belong crewe care village inspection report march 2013

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| Inspection Report |Belong Crewe Care Village|March 2013 www.cqc.org.uk 1

Inspection Report

We are the regulator:Our job is to check whether hospitals, care homes and careservices are meeting essential standards.

Belong Crewe Care Village

Brookhouse Drive, Crewe, CW2 6NA Tel: 01270561200

Date of Inspection: 21 February 2013 Date of Publication: March2013

We inspected the following standards as part of a routine inspection. This is what wefound:

Respecting and involving people who useservices

Met this standard

Care and welfare of people who use services Met this standard

Safeguarding people who use services fromabuse

Met this standard

Staffing Met this standard

Assessing and monitoring the quality of serviceprovision

Met this standard


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Details about this location

Registered Provider CLS Care Services Limited

Registered Manager Miss Caroline Ray

Overview of theservice

Belong Crewe Care Village is a purpose built complex thatprovides modern accommodation for people who requirenursing or personal care and is registered to care for up to67 older people. The village is located in a residential area ofCrewe and local amenities such as a medical centre,chemist, bus stop and shop are within a short walkingdistance. There are six separate households, each able toaccommodate 10 or 12 people who require differing levels of

care, support and treatment.

Type of service Care home service with nursing

Regulated activities Accommodation for persons who require nursing or personalcare

Diagnostic and screening procedures

Treatment of disease, disorder or injury


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Contents

When you read this report, you may find it useful to read the sections towards the backcalled 'About CQC inspections' and 'How we define our judgements'.

Page

Summary of this inspection:

Why we carried out this inspection 4

How we carried out this inspection 4

What people told us and what we found 4

More information about the provider 4

Our judgements for each standard inspected:

Respecting and involving people who use services 6

Care and welfare of people who use services 7

Safeguarding people who use services from abuse 9

Staffing 10

Assessing and monitoring the quality of service provision 11

About CQC Inspections 13

How we define our judgements 14

Glossary of terms we use in this report 16

Contact us 18


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Summary of this inspection

Why we carried out this inspection

This was a routine inspection to check that essential standards of quality and safety

referred to on the front page were being met. We sometimes describe this as a scheduledinspection.

This was an unannounced inspection.

How we carried out this inspection

We looked at the personal care or treatment records of people who use the service,carried out a visit on 21 February 2013, observed how people were being cared for andchecked how people were cared for at each stage of their treatment and care. We talked

with people who use the service, talked with carers and / or family members and talkedwith staff.

What people told us and what we found

Not all the people we spoke to living at Belong Crewe were able to use words to tell us ifthey were happy with the way the service was run, and the way they were supported.People gave us the thumbs up or could indicate with a few words if they were happy. Wewere able to speak to people and observe their care as well as interactions between themand staff. People told us they enjoyed living at Belong Crewe and that staff respected theirroutines and lifestyle.

One person living at Belong Crewe told us the importance of maintaining theirindependence was essential to them. They told us they were able to choose their ownroutines and lifestyles and these decisions were respected by staff. They said that staffsupported them to maintain their independence but were quick to respond to their requestsfor assistance. They said, "The problem is my memory is getting worse. The staff keep meup to date and doesn't mind how many times you ask them something. At home I was nottaking my tablets, I was forgetting. Now the staff help me I am feeling the benefit".

We saw that people's health care needs were supported by staff who they commented

were 'polite', 'friendly', 'I absolutely love them', 'such fun' and 'everyone knows your nameeven if you have only met them once'. Staff told us they were well trained and supported.We saw they were respectful of the needs of people living at the home.

You can see our judgements on the front page of this report.

More information about the provider

Please see our website www.cqc.org.uk for more information, including our most recentjudgements against the essential standards. You can contact us using the telephonenumber on the back of the report if you have additional questions.


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There is a glossary at the back of this report which has definitions for words and phraseswe use in the report.


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Our judgements for each standard inspected

Respecting and involving people who use services Met this standard

People should be treated with respect, involved in discussions about their careand treatment and able to influence how the service is run

Our judgement

The provider was meeting this standard.

