Belong Atherton Care Village

Belong Atherton Care Village is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care village is situated in Atherton, Greater Manchester and is registered to provide accommodation for up to 73 people who require personal care and support. At the time of this inspection 71 people were living at the care village.

The care village comprised of six separate households over three floors, these were named after local historical mills and coal mining pits. The households were called; Astley, Pretoria, Caleb Wright, Ena, Tyldesley and Chanters. Each household had 12 single occupancy bedrooms and each room had an en-suite bathroom. Central to each household was a kitchen, dining area and lounge. The care village had a bistro, internet café, library, craft room, beauty therapy room, gym, training rooms and the ‘Venue’ which hosted coffee mornings and doubled as a cinema room and events facility.

For the purpose of the report, the care village also has independent living apartments which do not form part of this inspection but are central to the care village and its design.

Belong Atherton Care Village was previously rated as requires improvement following our inspection on 19 December 2016 and 04 January 2017. Following the last inspection, the care village was rated as requires improvement in the key question of safe and well-led, as we identified a breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the management of risks. During this inspection we found the provider had addressed the previous regulatory breach and was meeting all the requirements of the regulations.

The service 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 were at the heart of the service design and recruitment to ensure they received the right support from the right staff in an environment that was conducive to their well-being. People and their relatives told us they had been involved in the planning of their care through the assessment and life planning process and on-going reviews. Involvement of people who used the service was clearly embedded into everyday practice. There was a clear emphasis on people achieving their aspirations and staff were positive, motivated and focused on people’s successes to support their continued progression.

Staff were creative and adapted their support in response to people’s changing needs to mitigate risks. The staff had achieved outstanding results based on people’s goals and aspirations. People themselves told us that they had not believed their achievements had been attainable spoke highly of the support received, attributing their progress, enhanced sense of wellbeing and quality of life to the facilities and support received.

We saw people were supported to fulfil their dreams and people’s achievements were celebrated and their views were sought and acted on. People were supported by staff that were compassionate and treated them with dignity and respect. People were empowered to make a difference and to demonstrate what dignity meant to them and educate other’s on their experiences.

The service’s ethos, vision and values promoted people’s rights to make choices and live fulfilled and valued lives. There was a strong emphasis on people pursuing full, active lives engaged with their local communities. There was active participation in the local community and strong links with local schools to optimise outcomes for older people and young children. There was a bistro on site which was open to the general public and people at the care village could access the bistro for meals or request meals from the menu were brought to their household.

The open, inclusive and supportive nature of the service meant that promoting equality and diversity and respecting people’s human rights was a golden thread that ran through every aspect of the service.

We saw staff received comprehensive training which provided them with exceptional knowledge and skills. Training was developed and facilitated in line with developments in best practice. There was a culture of learning from incidents and disseminating that learning across the other Belong villages in the organisation. The care village was open to others and the management shared the facilities and resources to achieve the best outcomes for people accessing services.

Staff told us they felt extremely well supported by management and received excellent support through training, regular supervision and team meetings. They spoke of being given opportunities to progress and felt they were supported to achieve their full potential.

Staff demonstrated an in-depth awareness of the principles of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards (DOLS).

The management and staff were clearly motivated to make a difference to people living at the care village and in the wider community. They had been instrumental in making changes to health care provision and were driven to make continued improvements to the accessibility of services.

The staffing structure in place made sure there were clear lines of accountability and responsibility. The vision and values were imaginative and person-centred and made sure people were at the heart of the service.

The service was last inspected on 03 March 2015 when the service was rated as good overall and in four of the key lines of enquiry (safe, effective, caring and responsive). The service was rated as outstanding in well led.

Belong Atherton care village is situated close to Atherton town centre and is operated by the CLS Group, providing care and support to older people who require 24 hour care. A large proportion of the people living at the care village are living with a diagnosis of dementia so the service ethos is directed towards providing care and support appropriate for their needs.

The care village has 12 bedrooms on each household and there are six households that make up the care village. The care village is registered with the Care Quality Commission (CQC) to accommodate up to 73 people. On the day of our first inspection visit there were 70 people using the service.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like the registered provider, 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 inspection on 19 December 2016, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to good governance and safe care and treatment. Following our inspection visit on 19 December 2016, we raised two safeguarding alerts with Wigan local authority and wrote to the provider outlining our concerns. At our second visit 04 January 2017, we found the service was no longer in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the management had addressed all the concerns identified.

