Valley Lodge Care Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed 2 quality statements from this key question. We have combined the score for this area with scores based on the rating from the last inspection, which was requires improvement. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack capacity to. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We found the service did not always support people in line with the MCA, and consent to care and treatment was not always sought in line with law and guidance. This was a breach of regulation.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from people’s relatives. Two people’s relatives shared concerns that they did not feel the service provided care that met their loved one’s needs. Another person’s relative felt they did. A person told us they had their own fridge and kettle to support maintaining their independence because this was important to them.

Conflicting information in care records was reflected in staff feedback. Although staff could tell us in detail how they supported people in line with people’s individual needs and wishes, the details were not always consistent across the staff team. For example, 3 staff members gave 3 conflicting accounts when describing how 1 person was supported in relation to a specific need.

Care plans and risk assessments were not always completed or updated following incidents or changes in needs, so did not always contain sufficient or up to date information. We saw some care plans that were detailed and showed people had been involved, but this was not consistent, and we did not always see evidence they were being followed in practice.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We could not collect sufficient evidence to score this evidence category. However, we saw on most occasions staff sought verbal consent from people before supporting them.

Most staff and management did not demonstrate a robust understanding of the MCA. Although staff told us they asked for consent and understood people’s right to refuse, we were not assured this was applied in practice. For example, staff told us they could administer some people’s medicines covertly if they refused, but processes had not been followed to ensure this was done lawfully. Another person repeatedly unplugged their sensor mat, blocked their bedroom door with a chair and shouted at staff when they attempted to complete night checks. The registered manager told us the person had capacity and had previously consented to the mat and checks. However, staff and the registered manager told us they continued to plug the sensor back in without consent and attempt 2 hourly checks, despite the person’s clear and repeated requests to stop. This meant the person’s right to withdraw consent at any time was not being upheld.

We saw consent forms signed on people’s behalf by staff who did not have the legal authority to do so. For example, to consent to CCTV, photographs for marketing purposes, accepting assistance with medicines and care assessments. When people had capacity to consent, consent forms had not always been signed. When decisions were made on people’s behalf, capacity assessments were not always completed in line with the MCA. We did not see evidence people were always supported, as far as possible, to make their own decisions. When capacity assessments were completed, best interest decision making processes were not followed to ensure any decisions made on people’s behalf was the least restrictive option. The registered manager advised they were aware this was an area of concern that was being worked on and was open to feedback. However, we received records dated after our visits when these concerns were raised that included consent signed by staff, and best interest decisions recorded for people who were assessed as having capacity to make their own decisions. We also found breaches of regulation in this area at our last 2 inspections.