Valley Lodge Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed 5 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. We identified breaches of regulations relating to safeguarding and safe care and treatment. The provider did not have effective systems to prevent or investigate allegations of abuse, or ensure legal authorisation was sought when people were deprived of their liberty. Risks to people were not always assessed or action taken to mitigate these risks in the least restrictive way. Medicines were not always managed safely. Staff did not always receive training or competency checks to ensure they could safely meet the needs of people living at the home. The home appeared clean, staff could tell us about checks they completed before using equipment to ensure its safety and we observed safe moving and handling practices.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s feedback about their feeling safe was varied. One person told us they felt they needed to keep their bedroom door locked because another person living at the home, unclothed, had tried to enter their room. Another person told us they asked to keep their bedroom door locked because they were concerned another person living at the home would enter and hit them. However, another person told us they felt safe. A provider feedback survey that people were supported by staff to complete, showed most people felt safe.

Most staff had received safeguarding training and could provide examples of different types of abuse, who they would report a concern to and how. However, we found they did not always record or report incidents and potential safeguarding concerns. Therefore, we could not be assured any training and knowledge was being applied.

We saw that people appeared to feel comfortable around staff.

When people were deprived of their liberty, appropriate legal authorisations were not always applied for or followed up on. When applications were made, they did not always contain accurate information. For example, a person’s application stated they had not made any meaningful attempts to leave the home. However, the person frequently asked to leave and had attempted to do so on multiple occasions.

We received mixed feedback from people’s relatives. Some felt involved in their loved one’s risk assessments and care planning, but others did not. A relative shared concerns about how their loved one was supported in relation to their risk of falls. One person spoke positively about how they work with staff to manage risks relating to a health condition.

Staff did not always know when people were at risk of choking, if they needed a modified diet or what foods and textures could pose a risk to individuals. When staff gave examples of measures in place to reduce risk, these were not always person-centred or proportionate. For example, a staff member told us, “[Person] was found to be throwing food down the toilet. So now [person] has to be in the dining room or if [person] doesn’t want to, [they] will be served last and staff will sit in the room with [them] to make sure [they’re] eating”. However, staff were able to explain how they supported people to manage other risks, such as falls.

During our second site visit, after we had previously raised concerns about choking, an inspector was required to prompt staff who were serving 2 people meals that were not prepared safely, in line with their texture requirements. The concerns were immediately raised with the registered manager again, who took action to address this and reduce the risk. We observed staff support people to stand and transfer safely, using appropriate moving and handling techniques. We also saw staff support people to mobilise in line with their assessed needs, for example walking with them and prompting to use mobility aids.

Risk assessments and care plans were not always person-centred, lacked detail and sometimes contained conflicting information. For example, there was limited information to guide staff on how to safely support a person when they were distressed to reduce the risk they could pose to themselves or others. Another person had 2 diabetes care plans which contained conflicting information about when staff should seek medical advice. However, we did see some examples of risk assessments that contained more detail. The provider told us they knew this was an area of concern and were working to make improvements.

Most feedback about the environment from people and their relatives was positive. Comments in a provider feedback survey completed by people’s relatives included, “It seems to be a safe and comfortable environment” and “Tidy and well maintained”.

Staff told us how they checked equipment prior to supporting people to ensure it was safe for use.

We observed staff using moving and handling equipment safely. The home appeared clean and toilet doors were blue with signs to help people identify them. However, there was little other signage to help people navigate around the home, for example the lounge or garden.

Actions identified in environmental risk assessments were not always completed. This included actions relating to water safety and legionella, which were identified as a concern at our last inspection.

A person told us they felt there were enough staff. A provider feedback survey completed by people’s relatives included positive feedback about staff.

We received mixed feedback about staffing levels. Some staff felt there had previously been issues with staffing levels, but this had now improved. However, other staff felt there wasn’t always enough staff. A staff member told us, “I think it is a struggle at the moment… It’s alright when they’re [people who require 1 to 1 support] asleep, but when they’re awake they have to have a carer with them all the time so it does get busy”.

We observed multiple instances when up to 20 people were in the lounge and there were no staff present. Many people in the lounge at these times were assessed as at risk of falls or could at times become distressed and pose a risk to themselves or others. In addition, records showed a high number of falls and other incidents in the lounge were unwitnessed. Although on our first site visit there was staff training which meant there were less staff available for direct support, the registered manager told us they were still within their assessed safe staffing numbers.

Records showed staff did not receive sufficient training or competency checks to ensure they could safely meet the needs of people living at the home. For example, dementia and diabetes. The provider was unable to demonstrate staff who administered insulin had been trained, assessed as competent and delegated this task by a registered nurse as required. We raised this with the registered manager who confirmed this task would be passed back to the nurses until the relevant training and competencies could be confirmed. When there were concerns about performance, the provider did not implement robust performance plans to support staff development and improvement.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We could not collect sufficient evidence to score this evidence category.

Staff who administered medicines gave conflicting information and demonstrated a varied understanding about how to safely support people with their medicines. Although staff could tell us what process should be followed if an error was made, we did not see evidence of this happening in practice.

Processes did not always support safe medicines management. For example, when there were gaps in medicines administration records this was not always followed up. Records also showed when people refused their medicine, staff would attempt to administer again until up to 12 hours later. However, the service was unable to provide evidence that having less time between doses had been confirmed as safe with a pharmacist. Therefore, we could not be assured people always received their medicines as prescribed. Covert administration is when medicines are administered in a disguised format, without the person’s knowledge. Staff told us they could administer 4 people’s medicines covertly. However, processes had not been followed to ensure any decision to administer medicines covertly were completed in line with relevant legislation to ensure people’s rights were protected. This meant people were at risk of receiving their medicines without their knowledge or consent.