This was an unannounced inspection which took place on 18 and 20 December 2018. We did not announce our visit on the first day.

Belong Care Village Wigan 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. It is purpose built and provides care and accommodation for up to 67 people in six households, five with eleven single bedrooms and one with an adjacent small suite to accommodate a person with a greater degree of independence. People with a wide range of needs are supported, from residential care to nursing. Nursing care was provided by registered nurses, but each household had a mix of needs. The village is set on three levels with two households on each. All bedrooms provide single accommodation and have ensuite facilities. There were 67 people living at the home at the time of our inspection.

At the last inspection in May 2016 the service was rated Good. At this inspection we found the service had improved and we have rated the service as outstanding.

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.

The people who lived at Belong Care Village were at the heart of all aspects of the service, and their views were consistently sought and taken into account when planning and reviewing service delivery.

Care support and treatment was delivered to people by passionate and enthusiastic staff. All the people we spoke with told us that they felt safe and well cared for and that Belong Care Village provided a safe environment in which people lived fulfilled lives. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Where people lacked capacity, the appropriate authorisation to provide care and support had been granted.

People, their relatives, and professional visitors told us about the exceptional care they received. Excellent recruitment procedures ensured that the staff had the right background, values and temperament to work with vulnerable people and they received good training to help them understand and report signs of abuse. High staffing levels meant support workers and ancillary staff had time to spend with people. Call bells were promptly answered. We found many examples where staff would go the extra mile to ensure people were happy with the care and support they received. One member of staff brought each person on their household a small personal token when they returned from holiday, another promised to bring treats to celebrate new year.

The service was extremely person centred, and people had choices in all aspects of their care. Detailed care records reflected delivery of person-centred care in all interventions, and people were encouraged to maintain their independence and autonomy. There was a clear understanding that people were not defined by their age or disability and were supported to maintain their own lifestyle.

The building had been built to meet people's needs. Imaginative design and placement of furniture minimised the risk of accidental injury, and the non-clinical environment did not detract from the high quality of care and support provided. It was warm, spacious and clean, and a strong approach to infection control ensured the safety of the environment. Equipment was well maintained and fit for purpose.

Staff monitored risk, whilst a person-centred approach allowed people to take charge of their own risks. Medicines were carefully administered by trained staff and regularly audited. An op

In response to concerns about a specific incident, we carried out an unannounced comprehensive inspection of Belong Wigan Care Village on 06 and 16 May 2016.

The service was last inspected on 01 May 2014 and they were found to be meeting all the regulatory requirements inspected at that time.

Belong Wigan Care Village is operated by the CLS Group, providing care and support to older people who require differing types of specialist 24 hour care; including nursing, residential and respite care as well as care for people living with dementia. The Care Village consists of six households; five have the capacity to accommodate 11 residents and one household 12. The six households are internally known as Acacia, Beech, Willow, Elm, Cedar and Laurel. Belong Wigan Care Village is situated in Platt Bridge on the outskirts of Wigan town centre. On the day of the inspection there were 67 people living at Belong Wigan Care Village.

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.

The Care Village was designed and built to meet people’s needs. The service was clean and comfortable and there was sufficient signage to support people to navigate the service independently. Equipment was maintained and fit for purpose.

Prior to our inspection we had received information of concern in relation to the clarity of the procedure to be followed by support staff when they needed to escalate health concerns. This had been raised in a report from the coroner with regards to a person who previously lived at the home who had sadly passed away. As a result of this report we looked in detail at this area during the inspection. We found the service had addressed the areas of concern. We saw a ‘Contingency flow chart for unexpected changes in health’ had been developed. We spoke with the night staff and they were able to tell us where the flow chart was located and what the procedure was. We also saw that a night time record sheet had been introduced. The record was time specific and was completed by staff as people’s care and support needs were met.

People told us they felt safe living at the service.

People living at the service and their relatives spoke positively about the staff and management at the home. It was observed throughout the inspection that staff knew and understood people’s needs and provided flexible, tailored support. Staffing was calculated based on people’s independence and level of need. We saw there were sufficient numbers of staff deployed and staff were responsive to people’s needs and preferences. Staff went through a robust recruitment process before starting work.

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. Medicines were stored and administered safely.

Staff received regular training and opportunities for continued professional development. 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 saw staff assessed peoples’ nutritional needs and varied menu’s had been developed. People were offered choice and the dining experience was interactive and relaxed.

The experiences of people who lived at the service and their relatives were positive. We saw that people were treated with kindness and compassion. People and relatives had been involved in assessments, reviews and ongoing discussions about the care received. People were treated with dignity and respect and their privacy and independence was promoted.

People’s health care

Belong Wigan is registered with the Care Quality Commission to provide personal care and accommodation for up to 67 people. As part of our inspection we spoke with nine people who used the service, six relatives, thirteen members of staff and a visiting professional.

