Archived: Valewood House Nursing Home

We carried out an unannounced comprehensive inspection of this service on 24 November 2014. Breaches of legal requirements were found in ten areas. We took enforcement action in two of these areas; staffing and assessing and monitoring the quality of service provision. Warning notices were issued to be met by 30 January 2015. As a result we undertook a focused inspection on 5 February 2015 to follow up on whether action had been taken to deal with the breaches in these two areas.

You can read a summary of our findings from both inspections below.

Comprehensive Inspection of 24 November 2014

The inspection took place on 24 November 2014 and was unannounced.

Valewood House Nursing Home provides care and nursing support to adults and older people who have a range of physical and mental health needs, and people living with dementia. The home is registered to accommodate 40 people, with some bedrooms as shared occupancy. At the time of our visit, there were 36 people in residence who ranged in age from 43 to 101 years old. There are two main communal areas, known as the lounge and the cottage lounge. In addition to the main premises, there is a rehabilitation area where people are able develop skills such as cooking. The home has a no-alcohol policy which people are required to sign up to before moving in. The home is in a rural setting accessed by a country lane.

The service has a registered manager. 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 manager did not have the support of a dedicated deputy manager or administrative support. We observed that the manager was active in supporting people and in liaising with healthcare professionals in relation to their needs. This left little time for clinical oversight and quality assurance. As a result, areas of practice such as medication were not reviewed by the manager. Where issues had been identified these had been discussed with staff but there no evidence of follow-up. Quality assurance processes were not effective in identifying concerns or implementing and sustaining positive changes in the way the service was run.

There were not enough staff employed to ensure the safe running of the service. In addition to the registered manager, the service employed one nurse and had been unable to recruit additional qualified staff. This meant that there was a high use of agency nursing staff. Furthermore, we found examples of shifts where the number of staff on duty was lower than the intended number.

The lack of staff had an impact on all areas of the service. We observed that staff were rushed and had little time to spend with people outside of delivering care to them. People told us that they felt lonely and that they were not able to get attention from staff when they needed assistance. One person said, “I don’t feel happy here, the staff don’t have time”. We found that parts of the home were dirty. There were not enough cleaning staff to ensure that people’s bedrooms were attended to on a regular basis. Medicines were not handled safely and records of the medicines administered contained gaps.

Staff had a caring attitude but pressures on their time meant that much of the support they delivered was task-based. They did not pick up on situations that compromised people’s dignity or notice when people were anxious and required reassurance. One relative had commented in a survey, ‘The staff are very helpful but they do seem to be busy a lot of the time’.

Some people felt unsafe because of the behaviour of others who lived at the home. Staff were not always available to intervene and keep people safe. The manager had not reported safeguarding incidents and there was no information for staff to describe the action they should take if they were worried someone had been abused or was at risk of harm.

The manager knew people well and was able to discuss their support needs in detail. It was clear that they cared about the people in residence. People had access to healthcare professionals, such as the GP, dentist and optician. We found examples of good care and a quick responses to changes in people’s needs. We found, however, that this was not consistent. People could not be assured that their care needs would be met.

There was a core team of staff who knew people well and understood their needs and wishes. One relative said, ‘I have always found the staff to be lovely, caring people’. We found, however, that records relating to people’s care lacked detail. Where risks had been identified, assessments were not always complete and support was not reviewed after incidents to ensure that it still met with people’s needs and protected them from harm. Records relating to the monitoring of people’s needs, such as repositioning, weight and fluid records had not been used effectively. There was a risk that people’s needs would not be met and that changes in their health may not be quickly identified.

There was no system to check the competency of staff or the effectiveness of the training that staff received. We recommend that the manager reviews the induction and training processes to ensure that staff are equipped with the skills to deliver care to an appropriate standard, and prepared for the launch of the Care Certificate in 2015.

People were involved in day to day decisions relating to their care, such as on what they wished to eat and where they preferred to spend their time but did not feel involved in planning their support. Where people lacked the capacity to consent to decisions relating to their care or treatment, the manager was unable to demonstrate that best interest decision making procedures had been followed.

People did not always feel listened to. There were examples of personalised care but this was not consistent. People enjoyed the activities on offer but told us that they had a lot of time with nothing to do. We recommend that that manager considers a structured approach to gathering people’s views to ensure that they have regular opportunities to share concerns or ideas.

People and their relatives told us that they knew how to complain. Where complaints had been received, these had been thoroughly investigated and responded to. We recommend that the complaints procedure is made more readily available to people and visitors. The manager had recently requested feedback from relatives and professionals regarding the service. The feedback was mostly positive. One relative commented, ‘I have been impressed by their ability to cope with my mother and meet her needs when so many other facilities have failed’. A mental health professional wrote, ‘Valewood has been instrumental in improving this client’s holistic well-being and quality of life’.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of the report.

Focused Inspection of 5 February 2015

We undertook a focused inspection to check that the provider had taken action to meet the legal requirements in relation to staffing and quality assurance and the warning notices that we had issued. We found that the warning notices had been met and that the provider was meeting legal requirements. We also observed improvements in the cleanliness of the home and found that the breach in relation to infection control had been met.

Since our last inspection staffing levels in the home had increased. There were additional nursing, care, activities and cleaning staff working each day. This had led to improvements in people’s care, a happier and calmer atmosphere in the home and increased time for the registered manager to dedicate to management tasks. People and staff spoke of improvements. The deputy manager explained, “The care plans are more effective. The residents get more attention and they have more to do; we have a dedicated activity coordinator now”. A relative told us, “We visit different times, morning, noon and night and always unannounced and never have concerns about staffing levels. [Our relative] always looks clean and looks calm and happy. His room is always immaculate and warm. His finger nails are cut. Staffing is not an issue. He gets help when needed. Staff all appear kind. We have no concerns”.

