This inspection took place on 14 March 2018 and was unannounced. We made a further visit on 16 March 2018 which we announced so we could complete the inspection.

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 live

In response to concerns about a specific incident, we carried out an unannounced comprehensive inspection of Belong Atherton Care Village on 19 December 2016 and a further announced visit on 04 January 2017.

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 suf

The inspection took place on 03 March 2015 and was unannounced. The last inspection took place in March 2014 and was a responsive inspection due to concerns raised, the village was found to be meeting all regulatory requirements inspected.

Belong Atherton is a care village operated by the CLS Group, providing care and support to older people who require differing types of specialist 24 hour care. The residential accommodation consists of six households each having the capacity to accommodate 12 residents, up to 72 in total. The six households are situated near to Atherton town centre and forms part of Belong Atherton Care Village.

On the day of the inspection there were 68 people using the service permanently and two people in short term respite care.

There was a registered manager at the village. 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 told us they felt safe and secure at the village. The building was suitable for people with restricted mobility and equipment was well maintained and fit for purpose.

We saw that the village recruited staff in a robust and safe way. We observed that there were sufficient staff on duty to ensure people’s needs were met.

The village had appropriate policies with regard to safeguarding vulnerable adults and whistle blowing. Staff were aware of the policies and procedures and demonstrated an understanding of the issues.

We saw that there were systems in place to help ensure medicines were ordered, dispensed, stored and disposed of safely.

The village’s staff induction programme was robust and included a range of training and support, which was on-going. We saw the training matrix which evidenced that staff had completed the required training to help them carry out their roles effectively.

We saw that there was an excellent choice of food available at the village. People’s nutritional and hydration needs were catered for and there were nutritious snacks and drinks available throughout the day.

Care plans included a range of health and personal information. There were monitoring charts relating to issues such as weight, nutrition and falls where these were required.

We saw that staff sought consent from people who used the service, when delivering care. Written consent was evident within care files where appropriate.

Staff worked within the requirements of the Mental Capacity Act (2005) (MCA) and understood and adhered to the conditions of Deprivation of Liberty Safeguards (DoLS), which are used when people are deprived of their liberty in their own best interests and lack capacity to make this decision themselves.

We observed care being delivered in a kind and respectful manner during the day. Staff had regard to people’s dignity and privacy when delivering assistance.

The households within the village were small, housing up to 12 people in each, and pets were allowed if people wanted them. This helped people feel they were part of regular family households. We saw that people were involved in decisions about their care delivery and the support they required.

The service produced a range of information, which was available for people who used the service. This included information about the services offered, a programme of events, a regular newsletter and feedback forms.

Staff at the village were involved in end of life programme training. This was to enable people to stay in familiar surroundings, with people around them that they trusted, at the end of their lives if they so wished.

We looked at three care plans and saw that they reflected people’s individual needs, wishes and preferences. Regular household meetings took place where people felt they could air their views and suggestions.

We saw that a number of activities were on offer for people, and there were facilities in the building, such as the gym, hairdressing salon and internet areas. People could use these resources whenever they wished to and this also allowed them to interact with members of the wider community.

The service had an appropriate complaints procedure, which was outlined in the service user guide. We saw the service’s complaints log and this evidenced that complaints were followed up appropriately.

People who used the service, relatives and staff all described the management team at the village as approachable. We saw that the village worked to current best practice guidelines and ensured they were up to date with this information. This was discussed regularly with staff at meetings and within supervisions. Regular meetings took place with the various staff groups and staff supervisions sessions and annual performance development reviews were undertaken regularly.

The village had excellent links with the local community due to having facilities which were used by people who used the service and members of the community. This enabled people to continue to feel part of the wider community after they had been admitted to the village.

We saw evidence that the village worked well in partnership with other agencies. Regular feedback from people who used the service, relatives and professional visitors was sought in various ways to help facilitate communication, encourage suggestions and the raising of concerns.

A significant number of audits and checks were carried out and the results analysed. This helped the service to ensure continual improvement to the service.

We visited Belong Atherton because we had received some expressions of concern about the care provision and staffing levels in place.

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 spoke with fifteen people who lived at Belong Atherton. They told us that staff treated them with respect and looked after them well. One person told us "Staff always ask us what we want to do and when we want to do it", another person told us "they let us make our own decisions about how we are cared for and make sure we are never embarrassed."

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."

The people using the service who were able to tell us said that they were happy living in the home. Comments included; “I am fine”, “I am very happy here, the staff and manager are very good’, “This is a nice place to live, I like it here”. “There are always people to talk with”; “Staff are very helpful”. Relatives of people living in the home told us that they felt staff treated people with respect and provided needs led care at all times.

The people we spoke to told us that their needs were being met by the staff members and that they did not have any concerns. Comments included, “I like it here, people are nice”, “The staff are good” ”Staff are very good to us”, “I am not sure I would still be alive if it wasn’t for being here”.” We have activities and I love it here”. Relatives of people living in the care village told us that they felt the staff were very kind and caring. However they said that on occasions they were not able to give immediate assistance to people as “they could not do everything at once”.