People's views and experiences were taken into account in the way the service wasprovided and delivered in relation to their care.

Reasons for our judgement

We looked at the assessment records of a people who had moved into the home. Wefound that detailed information was gathered about the needs of people and that they wereinvolved in providing information about their care and support needs. One person told usthat they had been involved in providing information about their care and support plan andsaid, "The staff asked me lots of questions about the things I like, about what food I likeand how I wanted to be helped. They asked me if I wanted a male or female carer and I

said I don't mind as long as they didn't".

The family member of a person living at the home said that they had been supported tohelp their relative choose the home and had been able to contribute to the care andsupport planning process. They said," We wanted mum to have an apartment but hermemory deteriorated so quickly that was impossible so we chose the care side. This is agreat concept, small units of people with plenty of staff. This is an excellent place. We

have support from the general manager in getting mum a place. I can be very picky butwould have to be to find fault".

Care and support plans were thorough; person centred and identified the persons' capacity

for making choices. We looked at care records relating to three people living in the home.We found evidence to show that people's care and support plans were being reviewed andtheir views recorded regarding their needs and how they wanted their care and support tobe provided. Care planning was person centred. This meant people were given anopportunity to manage their own care and maintain their independence. Staff key workingarrangements were in place. This meant people were supported by the same staff thatwas familiar with their individual needs and choices.


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Care and welfare of people who use services Met this standard

People should get safe and appropriate care that meets their needs and supportstheir rights

Our judgement


People experienced care, treatment and support that met their needs and protected theirrights.


During this visit we spoke to ten people and made observations of care practice. We foundpeople were supported with personal care needs when they needed it, and requests forassistance were prompt. People were supported to eat and drink at leisure.

People told us they were very happy at the home. Staff were always at hand to help them.We spoke to one person in their bedroom. They told us "I am getting a new hearing aidand a new doctor. Staff are helping me with my medication and I am feeling the benefit ofthat and am much better. What I like about here is that if where ever you go people knowyour name even if they have only met you once. That has helped me settle in quickly and Ifeel like I belong here because people care. I see the staff caring for other patients and

they do that with respect. Staff are patient and take their time to explain things to you. Ihave never heard the other patients complain. The biggest compliment I can pay the staffis that I would be happy to end my days here ".

We found that care and support plans focussed on the needs of people using the service.Guidance for staff was clear and written in a person centred way to reflect individualneeds. Person centred planning tools such as one page profiles were used to support staffprovide person centred care. Each person had a care and support plan called 'my lifeplan'. This provided staff with information about helping people with the health andpersonal care needs, maintaining their individual routines and personal preferences totheir diet.

We found care and support plans were very detailed. We found terms used for example'requires assistance' defined what that assistance would involve. Care plans were clearand guided staff on supporting people to make decisions about their care.

Risk assessments were carried out. These were linked to peoples' welfare and safety.They identified who may be at risk of falling, developing pressure ulcers or who may noteat enough. Improvements were noted as staff were given guidance on how to manageknown risks. We saw examples that routines were flexible to allow people to get up whenthey wanted to. People had options of a wide range of meals and dining facilities. People

could eat in the units or at the bistro. People could order food from the bistro or have itsent from the kitchen or prepared in the units. We saw that high calorie snacks wereprovided throughout the day to people who expended energy as a result of their mental


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health needs or who could not remember if they had eaten. We saw if people got up laterin the morning they could have a light snack before lunch.

We saw that the care home had an equipped gym on site which was available for visitingphysiotherapists to use to treat their patients and for people to use for exercise andmobility programmes.

We spoke to the nurse that managed the health care needs of people at the home. Theysaid that their role was supporting the care staff in the home and providing advice andguidance to them. They said they were the link between local general practitioners andcommunity based health professionals. They said their job was made easy because of thecompetence of the staff who worked in the care home units. They said, "The staff here arebrilliant. We have a great team of staff who are on the ball. I have done training with themso they can do the basic monitoring of people's health. I do the clinical observations butthey can manage otherwise. If they need advice they call me and I will assess peoplebased on what they tell me. I have every confidence in them and am not just saying thatbecause I work here".


