines on time and in a safe way. There was a safe system in place to monitor the receipt and stock of medicines held by the home. Medicines were disposed of safely when they were no longer required. However, we found that medicines were not always stored safely as the home did not have in place a robust system to ensure that people or unauthorised staff could not access medicines. We spoke with the registered manager about this who took immediate action.

People who used the service told us that they knew how to raise concerns and felt able to report concerns to the manager. People said that they felt safe and relatives told us “they have created a place where people are safe”. There were systems to help ensure people were protected from all forms of abuse. Staff told us they had received safeguarding training in how to recognise signs of harm or abuse as well as whistleblowing and knew where to get further information. Throughout our inspection, there was a relaxed and friendly atmosphere, people were relaxed in the company of staff and it was apparent that staff were knowledgeable about people individual needs.

Recruitment procedures were robust and records demonstrated the manager had carried out checks to help ensure that staff employed were suitable to work with vulnerable people. These included checks on people’s previous employment history, people’s identity, obtaining references and carrying out DBS checks (police checks). The registered manager ensured there were sufficient numbers of staff on duty with the right skills to keep people safe and meet their identified needs. The registered manager determined staff levels according to people’s needs and adjusted the rota accordingly.

There were safe systems in place to manage and assess risk within the service, risks to each person’s safety, health, and wellbeing had been individually assessed. The registered manager completed comprehensive assessments of people’s needs prior to them moving into the home and we saw that these had been regularly reviewed. Each person had a personal emergency evacuation plans (PEEPs) and the provider had contingency plans to ensure people were kept safe in the event of a fire or other emergency.

People’s mental and physical health were monitored by staff and we saw that where concerns had be

Inspection carried out on 24 September 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found.

Is the service safe?

Belvedere is a small home for up to four younger adults. At the time of our inspection there were four people living at the home. The home was staffed by two or three people at all times and during working hours the registered manager was also available. At night the home had two sleep-in staff members who had access to a registered manager through a whole organisation on call rota system. Staff told us they felt well supported by the management of the organisation, in particular, by the registered manager of Belvedere who was described as being "on the ball".

Staff were well trained and skilled in the work they were employed to do.

The home had effective systems in place to ensure the safety of the people who lived at Belvedere and the wider community. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst no applications have needed to be submitted, policies and procedures were in place. Staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew them well. One person told us: "I am lucky I get to live here, I am content with my life." Another explained how staff were supporting them to achieve their creative ambitions.

Is the service caring?

People were supported by kind and attentive staff. We saw the care workers were patient and gave encouragement when supporting people. We saw staff were skilled in defusing situations and offered people safer alternative solutions which still enabled people to make their own decisions. Staff knew what each person found important and worked to ensure their needs were met. During our visit, we observed one person being demanding of staff's attention. Staff supported them with respect, patience and diversionary skill.

Is the service responsive?

People's needs were regularly reviewed and we saw that people were involved in this. People were encouraged to talk with the manager and staff informally about the things they wanted to do. For example, everyone living at Belvedere had planned to go out for a celebratory meal. One person did not want to go, as they preferred to stay at home to watch the football. Staff were able to facilitate this.

Is the service well-led?

Staff had a good understanding of the ethos of the home. There were systems in place to ensure staff and the people living at the home were safe and felt well supported. Staff and the people who used the service commented on the excellent quality of the registered manager. We saw people were involved with the way Belvedere developed.

Inspection carried out on 5 November 2013

During a routine inspection

This was a scheduled inspection. We met all four people that lived at the home and talked with three of them. People told us that they were very happy with the care workers and the manager. They told us that the care workers were �100% cool�. Another person said �The staff are really good�.

Care workers at Belvedere obtained people�s consent before they assisted them with their care and welfare needs. We saw care workers respected people's privacy and dignity. Peoples' choices about their care were considered.

People that used the service were supported to use community facilities. The organisation provided an activity programme that was available to all the people that used its services. We saw that this programme included a wide range of activities and events. People told us they could decide what they wanted to do.

People told us that they felt safe. One person said �Yeah, I feel very safe.� Care workers knew about different types of abuse and what they should do if they witnessed abuse occurring.

People were protected from the risks associated with care workers who may be unsuitable to work with vulnerable people. This was because the provider had effective recruitment procedures in place.

The provider had systems in place to assess and monitor the quality of the service provided.

Inspection carried out on 8 March 2013

During a routine inspection

At the time of our inspection 3 people were living at Belvedere. There were two support workers on duty and the manager.

People we spoke with told us that they were happy with the service they received. One person said �The staff are all experts and I like them all.� This person said �I am very happy here.�

People told us that they felt safe and that the manager and support workers were kind. The home provided activities and people told us they were able to choose whether they took part in them. We observed that people were treated respectfully. People told us they were involved in decisions about their care.

Records showed that people's care needs were assessed and had been reviewed on a regular basis. Daily care records showed us that care had been delivered in line with the care plans. The home had measures in place to deal with emergencies.

People were very complimentary about the support workers and we saw there was a mutual respect shared. Support workers were knowledgeable about peoples care needs and were supported through effective induction, training and supervision systems.

Records were well maintained and reflected the level of the service provided and showed that the service monitored the safety and efficiency of the business.

Reports under our old system of regulation (including those from before CQC was created)