Belong Warrington Care Village

Belong Warrington Care Village is a 'care home' and support up to 73 older people and younger adults who are living with dementia and physical disabilities. People in care homes receive accommodation, nursing or personal care as a single package under one contractual agreement. At the time of our inspection 63 people lived at Belong Warrington Care Village across six adapted ‘households’.

People’s experience of using this service

We have made a recommendation about staffing. The skill set, experience and knowledge of staff needed to be considered so that people received a consistent level of care from the right staff. Pre-employment recruitment checks were conducted, and disclosure and barring service (DBS) checks were carried out.

Safeguarding measures and procedures were in place. However, we noted that the procedures were not always followed in a timely manner. Shortfalls had been identified by the new management team and improvements were being made as a measure of keeping people safe and protecting them from the risk of abuse.

Improved quality assurance and governance measures were in the process of being embedded. The new registered manager acknowledged that additional oversight and monitoring measures needed to be implemented and complied with. Individual risks to people were assessed and reviewed.

The registered manager expressed that areas of improvements had been identified prior to our inspection but a period of sustained stability was needed at the service. The registered manager provided assurances that improved processes and systems would support positive outcomes and the delivery of high-quality, compassionate care. Staff expressed that improvements across the service were being made and their feedback and suggestions were being listened to.

Medication administration procedures were in place. Staff received medication administration training, regularly had their competency levels checked and there was an up-to-date medication policy in place. Regular medicine audits were completed, and staff competence was monitored.

Infection prevention and control (IPC) measures and arrangements were in place. There was an up-to-date infection control and hygiene policy, staff had access to the required PPE and safe visiting guidance and arrangements were being followed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was good (published 16 March 2020). At this inspection, the service has been rated requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

For all types of inspections in care homes, we look at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed

One recommendation has been made, which is a proportionate response to the evidence we found. We will continue to monitor the service and will take further action if needed.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The care home is registered to provide accommodation along with personal and nursing care for up to 72 people. At the time of our inspection 71 people were living at the home.

We found the following examples of good practice.

We were assured the provider, management and staff at the home had taken appropriate and effective action to help minimise the spread of infection and help ensure people were safe during the COVID-19 pandemic.

The design of the home meant that cohorting of people and staff was easily facilitated as it was built into the design of the home. This helped to prevent the spread of any infection. The home was made up of six ‘households’ that mostly operated independently. Each household had a lounge area set out in the style of a traditional living room, a dining area, kitchen and private outdoor space.

Each household had their own staff team. Only in exceptional circumstances did care staff move between households. There was a separate staff entrance for each household with an area for staff to prepare before entering the household. The use of communal areas within the building had been changed to help keep people safe. The bistro area was being used to facilitate socially distanced visits and the home had a one-way system with a dedicated entrance and exit which helped prevent staff and visitors coming close to each other.

The service made effective use of available COVID-19 testing for both people living at the home and staff members. Staff members were checked for symptoms at the start of each shift including the testing of their temperature. One staff member undertook the testing role to help reduce cross contamination. The home made some use of agency staff. However, these only worked in Belong Warrington Care Village and participated in the same regime of testing and checks as other staff members.

People living at the home and staff had been supported to take part in the vaccination programme. Staff worked in partnership with medical professionals to ensure this went smoothly and ensured a vaccine was made available to everybody.

The home was clean and very well maintained. Each floor of two households had a housekeeper who was supplied with appropriate equipment to keep the home clean. There was an innovative laundry system that ensured that it was almost impossible for cross contamination of dirty and clean laundry. There were two laundry assistants one assigned to work with dirty and one with clean laundry.

The service had been well-led during the period of the COVID-19 pandemic. Clear, detailed and accurate records regarding COVID-19 and the support offered to people and staff members were kept. These enabled leaders and senior staff to monitor, assess and have oversight of people’s wellbeing and the support they were providing to help keep people, staff and others safe.

Staff made appropriate use of personal protective equipment (PPE). They had received training and followed best practice when putting on, removing and disposing of PPE. The provider has ensured that the service had always had good supplies of PPE available for staff.

