The Village Care Home

We found the following examples of good practice.

• Systems were in place to help prevent people, staff and visitors from catching or spreading infection.

• The environment was clean. Additional cleaning was taking place, including of frequently touched surfaces.

• Staff wore appropriate PPE to safeguard people and themselves, and there were sufficient supplies available. Staff carried out regular checks to ensure the home always had enough PPE for staff to access. PPE stations were in situ around the home for ease of access to staff.

• Staff had undertaken training in putting on and taking off PPE and other COVID-19 related training.

• People and their relatives were supported to keep in contact using a range of technology as well as visits to the home.

• The provider supported people and staff to access recommended vaccinations.

• Infection risks to people and staff were assessed and managed.

People’s experience of using this service: People told us they received a good service and felt safe. Accidents and incidents were recorded, and risk assessments were in place. The registered manager understood their responsibilities about safeguarding and staff had been appropriately trained. Arrangements were in place for the safe administration of medicines.

There were enough staff on duty to meet the needs of people. The provider had an effective recruitment and selection procedure, and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People’s needs were assessed before they started using the service. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

The provider had a complaints procedure and people were aware of how to make a complaint. An effective quality assurance process was in place. People and staff were regularly consulted about the quality of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (published April 2018). Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-Led to at least good. At this inspection we found improvements had been made in all the areas identified at the previous inspection.

Why we inspected: This was a planned inspection. It was scheduled based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The Village Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Village Care Home provides personal care for up to 40 people. At the time of our inspection there were 38 people living at the home who received personal care, some of whom were living with dementia.

A registered manager was in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We last inspected this service on 8 and 13 December 2016 when it was rated 'Requires Improvement' overall. During this inspection, although we found further improvements had been made, some improvements were still needed so the rating remains 'Requires Improvement' overall.

At the last inspection we recommended that the provider continued to regularly assess the quality of the service provided and take action to continuously improve the service. During this inspection we found the provider had breached Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding good governance. This was because although we noted improvements in this area, premises issues we found during the inspection had not been identified by the provider.

At the last inspection we found the provider had breached Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding person centred care. This was because there were few design features in the home to support people who were living with dementia. During this inspection we found improvements had been made and further work was planned.

You can see what action we told the provider to take at the back of the full version of the report.

Although the premises were mostly clean and comfortable some areas of the service looked worn and needed renovating. A refurbishment programme was in place for the coming months to address this.

People we spoke with said they felt safe living at The Village Care Home and were happy with the staff that supported them. Staff had completed up to date training in safeguarding vulnerable adults and understood their responsibilities in this area.

Accidents and incidents were recorded accurately and analysed regularly. Each person had an up to date personal emergency evacuation plan should they need to be evacuated in the event of an emergency. Risks to people were identified and plans were in place to help manage and minimise risks.

Medicines were managed in a safe way and checks were made to ensure staff were competent to administer people's medicines. There were enough staff to meet people's needs promptly. The provider was proactive in increasing staffing levels when needed.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service. Identity and background checks had been completed which included references from previous employers and a Disclosure and Barring Service (DBS) check.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's nutritional needs were met and they enjoyed the food and drink they received. Food and fluid charts were completed accurately. People's day to day health needs were met.

Staff were provided with effective training, support and development opportunities to enable them to meet people's needs.

Each person who used the service was given information about how to make a complaint and how to access advocacy services. An advocate is someone who represents and acts on a person's behalf, and helps them make decisions.

Care plans were specific about people’s individual care needs and were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

People told us staff were kind and caring and staff treated them well. Staff knew how to support people in the way they needed and preferred. People were comfortable in the presence of staff. Staff recognised and promoted people’s diverse needs and understood the importance of treating people equally.

The provider employed an activities co-ordinator who arranged a variety of activities. People told us they enjoyed the range of activities on offer.

People and relatives we spoke with knew how to make a complaint. They told us they would speak to a member of staff or the registered manager if they had any issues.

