Archived: Valley View Residential Care Home

Valley View Residential Care Home is registered to provide accommodation for people who need personal care. It provides a service primarily for older people, including people living with dementia. There were 27 people living there at the time of this inspection.

The home did not have a registered manager. The deputy manager had taken up the post of acting manager with support from an external consultant. 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.

Due to a lack of management oversight at the home progress towards improving the service and meeting the regulation had been delayed. The provider had only just developed a comprehensive improvement plan for the home with most actions not yet commenced.

Quality audits were not completed regularly or consistently such as bedroom and kitchen audits and monthly checks of airflow mattresses and pressure prevention cushions had not been completed since March 2017. Medicines audits lacked scope and detail and not been effective. A new medicines policy was not specific to the home or fit for purpose. Safeguarding concerns, incidents and accidents were not monitored or analysed.

Medicines were not always managed safely. We found shortfalls with the storage and recording of medicines.

Medicines care plans were not in place to guide staff as to people’s support requirements to ensure people received their medicines as prescribed.

People, relatives and staff told us the home was safe.

Staff showed a good understanding of safeguarding adults and the provider’s whistle blowing procedure. They knew how to raise concerns but told us there hadn’t needed to.

There were sufficient staff deployed when we inspected the home. This was confirmed from feedback we received from people, relatives and staff and from our own observations. The provider had effective recruitment checks in place. Pre-employment checks were carried out to ensure new staff were suitable to work at the home.

There were regular health and safety checks in place to help keep the premises safe, such as checks of fire safety check; hot water temperatures, emergency lighting, gas and electrical safety. We observed that staff used equipment such as moving and handling equipment correctly.

Where potential risks had been identified, a risk assessment had been carried out. Risk assessments had been completed for a range of areas such as moving and handling, falls, malnutrition and pressure ulcers.

People and relatives were happy with the care they received and the staff providing it. We found a small number of times when staff weren’t as attentive to people’s needs as they should be.

Staff confirmed they felt supported, however formal one to one supervisions and appraisals were not being completed. Staff were undertaking training and apprenticeship programmes to develop the skills and knowledge they need in their role. This was on-going when we inspected with some training such as moving and handling having been completed in full.

People received the care and support they needed to ensure their nutritional needs were met. People and relatives gave mostly positive feedback about the meals at the home. Where people needed assistance or specialist equipment this was provided. Accurate diet and fluid records were kept for each person.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not always support this practice. Information relating to whether people had appointed a lasting power of attorney (LPA) was not available.

People were supported to access health care services when required. They was regular input into the home from community health professionals, such as GPs, community nurses, occupational therapy, speech and language therapy and physiotherapy.

Work had commenced to make the environment more ‘dementia friendly.’ However, this required further development. People living with dementia on the first floor of the home had limited space available to move around and were restricted as to the areas of the home they could access.

There was currently no activity co-ordinator employed at the home. Most activities were based around group activities. Where specific activities were identified as being suitable for individual people, these were not usually available. During the two days of our inspection there were some activities provided, such as bingo, time in the garden and reminiscence. People and relatives had mixed views about the availability of activities.

Care plans were in place and were based on people’s needs and preferences. Some care plans had been re-written for priority areas such as nutrition and moving and handling. Other care plans required updating.

Opportunities for people and relatives to give their views required further development. Relatives told us meetings did not take place very often. Relatives, staff and health and social care professionals gave positive feedback about the acting manager.

Relatives' surveys had been carried out with positive feedback given. However, the views of people using the service had not yet been gathered.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Requires improvement' and the service remains in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Valley View is registered to provide accommodation for people who need personal care. It provides a service primarily for older people, including people with dementia. There were 35 people living there at the time of this inspection.

There was a registered manager who had been in post since 2010. 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 registered manager had not always notified the CQC of all incidents as required. Six safeguarding alerts had been raised with the local authority but notifications had not been submitted as required to the CQC where possible harm occurred.

People, staff, external professionals and our observations told us that staff were not always able to respond quickly and consistently to people’s need for support. People’s care plans were not always updated promptly with any changes to their support needs.

Routine checks of the service’s safety had not always been completed consistently nor had they identified the issues we found at inspection. Records of people’s care did not demonstrate that people were receiving the support they required. People’s personal care and support records were not being used to consistently support people’s wellbeing.

People’s medicines were not safely managed. There had been a number of concerns raised about gaps in recording and failing to have adequate supplies of medicines.

Most people, relatives, staff and external professionals we spoke with told us there were not enough staff to meet people’s needs. Sufficient staff were not in place to support people throughout the day and night and to maintain accurate records. We had previously recommended the provider use a suitable staffing calculation tool and this had not been acted upon.

Staff were not properly trained and supported to meet people’s needs. Staff were overdue essential training. Staff were not receiving regular supervision or appraisal of their future development needs.

The service did not always records best interests decisions in line with the principles of the Mental Capacity Act. We have made a recommendation to improve how this is recorded in future.

People were not always supported to maintain a suitable food and fluid intake, recording of intake was inconsistent and not in line with people’s needs. Due to limited staffing people told us they missed meals or were not supported to avoid malnutrition or de-hydration.

Staff were aware of people’s choices and how they preferred to be cared for. Where decisions had to be made about people’s care, they and their families were not always involved and consulted as part of the process. It was not always recorded how people’s consent had been agreed.