Our inspection was co-ordinated and carried out by an inspector from the Care Quality Commission who addressed our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We also used a specialist advisor who assisted us on the day of our inspection.

There are six households at Belong Wigan and we visited five of them including Cedar, Elm, Acacia, Beech and Willow House. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they were treated with respect, dignity and felt safe in the presence of staff.

Safeguarding procedures were in place and staff were able to demonstrate how they would safeguard the people they supported. This meant that people were safeguarded from abuse. One member of staff told us; “I have reported abuse in the past and would not hesitate to do it again”.

There were systems in place to make sure that the management and staff learned from events such as accidents and incidents, complaints and concerns.

The service had policies in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications have been submitted. All staff spoken to were able to demonstrate a good understanding of the relevant legislation and the action they would take if they had concerns

We found equipment was available where required, was well maintained and available in sufficient quantities. Service records identified necessary checks were undertaken each year to ensure equipment was in good working order and still safe to use.

People who used the service and staff told us they felt there were enough staff to care for them. One member of staff told us they felt meal times were busy and rushed due to the fact carers were responsible for the preparation of food and also needed to assist certain people to eat and drink. We discussed this with the manager.

We found people’s nutrition and hydration requirements were met in a safe and timely manner. This included assisting people to eat, making appropriate referrals to dieticians and SALT (Speech and Language Therapy) and ensuring people’s food was purified where required.

Is the service effective?

We found one of the main functions of the service was to provide an ‘Independent Living Service’ to people who lived there although support and assistance was available from staff 24/7. Onsite services included a bistro café, exercise studio, internet café and laundry facilities which are also available to members of the general public. Each household consisted of kitchen facilities where people were encouraged to prepare their own food if they were able to.

People’s health and care needs were assessed with the people who used the service or their representatives. Special dietary mobility and equipment needs had been identified in care plans where required.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Visitors confirmed that they were able to see people in private and that visiting times were flexible. There were designated ‘quiet areas’ where people could spend time with their loved ones when they visited the home.

Is the service caring?

We observed people were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people. We asked people who lived at Belong Wigan their opinions of the care they received. Comments included; “Magnificent” and “I like it here. The staff are nice. They make an effort to spend time with me” and “I would say the care is good. Nothing bad to say really”.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. Whilst speaking with one lady, we noticed she was well presented, wore her favourite jewellery and wore her favourite perfume. She told us this was of importance to her and liked to be well presented at all times. This was clearly recorded in the care plan.

Is the service responsive?

People completed a range of activities inside and outside the service regularly. The people we spoke to said activities took place most days. On the day of our inspection we observed people playing dominoes, bingo, completing jigsaws and watching television. One lady told us she enjoyed helping staff fold up the napkins in the dining room as it kept her occupied.

People we spoke to were aware of the complaint procedure. We looked at how complaints had been dealt with and found appropriate response had been made to the complainant in question. People can therefore be assured complaints would be investigated and action is taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. We saw evidence of communication and involvement with health professionals and saw when people needed to go to hospital, the transfer to hospital forms were well documented and were accompanied by current medicines charts.

The service had quality assurance systems in place to monitor the quality of the service provided. This was done with use of audits, surveys and the learning from incidents and complaints. Where shortfalls were identified, we read about any action taken to avoid future re-occurrences.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality service at all times.

We visited Belong Wigan because we had received some expressions of concern about the care provision, standards of hygiene, staffing numbers and food portions and choice.

We spent time 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 with the people. Staff provided quality care wherever possible and appeared to fully understand people’s needs whilst carrying out their many tasks.

Staff told us that food choices were always available. People living at the service were able to take their meals within their household or at the Bistro on the ground floor of the building.

We were provided with feedback and details of Belong staff rotas; infection control and laundry policies and audits by the general manager and senior staff to enable us to review the processes undertaken by the service in relation to the expressions of concerns raised.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences.

During our visit we met with 30 of the people living at Belong Wigan Care Home and seven of their relatives. We also met with other people living there and observed the support provided to them.

In addition we spoke with 15 members of staff who held various roles within the home.

Relatives told us that in their opinion people had received the support they needed with their personal care. They said that generally there had been sufficient staff available to provide the support people needed. In discussions relatives also told us that they believed people living at Belong Wigan Care Home had benefited from the atmosphere provided in a small household environment.

One of the people living at Belong Wigan Care Home told us, "I love it here" and a relative commented, "It's lovely, really nice and the staff work very hard to ensure our loved ones are well cared for."

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, ‘The manager and staff are fine’, ‘The staff are good’,”Staff are kind and helpful”.

People told us that they liked living at Belong Care Village. They said that in the main the food was good and that the staff were nice.

People said that they received prompt and effective medical and health care.

We were also told that people would like the opportunities to develop friendships and spend time in each others company without having staff about.

People said that they felt safe and able to make any concerns known and that they would be listened to.

Comments from people using the service included:

'It's not a bad place to be.'

And

'All told it's ok.'