All the people we spoke with told us they felt safe living at Atherton care village. We received mixed reviews from relatives regarding their family members safety. One person’s relative expressed their family member had improved since living at the care village. A second person’s relative told us they visited daily and would be concerned about their relatives hydration if they didn’t. However, we found no evidence to support this concern or that the person’s relative had raised this with the registered manager to give them an opportunity to look in to their concern.

At our first inspection visit, we found risk assessments had been completed and the necessary professional guidance sought but life plans had not been updated to provide staff with the required guidance to mitigate the risks. We raised two safeguarding alerts and wrote to the provider outlining our concerns following our first visit. At our second visit, we found the provider had addressed the issues identified. We looked at 11 people’s life plans during our second visit and found all the life plans had been updated to include the current guidance so staff could mitigate the risks of an ‘unsafe swallow’ for people living at the care village.

At our first inspection visit, we found medicine files were unorganised and did not contain all the required information to manage people’s medicines safely. An audit had been conducted following our first visit and all the issues had been addressed by 04 January 2017 to ensure people’s medicines were managed safely.

We found the service had an up to date policy and suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. ‘See something, say something’ was advertised throughout the care village.

Staff felt well supported. Staff received an induction , supervision, annual appraisal and sufficient training to promote better outcomes for people.

The manager and staff were aware of their responsibilities around legislation regarding people’s mental capacity. Staff were observed obtaining people’s consent before delivering care.

We received mixed reviews from people and their relatives regarding the quality and choices of food offered. At our first visit, people told us they weren’t informed of the food choices available. However, by our second visit we saw that pictorial menu’s were available on the households informing people of the daily options. People were also able to attend the Bistro daily if they wanted to eat off the household.

The catering manager was passionate about providing people choices and was a finalist in the Great North West awards for their catering and dysphagia training. The catering manager experimented with foods that people expressed missing and had made a dysphagia pie, sandwiches and toast.

We saw people were treated with kindness and compassion. Staff spoke fondly of people and we saw they were responsive to people’s needs.

People and relatives had been involved in assessments, reviews and on-going discussions about the care received. People were treated with dignity and respect and their privacy and independence was promoted.

We received mixed reviews regarding the activities on offer at the service. There was an experience coordinator employed at the service and they told us they undertook different activities on different households daily. There was a gym, venue coffee shop and bistro that people could access. People told us they didn’t go on outings and their family members felt interactions between staff and people were task led.

People and their relatives did not feel the management were visible and expressed not seeing them. However, staff told us morale was good and we observed staff were motivated and worked well together. Staff said the management undertook daily walk rounds on the households and they felt they were approachable and supportive.

We found audits had not been effective as they had not identified the issues raised during our first inspection. The audits had identified whether life plans were in place but not considered the detail and whether they were representative of people’s needs. The registered manager told us they were looking at staff conducting audits on opposing households to the one they worked so that audits were more effective at identifying issues in the future.

We found the management were receptive to our feedback. The issues identified following our initial inspection visit were promptly addressed and actions taken to prevent reoccurrence.

We met with people who lived in the home and observed how they were cared for. We also spoke with staff and observed them carrying out their various roles and noted how they interacted positively with the people who lived in Belong Atherton. People told us they were happy and well cared for by very kind staff.

Staff provided quality care wherever possible and appeared to fully understand people's needs.

However staff told us they often had to struggle to undertake their many tasks and as a consequence people's needs were not always met in a timely manner.

Staff rotas showed that staffing levels on each household never fell below 2 staff during the hours between 7.45 and 21.45. The rota also showed that extra staff were employed to act as "floaters" to assist any households which needed extra help.

We were provided with feedback and details of Belong staff rotas, care records and staff training by the Belong General Manager and senior staff to enable us to review the processes undertaken by the home in relation to the expressions of concerns received.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We found that people's choices were recorded within the care plans and these were being followed by staff members. We saw the staff members on all units treating people with respect and spending time with people on an individual basis.

The people we spoke with told us that staff were kind and caring and nothing was too much trouble for them. People said that staff worked very hard but were always available to provide appropriate care and support.

Observational practices evidenced that there were appropriate staff numbers and skill mix for the layout and purpose of the home. People told us they felt safe and were involved in the way their care was delivered and in the general running of the home. Comments included; "Staff ask us if we would like anything changed such as menus, activities and decoration", "we fill forms in to tell them what we think about this place."