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Inspection carried out on 7 August 2018

During a routine inspection

Belmont 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.

Belmont can accommodate up to seven people with learning disabilities. On the day of our inspection, there were six people living at the service. Each person has their own bedroom and they all shared a lounge, kitchen/diner, conservatory, laundry and utility room, bath/shower rooms and large rear garden.

The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection we rated the service overall as Good, although we rated the service as Requires Improvement in Well-Led because at the time, the service did not have a registered manager. At this inspection a registered manager was in post and we found continuing evidence to support the overall rating of Good with no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is therefore written in a shorter format because our overall rating of the service has not changed since our last inspection.

Medicines were managed safely and people received their medicines when they should. People were supported to maintain good health and attended appointments and check-ups. People were supported in a safe environment and risks had been identified, and were managed in a way that enabled and encouraged people to live as independent a life as possible.

Staff understood how to protect people from the risk of abuse. They had received safeguarding training and were aware of how to recognise and report safeguarding concerns. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened the staff knew what to do.

A robust system to recruit staff was in place. There were sufficient numbers of staff on duty to meet people’s assessed needs. Staff received regular training and supervision which enabled them to support people effectively.

People were supported to make decisions and choices about all aspects of their lives. People took part in a range of activities which they had chosen and enjoyed. Staff knew people and their support needs well. People had detailed care plans, risk assessments and guidance in place to help staff to support them in an individual way.

People were supported to raise any concerns they may have. Staff understood when people were unhappy and supported them to resolve any concerns and issues.

Staff were caring, kind and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

The registered manager had good management oversight. Staff said they were listened to and suggestions discussed and implemented. Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve.

Further information is in the detailed findings below.

Inspection carried out on 16 December 2015

During a routine inspection

This inspection took place on 16 December 2015 and was unannounced. The previous inspection was carried out in September 2014 and there were no concerns identified.

Belmont is registered to provide accommodation and personal care for up to six people who have a learning disability. At the time of the inspection four people were living at the service, each having their own bedroom, one with an ensuite wet room. People had access to a communal lounge, dining room, kitchen, conservatory, laundry room and shared bathrooms. There is a well maintained garden and outside area. There is off street parking within the grounds and access to public transport.

The service does not have a registered manager. The provider had recently appointed a manager, who intends to apply to register with the Care Quality Commission and was present  during the inspection visit. 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 recruitment procedures were safe and made sure that the staff employed to support people were fit to do so. There were sufficient staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. When staff had completed induction training they had gone on to complete other basic training provided by the company. There was also training for staff in areas that were specific to the needs of people, like epilepsy and autism. Staff were supported to carry out their duties effectively and were offered further support through one to one supervision, team meetings and appraisals.

People had in depth personalised care plans, risk assessments and guidance in place to help staff to support them in an individual way. Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. People were supported to pursue individual interests and hobbies. Staff spoke about people in a respectful way which demonstrated they cared about the people’s welfare. People interacted positively with staff, smiling and being involved in conversations.

People were supported to make their own decisions and choices and these were respected by staff, who gained consent from people by talking through their care and support needs with them. People’s care files made reference to capacity for different decisions. Staff were aware of the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time.

People had family that were important to them and contact was supported by staff. People felt safe in the service and when out with staff. The service had safeguarding procedures in place and staff had received training in these. People received care and support from a small team of staff and the registered manager worked on rota alongside staff at times. People were happy with the service they received and felt staff were kind.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. Safety checks were completed and there were regular fire drills so people knew how to leave the building safely.

People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. People were supported tomake their own drinks and cook when they wanted to. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy diet.

People felt staff were caring, they said they were kind. Staff knew people and their support needs well. Established members of staff had built up relationships with people and were familiar with their life stories and preferences. People’s individual religious needs were met.

People felt comfortable in complaining, but did not have any concerns. People and their relatives had opportunities to provide feedback about the service both informally and formally.

In the absence of a registered manager, the service has been managed by senior support staff with a registered manager from another of the provider’s services and locality manager offering support and guidance. Staff told us they felt well supported during this period but were happy to be returning to their usual duties now that a manager had been appointed.

Inspection carried out on 15 September 2014

During a routine inspection

We carried out an announced inspection to check the service was compliant as there was a breach in the regulations at the previous inspection in October 2013.

One inspector carried out the inspection.

We spoke with two people using the service and three members of staff. We also observed staff supporting people with their daily activities.

Belmont can provide accommodation for up to 6 people. There were four people using the service at the time of our inspection.

We considered our inspection findings to answer questions we always ask:

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well-led?

This is a summary of what we found. This summary is based on our observations during the inspection.

Is the service safe?

The service was safe.

People had a care plan which detailed their care and support needs. There was guidance for staff to follow to reduce risks and implement strategies to make sure people were as safe as possible.