People, relatives and staff spoke positively about the manager being approachable and supportive. People's feedback was sought regularly and acted upon. There was an emphasis on team work and communication sharing amongst the staff. There was a positive ethos at the service.

The Village Care Home is a residential home which provides personal care for up to 40 people. There were 26 people living there at the time of our inspection, some of whom were living with dementia.

The service had 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.

We last inspected the home on 29 March 2016 and found the provider had breached Regulations 17 (good governance) and 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection we issued a warning notice to the provider in relation to the breach of regulation 17. We asked the provider to submit an action plan setting out how they would become compliant with the breaches identified at the previous inspection.

At the last inspection we found that due to a lack of management oversight staff had not received regular one to one supervision with their line manager and some essential training was overdue for all staff. The registered provider did not have an appraisal system to support the development and performance of each staff member. Care plan audits were overdue and medicines audits were infrequent and ineffective in ensuring the safe management of medicines. Feedback from consultation with people and family members was not collated and analysed to ensure negative feedback was investigated. Opportunities for people or family members to give their views had lapsed. Actions identified following external quality audits had not been fully implemented to help keep people safe.

During this inspection we found the provider had made improvements in most of these areas. However, we found the provider had breached Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 person centred care. This was because the provider failed to act on our recommendation following the last inspection to consider current guidance on caring for people living with dementia and update their practice accordingly. We have made a recommendation about quality monitoring.

You can see what action we told the provider to take at the back of the full version of the report.

Cleaning schedules were not in place which meant we could not be sure the cleaning regime adequately protected people, visitors and staff from the risk of infection.

Menus were available in picture format but did not reflect the choices available during the days of our inspection. Fluid charts lacked detail and guidance for staff.

Appraisals had not been carried out since the last inspection in March 2016 but were planned for January 2017.

Medicine administration records (MARs) had been completed accurately, which meant people received their prescribed medicines when they needed them. Medicines that are liable to misuse, called controlled drugs, were stored appropriately. Records relating to controlled drugs had been completed accurately.

Staff understood their safeguarding responsibilities and told us they would have no hesitation in reporting any concerns about the safety or care of people who lived there. Staff said they felt confident the registered manager would deal with safeguarding concerns appropriately. Staff also understood the provider's whistle blowing procedure.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service. Identity and background checks had been completed which included references from previous employers and a Disclosure and Barring Service (DBS) check.

Risks to people's health and safety were recorded in care files. These included risk assessments about people’s individual care needs such as using specialist equipment, pressure damage and nutrition. Regular planned and preventative maintenance checks and repairs were carried out and other required inspections and services such as gas safety were up to date.

People and relatives told us there was enough staff to attend to people's needs. People’s needs were met in a timely manner.

The recording and analysis of accidents and incidents had improved since the last inspection. More detail was recorded and action following an accident or incident was evident.

Staff training in key areas had improved significantly. For example, staff had completed training in safeguarding vulnerable adults, moving and assisting, fire safety, first aid, end of life care and falls prevention. Staff told us training had improved and they felt supported by the management team. Staff told us the registered manager was approachable and they could speak to them at any time.

The provider followed the requirements of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been authorised for relevant people.

People spoke positively about the care they received. One person said, “Staff are kind and caring.” Another person told us, “It’s great here. The staff are fantastic and always make sure I’ve got everything I need.”

A relative said, “[Family member] receives good care and the staff try to keep them independent. I'm informed straight away if there are any issues.” Another relative told us, “[Family member] is very happy here. They are treated with dignity and respect.” Relatives said there was a homely atmosphere and they were always made to feel welcome when they visited.

Care records contained detailed information and guidance about how to support people based on their individual health needs and preferences. Care records were reviewed and updated regularly or when people's needs changed.

People we spoke with said they had no complaints about the home. People told us if they had any concerns they would speak to staff immediately. No formal complaints had been received.

Staff meetings were held regularly and staff told us they had enough opportunities to provide feedback about the service.