There had been effective communication and partnership working with local infection control teams and health professionals. The service had kept up to date with current best practice guidance and staff had participated in ongoing training update webinars from the infection control team.

Senior staff had ensured that people’s friends and relatives were kept in regular communication about the steps being taken within the home to care for people during the COVID-19 pandemic. Many different types of technology were being used to help people communicate with loved ones. The provider had held their annual awards ceremony online. One senior staff member told us that this enabled them to include more people at the home along with their friends and relatives.

Additional checks on people’s wellbeing had been put into place. These included regular checks for any symptoms people may experience. For example, regular checks on people’s breathing, oxygen levels, skin and temperature. These were recorded and medical professionals alerted if there were any concerns.

People continued to be supported with their emotional and social wellbeing during the pandemic. Each household participated in activities and celebrate special occasions within their social bubble. People’s ongoing health continued to be explored and promoted. For example; during the pandemic there was a workshop to help staff support people with appetising and healthy food. Also, a gym instructor who was employed at the Village visited each household weekly and supported people who wanted with individualised exercise plans for building up strength and exercising for mental wellbeing.

Staff told us that they felt they had been really well supported. One said, “It has been really difficult. But we have had great support, and everything has been in place for us to care for people well.”

Belong Warrington 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 the premises and the

care provided, both were looked at during this inspection. Belong Warrington Care Village is a purpose-built care home close to local amenities. It can accommodate up to 72 people across six unit called households. At the time of our inspection there were 71 people living there.

People’s experience of using this service and what we found

Feedback received about the support provided to people was very positive. People received good, personalised support from a passionate and committed staff team. People and relatives told us they loved the home-made food and felt it was a lovely environment to live in and enjoy.

The service was very good at helping people enjoy a range of activities and therapies that really enhanced their enjoyment of hobbies and events special to them. People told us how much the physical activities and the use of the gym really helped improve their mobility and confidence.

People said they really liked the staff and relatives felt they really did care about the people they supported. People loved the bistro and felt it really enhanced their relative’s enjoyment in spending quality time together.

Staff were fully committed to providing a person-centred service. The staff team were very well trained and skilled in effective communication to ensure people felt supported and able to meet their requests.

The service provided a highly maintained environment that offered maximum comfort to people throughout the building. The service provided therapeutic support and additional resources with their in-house gym for people to gain improvements to their health and wellbeing.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests.

Relatives and people supported were fully involved in the assessment processes to provide detailed care plans. Information was always accessible via an electronic system that helped reassure families of their relative’s wellbeing at any time of the day.

The management team provided good leadership and constantly considered how they could enhance the service. Staff were very proud to work for the service and said they received good support from the management team.

Risk were well managed. People told us they felt safe and comfortable. Risks to people’s health and safety were assessed and mitigated. The management of medicines was much improved. People were empowered to retain their independence, people who were able to, controlled their own medications and were given a key fob so they could come and go as they pleased. There were enough staff to make sure people received care and support whenever they needed it. Recruitment checks were in place and records had improved to ensure staff were suitable to work at the service.

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

Rating at last inspection

The last rating for this service was 'requires improvement' (published January 2019.) The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Belong Warrington 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 the premises and the care provided, both were looked at during this inspection.

Belong Warrington Care Village is a purpose-built care home close to local amenities. It can accommodate up to 72 people across six households on three floors. Each household has separate adapted facilities. At the time of our inspection there were 68 people living there. Each household had a mix of people who required nursing or residential care.

Within the care village there is a bistro which is also open to the community, The Venue which is used for activities and social gatherings, a hair salon, a wellness centre and gym. The gym is available to everyone who lives at the service as well as the community, it is staffed by a qualified fitness instructor.

There was a registered manager in post who worked alongside a general manager and clinical lead. 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.

Medicines were not always managed safely. We found a missed medication and failure to follow up a prescription request from four weeks previously. We found medication keys were not always kept safely on the designated person but were left out on one of the households. This was a breach of Regulation 12, Safe Care and Treatment.