The registered manager had reviewed staffing allocations and, together with the staff team, had produced detailed roles and responsibilities. Staff were clear on what was expected of them and there was a clear system in place to check that all necessary tasks had been completed. There were daily, weekly and monthly checks to monitor and assess the quality of the service delivered. Where improvements were identified, action plans were put in place to ensure that changes were made. The registered manager said, “Now I’m not going to do jobs myself, I’m dedicating my time to checking and giving advice”.

There was a noticeable improvement in the cleanliness of the home and especially of people’s bedrooms. The laundry room had been refurbished to make it easier to clean and to promote good infection control.

The improvements in staffing and quality assurance had delivered benefits in other aspects of the service. For example medicines audits indicated improvements in the way that ‘as required’ medicines were recorded. The provider has submitted an action plan detailing how and by when they will meet the regulations in relation to the management of medicines and other areas where we identified breaches. We will return again to check that they have followed their plan and to confirm that they meet the legal requirements.

The inspection took place on 24 November 2014 and was unannounced.

Valewood House Nursing Home provides care and nursing support to adults and older people who have a range of physical and mental health needs, and people living with dementia. The home is registered to accommodate 40 people, with some bedrooms as shared occupancy. At the time of our visit, there were 36 people in residence who ranged in age from 43 to 101 years old. There are two main communal areas, known as the lounge and the cottage lounge. In addition to the main premises, there is a rehabilitation area where people are able develop skills such as cooking. The home has a no-alcohol policy which people are required to sign up to before moving in. The home is in a rural setting accessed by a country lane.

The service has a registered manager. 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 manager did not have the support of a dedicated deputy manager or administrative support. We observed that the manager was active in supporting people and in liaising with healthcare professionals in relation to their needs. This left little time for clinical oversight and quality assurance. As a result, areas of practice such as medication were not reviewed by the manager. Where issues had been identified these had been discussed with staff but there no evidence of follow-up. Quality assurance processes were not effective in identifying concerns or implementing and sustaining positive changes in the way the service was run.

There were not enough staff employed to ensure the safe running of the service. In addition to the registered manager, the service employed one nurse and had been unable to recruit additional qualified staff. This meant that there was a high use of agency nursing staff. Furthermore, we found examples of shifts where the number of staff on duty was lower than the intended number.

The lack of staff had an impact on all areas of the service. We observed that staff were rushed and had little time to spend with people outside of delivering care to them. People told us that they felt lonely and that they were not able to get attention from staff when they needed assistance. One person said, “I don’t feel happy here, the staff don’t have time”. We found that parts of the home were dirty. There were not enough cleaning staff to ensure that people’s bedrooms were attended to on a regular basis. Medicines were not handled safely and records of the medicines administered contained gaps.

Staff had a caring attitude but pressures on their time meant that much of the support they delivered was task-based. They did not pick up on situations that compromised people’s dignity or notice when people were anxious and required reassurance. One relative had commented in a survey, ‘The staff are very helpful but they do seem to be busy a lot of the time’.

Some people felt unsafe because of the behaviour of others who lived at the home. Staff were not always available to intervene and keep people safe. The manager had not reported safeguarding incidents and there was no information for staff to describe the action they should take if they were worried someone had been abused or was at risk of harm.

The manager knew people well and was able to discuss their support needs in detail. It was clear that they cared about the people in residence. People had access to healthcare professionals, such as the GP, dentist and optician. We found examples of good care and a quick responses to changes in people’s needs. We found, however, that this was not consistent. People could not be assured that their care needs would be met.

There was a core team of staff who knew people well and understood their needs and wishes. One relative said, ‘I have always found the staff to be lovely, caring people’. We found, however, that records relating to people’s care lacked detail. Where risks had been identified, assessments were not always complete and support was not reviewed after incidents to ensure that it still met with people’s needs and protected them from harm. Records relating to the monitoring of people’s needs, such as repositioning, weight and fluid records had not been used effectively. There was a risk that people’s needs would not be met and that changes in their health may not be quickly identified.

There was no system to check the competency of staff or the effectiveness of the training that staff received. We recommend that the manager reviews the induction and training processes to ensure that staff are equipped with the skills to deliver care to an appropriate standard, and prepared for the launch of the Care Certificate in 2015.

People were involved in day to day decisions relating to their care, such as on what they wished to eat and where they preferred to spend their time but did not feel involved in planning their support. Where people lacked the capacity to consent to decisions relating to their care or treatment, the manager was unable to demonstrate that best interest decision making procedures had been followed.

People did not always feel listened to. There were examples of personalised care but this was not consistent. People enjoyed the activities on offer but told us that they had a lot of time with nothing to do. We recommend that that manager considers a structured approach to gathering people’s views to ensure that they have regular opportunities to share concerns or ideas.

People and their relatives told us that they knew how to complain. Where complaints had been received, these had been thoroughly investigated and responded to. We recommend that the complaints procedure is made more readily available to people and visitors. The manager had recently requested feedback from relatives and professionals regarding the service. The feedback was mostly positive. One relative commented, ‘I have been impressed by their ability to cope with my mother and meet her needs when so many other facilities have failed’. A mental health professional wrote, ‘Valewood has been instrumental in improving this client’s holistic well-being and quality of life’.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of the report.