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Safeguarding people who use services from abuse Met this standard

People should be protected from abuse and staff should respect their humanrights

Our judgement


People who use the service were protected from the risk of abuse, because the providerhad taken reasonable steps to identify the possibility of abuse and prevent abuse fromhappening.


People said that they were safe living at the home and that their safety was ensured bystaff. One person told us, "I have never seen anything that I need to be concerned about.It was explained to me that when I moved here if me health got worse then that wasprogression. Well I have improved and that is progression. I see the staff caring for allthese patients. There are some patients who can be a bit rude at times but the staff arepatients and take their time. They don't show anger or anything like that when they arecaring for them".

We looked at the staff training record. We found all staff had been trained in safeguarding

adults. This meant staff had been supported to understand and recognise signs of abuse.We saw that all care staff had completed safeguarding adult's training and this includedstaff who had recently been employed and completed their induction.

We spoke to staff. They told us they were confident to report any suspicion of abuse andwere confident it would be dealt with appropriately. Staff were aware if the procedure onhow to report allegations of neglect or abuse. Staff said the training was in depth anddelivered good examples of what constituted neglect or abuse. One staff member said,"The training was quire hard hitting. The DVD's we saw we knew were actors but as agroup we were all crying. It was upsetting but showed the reality of what can happen. Ihave never worked in a care home before and thought that things like that neverhappened. I thought the training was going to be common sense but was mistaken".

Staff were provided with the provider organisation's zero tolerance to abuse called 'If yousee something say something" information card. This offered staff guidance on how toreport any concerns they had about the care of people living at the home and containedexamples of indicators of abuse.


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Staffing Met this standard

There should be enough members of staff to keep people safe and meet theirhealth and welfare needs

Our judgement


There were enough qualified, skilled and experienced staff to meet people's needs.


People living at the home commented that staff was 'polite', 'friendly', 'I absolutely lovethem', 'such fun' and 'everyone knows your name even if you have only met them once'.

We looked at the staff rota for the week. This showed the number of staff on duty day andnight at any one time but was not used as a judgement that staff was sufficient. Throughour observations we saw that staffing levels at the time of the inspection were very good.Sufficient numbers of staff were on duty to ensure people's welfare and safety waspromoted. We found care staff were deployed within the home to ensure continuingsupport for people. In addition to carers the provider employed staff for housekeepingduties and regular maintenance.

The home had organised social activities on throughout the day. People had access to thebistro and the venue.

The staff we spoke to were friendly and pleasant. They appeared to be well organised andhad a good team spirit. They told us they were able to provide the support people requiredbut found they always had time to provide personal care at times that suited people livingat the home.

We saw that staff could prepare meals on the units for people with their help. Staff wereable to share meals with people and had time to do social activities with people. Peoplesaid that staff were patient with them and were attentive to their needs. One person said,"My memory is getting worse and I am getting very frustrated with not being able toremember the simplest of things. My family visited earlier and they are happy that I havesettled in. The staff are very helpful but they don't know me very well but they try their best.This lady brought me a drink as I was very thirsty. They are trying their best and being verypatient". One staff member said, "We always have time to care for residents as they want.We always have the time to do the things that residents want us to do. We are notexpected to rush. Residents decide what they want to do. Some residents are still in bedand when they want to get up we will help them. There are no set routines and if a residentgets up late before dinner we will make them a light snack so they are not too hungry andwill still enjoy their meal".


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Assessing and monitoring the quality of serviceprovision

Met this standard

The service should have quality checking systems to manage risks and assurethe health, welfare and safety of people who receive care

Our judgement


The provider had an effective system in place to identify, assess and manage risks to thehealth, safety and welfare of people who use the service and others.


We looked at the quality assurance system in place.

We saw evidence that meetings were held for people using the service and relatives. Themanager said the meetings were repeated in the evening and weekends so people livingat the home and relatives had the opportunity to attend. We also saw minutes of theregular staff meetings held at the home and health and safety meeting.