The service had systems to manage risks to the people�s care without restricting their activities or their life styles.

Is the service effective?

The service was effective.

Care was consistently planned and delivered in response to people�s changing needs. People�s health and care needs were assessed with them and / or their representatives. We found that care plans were regularly reviewed to reflect any changes in a person�s needs.

Is the service caring?

The service was caring.

Staff understood people�s needs and provided care with kindness, respect and compassion. Staff showed patience when supporting people and promoted their independence.

Is the service responsive?

The service was responsive.

People received the care and support they needed to meet their individual needs.

The service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Is the service well-led?

The service was well led.

There was a clear management structure in place. Staff told us they were clear about their roles and responsibilities and that they felt supported by the registered manager.

Inspection carried out on 8 October 2013

During an inspection in response to concerns

Our inspection of 25 June 2013 found people did not always have their care needs met through an effective care plan. This included a person whose privacy was not maintained due to a listening device to alert staff to their epileptic seizures. At this inspection we found a new, specialist monitor for this purpose had been purchased. A person who was entering other people�s bedrooms was being supported through a new care plan to reduce this behaviour. We found that a lack of information about how often people should be checked at night had been addressed. Where people had inaccurate information in their care plans this had been removed.

However, we found further areas of concern at this inspection. One person was not receiving appropriate care and support to ensure they were not at risk of social isolation, dehydration or incontinence. We found that people did not always have their personal care needs met due to a lack of equipment.

People had their health needs met. Where people required support with their mobility the service had acted upon recommendations made by healthcare professionals to provide new equipment and support for the person.

Inspection carried out on 25 June 2013

During a routine inspection

We carried out this inspection to follow up on three compliance actions following our inspection on 10 September 2012. We also looked at two additional essential standards as part of our inspection programme.

When we visited Belmont there were six people using the service. People told us they were happy with their care and support. One person told us �I like living here, I have lots to do� and another said �I am happy at Belmont�. We found that people had care plans in place that met the majority of their needs, but we found that one person who required hourly checks throughout the night, because they had epilepsy, had not always received this care. We also found that there was a lack of clear guidance for staff to manage behaviours displayed by people that may affect others in the service.

People were supported to eat a balanced and nutritious diet and were able to make choices about their meals.

People that used the service told us they felt safe. Staff knew how to recognise and report any allegations of abuse in the service. Staff had received the training they needed to safely care for people. They told us they felt supported in their roles. There had been no complaints received about the service. People were given the opportunity to talk about their care each month and raise any concerns. There was a clear complaints procedure for people to follow if they wished to make a complaint.

Inspection carried out on 10 September 2012

During a routine inspection

During the inspection we spoke to people who live at the service and they told us they liked living at the service. One person told us how they were supported to choose what to wear each morning. We asked people about the staff and one person told us the staff were nice. A relative told us �the staff are nice� and �they do go out which is good�. Another told us they had seen positive interactions between the staff, their relative and other people living at the home, adding, �the staff interact very well.�

A relative told us they had not seen any female staff on duty during their monthly visits to the home for the last four months and they preferred the personal care to be given to their relative by a female member of staff.

During the inspection we found that there were appropriate numbers of suitable staff and staff were given the support they needed to carry out their role effectively. However, people were being cared for by staff who had not completed all the training necessary to undertake their responsibilities. Staff were not always implementing the guidelines drawn up to manage a person�s behaviour. Staff had not followed guidelines in response to a safeguarding concern; there was a delay in reporting the concern to the relevant local authority.

Inspection carried out on 23 February 2011

During a routine inspection

At the time of the visit four of the people who lived at the home were out and about doing different activities with three members of staff. We were able to talk to two people and a member of staff who was the manager of the home.

During our visit we saw that staff treated people that use the service with respect. We saw that staff listened to people and took their views seriously and always answered their questions in a way that they could understand. We saw that the staff were friendly with the people and they seemed relaxed in the home. People we spoke to told us that the staff were good and caring.

The people told us that they liked living at the home. They indicated that they were involved in decisions about their care and support and that their privacy and dignity was respected.

Care plans had been reviewed and developed with individuals to tell staff how people wanted to be supported. People told us they were happy with the care and support they received.

Menus showed that people had a varied and balanced diet. People confirmed that the food was good and they always had a choice.

People were involved in the running of the home from keeping it clean to preparing meals and meeting prospective staff.

Staff had training to learn and understand about the specific needs of the people they cared for which led to appropriate and effective support for people.

People had access to health care such as dentists, doctors and specialist teams.

People got their medication safely and on time. People indicated that they felt safe living at Belmont.

The home was clean and tidy and people said they helped keep it this way.

Staff had received the training and support they needed. This means they had the skills and knowledge they needed to look after people in a way that suited them best.

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