Staff were caring and valued the people they worked with. However staff told us they did not have ‘time to care’ due to limited staffing in place to meet people’s needs. Staff told us they missed breaks to support people and each other, but had negative feelings about how well they supported people as individuals.

The service supported people to access appropriate external healthcare services so the staff could keep them safe and well. External healthcare professionals expressed concerns about the services capacity to manage people’s needs.

The service did not have any regular and consistent activity or stimulation for people using the service. Staff told us they did not have time or resources to support people to take part in interest’s or activity to prevent isolation or boredom. We have made a recommendation to improve the activities on offer to people.

The action plan submitted by the provider after our last inspection had not been acted upon robustly. The service had failed to make the changes required to improve the service and had failed to identify or act on a number of the issues we found at inspection. The registered manager was not seen as effective or visible in the service.

We found breaches of regulation in safe care and treatment around checks of the service and managing people’s medicines. In nutrition and hydration ensuring people ate and drank enough. For the governance and leadership of the service and ensuring staffing arrangements and support to staff were robust. Please see details in the main body of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During the inspection five key questions were answered; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

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

Is the service safe?

All the people told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. One person told us, 'Everything is fine here. If I need anything the staff will come, I feel I am looked after here.' All the relatives told us they felt people were safe and well looked after. They told us they would not hesitate to report any abuse and told us they had no issues or concerns.

We spoke with staff about Deprivation of Liberty Safeguards (DoLS). The registered manager told us there had been no applications and showed us the policy and procedures they followed. They told us staff had received relevant training and had access to the policy and procedures.

We saw the service was safe, clean and hygienic. The home had an effective infection control system. Equipment was well maintained and serviced regularly, so preventing any unnecessary risks. All the staff told us how they worked to prevent infection and told us how they would manage an outbreak at the home so the risk of infection spreading could be reduced.

Is the service effective?

People explained how their care and welfare needs were met. One person told us, 'I've really improved in the home. They have really looked after me. I am walking now; I have come on leaps and bounds.' Another person told us, 'Generally speaking it's not bad. They have got to get you moving. The staff has helped me with my walking; I have a walking frame now which really helps.'

One relative told us, 'I am absolutely delighted with the care. My mother did not settle at first. I was worried she would not be able to stay. They staff put in a special plan to support her, I can't believe the difference. It has worked and she has settled.'

Is the service caring?

We saw staff communicated well with people and were able to explain things in a way which could be easily understood. We saw they did not rush people in the home and we saw the interactions were caring. All the relatives we spoke with said they felt the care was very good. One relative told us, 'It's brilliant. I find all the staff are good. I feel I can talk to them about anything and they will help.'

We saw people were treated with respect and dignity by the staff. We saw people were given choice in their care and all the relatives we spoke to told us they were very happy with the care. All the people we spoke with also told us they were happy with the care and support they received.

Is the service responsive?

All the people told us they were very happy with the service. One told us, 'I like this quiet room, it's nice and relaxing. It I want anything I just call the staff. They are good you know.' People told us if they were not well or needed support during the night the staff had responded straightaway. We saw staff responded to people's requests for help in a timely way.

Some of the people we spoke with told us they were involved in decisions about their care. They told us the staff were flexible and responded to their requests at times they had asked, for instance, in their rooms when they had pressed the buzzer for assistance or personal care tasks.

We saw there was a complaints policy at the home. People told us they found the registered manager very approachable and would not hesitate to raise any issues or complain.

People's care needs had been reviewed at least every six months. We saw when people's requirements had changed the provider had responded and reviewed their care needs so they could meet their changed support requirements. A doctor who visited the home every week told us, 'I have no concerns whatsoever about the home. We hold special meetings here every week with the manager. If people need a doctor we will see them. The arrangement works really well. In fact, it's great to come to this home.'

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service well-led?

We spoke with the registered manager. They showed us there was an effective system to regularly assess the quality of service people received. We found the views and opinions of people using the service and their carers, family and relatives were also regularly recorded. The manager showed us activities had been arranged in response to the views and opinions they had received.

We saw the home had systems in place to make sure managers and staff learnt from any accidents, complaints, whistleblowing or investigations. This reduced the risks to people and helped the service to continually improve.

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

We found the provider had also taken steps to improve staff recruitment processes. We saw that robust checks were in place before people were offered a job. This ensured they had taken reasonable measures to reduce the risk of unsuitable staff being employed.

We found the provider had taken measures to improve medicine management arrangements. This was because they had implemented regular competency checks of staff practice and received medicine supplies from an alternative pharmacist who could provide a greater level of support to the home's staff.

People received the care they needed. People said they were happy with the care received. One person remarked; 'We get well fed and well looked after.' Another person said; 'It's a happy home.'

We observed people being cared for with compassion, dignity and respect. Staff were busy, but well organised. There was a calm and relaxed atmosphere. We observed some help with manual handling did not accord with current good practice.

Equipment was available on both floors to help meet people's care needs. An electric 'stand aid' was purchased during our inspection, with another one ordered. We found equipment had been serviced to keep it safe.

People told us they were happy with the staff who worked with them. One person stated, 'The staff are very good, they're good workers, they're good to us.' Another comment was, 'The staff are wonderful.' A visiting relative we spoke with made similarly positive comments. We found pre employment references were not in place for one worker.

People told us they knew how to complain and were confident any concerns they might have would be looked into and addressed. We checked relevant records and found complaints were acknowledged, investigated and responded to.