The manager had a daily meeting of staff that were in charge of each unit. These wereattended by the senior managers. Information was gathered about any changes in

people's needs, any visits from external professionals and anything significant relating topeople using the service. The managers also shared important information that could becascaded to staff in each unit.

The manager undertook a range of audits at the home. These included; Medication, theenvironment, infection control, out of hour's manager visits and daily walks round audit bythe manager. The home had a clinical governance audit based on the outcome areas ofthe essential standards and action plans were developed in accordance with the results.

The provider also held meetings with managers of all the provider's registered care homes.This helped the provider organisation gather information from a range of different peopleand sources. We saw that the home was being very well maintained and facilities on siteincluded a bistro, hair and beauty salon, internet caf, exercise studio and The Venuewhere people can hold various functions such as parties and other activities.

We saw that surveys for people using the service were sent out annually, but werereturned to head office. The home manager received feedback form the surveys as well asthe information being available on the provider's Internet site. Information from complaintswas used to improve the serviced provided. For example comments were received aboutthe service form people that use services. Comments were both positive and negative.The provider included theses comments in the report and how they had addressed them.

The manager used a variety of ways to meet with people using services and their familymembers. There were coffee mornings, meetings with people that use services and an


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Alzheimer's Society caf each month.


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About CQC inspections

We are the regulator of health and social care in England.

All providers of regulated health and social care services have a legal responsibility to

make sure they are meeting essential standards of quality and safety. These are thestandards everyone should be able to expect when they receive care.

The essential standards are described in the Health and Social Care Act 2008 (RegulatedActivities) Regulations 2010 and the Care Quality Commission (Registration) Regulations2009. We regulate against these standards, which we sometimes describe as "governmentstandards".

We carry out unannounced inspections of all care homes, acute hospitals and domiciliarycare services in England at least once a year to judge whether or not the essentialstandards are being met. We carry out inspections of dentists and other services at least

once every two years. All of our inspections are unannounced unless there is a goodreason to let the provider know we are coming.

There are 16 essential standards that relate most directly to the quality and safety of careand these are grouped into five key areas. When we inspect we could check all or part ofany of the 16 standards at any time depending on the individual circumstances of theservice. Because of this we often check different standards at different times but wealways inspect at least one standard from each of the five key areas every year. We maycheck fewer key areas in the case of dentists and some other services.

When we inspect, we always visit and we do things like observe how people are cared for,

and we talk to people who use the service, to their carers and to staff. We also reviewinformation we have gathered about the provider, check the service's records and checkwhether the right systems and processes are in place.

We focus on whether or not the provider is meeting the standards and we are guided bywhether people are experiencing the outcomes they should be able to expect when thestandards are being met. By outcomes we mean the impact care has on the health, safetyand welfare of people who use the service, and the experience they have whilst receivingit.

Our inspectors judge if any action is required by the provider of the service to improve thestandard of care being provided. Where providers are non-compliant with the regulations,we take enforcement action against them. If we require a service to take action, or if wetake enforcement action, we re-inspect it before its next routine inspection was due. Thiscould mean we re-inspect a service several times in one year. We also might decide to re-inspect a service if new concerns emerge about it before the next routine inspection.

In between inspections we continually monitor information we have about providers. Theinformation comes from the public, the provider, other organisations, and from careworkers.

You can tell us about your experience of this provider on our website.


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How we define our judgements

The following pages show our findings and regulatory judgement for each essential

standard or part of the standard that we inspected. Our judgements are based on theongoing review and analysis of the information gathered by CQC about this provider andthe evidence collected during this inspection.

We reach one of the following judgements for each essential standard inspected.

Met this standard This means that the standard was being met in that theprovider was compliant with the regulation. If we find thatstandards were met, we take no regulatory action but wemay make comments that may be useful to the provider andto the public about minor improvements that could be made.

Action needed This means that the standard was not being met in that theprovider was non-compliant with the regulation.We may have set a compliance action requiring the providerto produce a report setting out how and by when changeswill be made to make sure they comply with the standard.We monitor the implementation of action plans in thesereports and, if necessary, take further action.We may have identified a breach of a regulation which ismore serious, and we will make sure action is taken. We willreport on this when it is complete.