Staff were not always recruited safely. The provider failed to explore staff’s employment history. This was a breach of Regulation 19, Fit and Proper Persons Employed.

The registered manager did not have complete oversight of medication audits, household audits, safeguarding or accident and incident logs. This was a breach of Regulation 17, Good Governance.

People told us they felt safe and happy living at the service. Relatives of people who lived there told us they were happy with the care their relative received.

Risk assessments were completed and regularly reviewed and updated to protect people from the risk of avoidable harm.

There were enough staff to keep people safe and provide companionship. Staff had time to spend with people and many examples of kind, caring, meaningful interactions were seen during the inspection.

The households were warm, welcoming and homely. There were communal areas on each household and people were able to visit the bistro and the Venue as and when they wished.

Food and fluid monitoring was not always effective, and procedures required improvement. This was highlighted during the inspection and the registered manager informed us this was already underway.

People were empowered to retain their independence, people who were able to, controlled their own medications and were given a key fob so they could come and go as they pleased.

There were varied activities on offer six days a week. There were social gatherings and activity areas for people to enjoy at any time.

Safe infection prevention and control procedures were in place. All staff used appropriate personal protective equipment and the service was clean and tidy with no malodours.

The service employed two practice development facilitators who conducted on site face to face training and reviewed staff techniques through a supervision process. Extra training was offered, and outside companies were commissioned to deliver this.

Belong Warrington Community Village is situated in the Stockton Heath area of Warrington. It is a purpose built dementia designed building providing dementia and nursing care. The Village offers ‘household’ living across six households, each household providing a home to 12 residents. Each household has 12 en-suite bedrooms which surround a shared living space with a lounge and dining area and kitchen facilities. The open plan layout of the households enables staff to observe each individual’s wellbeing closely but naturally. For the purpose of this report we will refer to the accommodation as households.

The home has 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.

The manager was available throughout the inspection and engaged positively with the inspection process. The manager was friendly and approachable; he operated an open door policy for people using the service, staff and visitors.

We found that care was provided by a consistent staff group in an environment which was friendly and homely.

People told us they felt safe at Belong Village. They told us it was like living in a family environment and we saw that people were settled, relaxed and comfortable living there. The relationships we saw were caring, respectful and dignified and the atmosphere was one of calm and comfort.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People's consent was gained before any care was provided and the requirements of the Mental Capacity Act were met. People’s capacity to make decisions was kept under review and the registered manager was aware of actions that would need to be taken where people had reduced capacity.

Staff were aware of their duty to safeguard vulnerable people and were provided with pocket booklets which gave information about safeguarding ‘If you see something, say something’. Staff understood their responsibilities with regard to safeguarding people, and people were supported by sufficient numbers of staff. The staff team had become established which helped people to receive consistent care from people who knew them well.

Staff members had developed good relationships with people living at the home and care plans clearly identified people’s needs, which ensured people received the care they wanted in the way they preferred.

People told us they liked the food and had a good choice available to them. People told us that they had been involved in choosing the meals and they were encouraged to make healthy choices.

Medicines were stored and administered safely. Staff had received training in the medicines they were giving to people and the systems were regularly audited to make sure safe practice was maintained.

Each person had a care plan which detailed their choices and preferences in relation to their care. Plans reflected people’s wishes, skills and aspirations as well as areas in which they needed support. People followed an active programme of individual and community activities.

Staff told us they worked well as a team and there were clear lines of authority within the management structure. Staff said the registered manager “knew his stuff” and was very supportive and cared deeply for the staff and the people who lived in the households.

The complaints policy was clearly visible within each household and in the reception areas of the premises and people told us they knew what to do if they ever needed to complain.

The registered manager undertook audits of safety and practice at the home and there were other quality assurance systems such as staff and residents meetings and questionnaires.

The care and support provided in all six households met the needs of the people living there and the environment was clean and comfortable with plenty of signage to ensure people were able to safely move around the building.