Enforcementaction taken

If the breach of the regulation was more serious, or therehave been several or continual breaches, we have a range ofactions we take using the criminal and/or civil procedures inthe Health and Social Care Act 2008 and relevantregulations. These enforcement powers include issuing awarning notice; restricting or suspending the services aprovider can offer, or the number of people it can care for;issuing fines and formal cautions; in extreme cases,cancelling a provider or managers registration or prosecutinga manager or provider. These enforcement powers are setout in law and mean that we can take swift, targeted actionwhere services are failing people.


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How we define our judgements (continued)

Where we find non-compliance with a regulation (or part of a regulation), we state which

part of the regulation has been breached. We make a judgement about the level of impacton people who use the service (and others, if appropriate to the regulation) from thebreach. This could be a minor, moderate or major impact.

Minor impact people who use the service experienced poor care that had an impact ontheir health, safety or welfare or there was a risk of this happening. The impact was notsignificant and the matter could be managed or resolved quickly.

Moderate impact people who use the service experienced poor care that had a

significant effect on their health, safety or welfare or there was a risk of this happening.The matter may need to be resolved quickly.

Major impact people who use the service experienced poor care that had a seriouscurrent or long term impact on their health, safety and welfare, or there was a risk of thishappening. The matter needs to be resolved quickly

We decide the most appropriate action to take to ensure that the necessary changes aremade. We always follow up to check whether action has been taken to meet thestandards.


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Glossary of terms we use in this report

Essential standard

The essential standards of quality and safety are described in our Guidance aboutcompliance: Essential standards of quality and safety. They consist of a significant numberof the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and theCare Quality Commission (Registration) Regulations 2009. These regulations describe theessential standards of quality and safety that people who use health and adult social careservices have a right to expect. A full list of the standards can be found within theGuidance about compliance. The 16 essential standards are:

Respecting and involving people who use services - Outcome 1 (Regulation 17)

Consent to care and treatment - Outcome 2 (Regulation 18)

Care and welfare of people who use services - Outcome 4 (Regulation 9)

Meeting Nutritional Needs - Outcome 5 (Regulation 14)

Cooperating with other providers - Outcome 6 (Regulation 24)

Safeguarding people who use services from abuse - Outcome 7 (Regulation 11)

Cleanliness and infection control - Outcome 8 (Regulation 12)

Management of medicines - Outcome 9 (Regulation 13)

Safety and suitability of premises - Outcome 10 (Regulation 15)

Safety, availability and suitability of equipment - Outcome 11 (Regulation 16)

Requirements relating to workers - Outcome 12 (Regulation 21)

Staffing - Outcome 13 (Regulation 22)

Supporting Staff - Outcome 14 (Regulation 23)

Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10)

Complaints - Outcome 17 (Regulation 19)

Records - Outcome 21 (Regulation 20)

Regulated activity

These are prescribed activities related to care and treatment that require registration withCQC. These are set out in legislation, and reflect the services provided.


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Glossary of terms we use in this report (continued)

(Registered) Provider

There are several legal terms relating to the providers of services. These includeregistered person, service provider and registered manager. The term 'provider' meansanyone with a legal responsibility for ensuring that the requirements of the law are carriedout. On our website we often refer to providers as a 'service'.

Regulations

We regulate against the Health and Social Care Act 2008 (Regulated Activities)Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009.

Responsive inspection

This is carried out at any time in relation to identified concerns.

Routine inspection

This is planned and could occur at any time. We sometimes describe this as a scheduledinspection.

Themed inspection

This is targeted to look at specific standards, sectors or types of care.


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| Inspection Report | Belong Crewe Care Village | March 2013 www cqc org uk 18

Contact us

Phone: 03000 616161

Email: [email protected]

Write to usat:

Care Quality CommissionCitygateGallowgateNewcastle upon TyneNE1 4PA

Website: www.cqc.org.uk

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belong crewe care village inspection report march 2013

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