Feedback from people and relatives about the service had been sought and acted upon since the last inspection.

People, relatives and staff told us they felt the service was well-run by the registered manager. One person told us, "I can speak to the manager at any time." Another person said, “There’s a great atmosphere here.”

The Village Care Home provides residential care for up to 40 adults. At the time of our inspection there were 38 people living at the home.

The home had 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.

During this inspection we found the registered provider had breached regulations 17 and 18 of the Health and Social Care Act 2008. Due to a lack of management oversight staff had not received regular one to one supervision with their line manager and some essential training was overdue for all staff. The registered provider did not have an appraisal system to support the development and performance of each staff member. Care plan audits were overdue and medicines audits were infrequent and ineffective in ensuring the safe management of medicines. Feedback from consultation with people and family members was not collated and analysed to ensure negative feedback was investigated. Opportunities for people or family members to give their views had lapsed. Actions identified following external quality audits had not been fully implemented to help keep people safe.

You can see what action we told the provider to take at the back of the full version of the report.

People gave us positive feedback about the care they received at the home. One person described the home as “first class”.

People told us they were treated with dignity and respect by kind and caring staff who knew them well. One person commented, “Number one they take notice of you.” Another person said, “They [staff] treat us right.” A third person told us, “Staff are definitely respectful.”

People said they felt safe living at the home. One person said, “Safe, oh yes. They are very, very careful.” Another person commented, “Safe enough, yes.”

Medicines administration records and records for the receipt and disposal of medicines had been completed accurately. The date of opening had not been recorded on a small number of medicines and the temperature of the treatment room and medicines fridge were not recorded.

Staff had a good understanding of safeguarding adults and the registered provider’s whistle blowing procedure. Staff said concerns would be dealt with correctly. One staff member said, “[Registered manager] would deal with concerns straightaway.” Safeguarding concerns had been dealt with appropriately.

There were enough staff to meet people’s needs in a timely manner. The registered provider followed effective recruitment and selection procedures including requesting and receiving references and carrying out Disclosure and Barring Service (DBS) checks before new staff started their employment.

The registered provider had procedures in place to deal with emergency situations. Health and safety checks had been carried out to help keep the premises safe, including checks of fire safety, emergency lighting and specialist moving and assisting equipment. The registered provider was unable to produce evidence of a current and satisfactory five year electrical installation safety certificate.

The registered provider was acting in accordance with the Mental Capacity Act 2005 (MCA), including the Deprivation of Liberty Safeguards (DoLS). DoLS authorisations were in place for people who needed support at all times or supervision to go out. Staff showed a good understanding of how to support who lacked capacity to make decisions and choices. Staff sought consent from people before providing care and support.

People were supported to have enough to eat and drink. They gave us positive feedback about the meals provided at the home. One person told us, “The food is very good.”

Further improvements were required to the care and support of people living with dementia, such as ensuring the environment was dementia friendly, the provision of meaningful activity for people living with dementia and updating dementia awareness training. We have made a recommendation about this.

People had their needs assessed and the information was used to develop personalised care plans. Staff had gathered background information about each person they cared for including details of people’s preferences. Care plans had been updated as people’s needs changed.

Activities were provided for people to take part in. However, this was inconsistent and mainly when the activity co-ordinator was working. During our inspection we saw little evidence of organised activities taking place.

People did not raise any concerns with us about the care they received. People were provided with information about how to complain.

A relative told us they were confident their family member was being looked after. They told us they believed they received good care and that staff involved them in deciding how their care should be given. One person said 'You couldn't get better', and another said they were 'Tip top'.

We saw effective recruitment and selection processes for the staff to make sure people using the service were being supported by staff who were fit, appropriately qualified and physically and mentally able to do their job. The system for recruiting was robust and checks were carried out to ensure people were able to carry out their role safely.

Service users we spoke with were aware of how to make a complaint if they were not happy and they were all confident any problems would be resolved. One person said 'There's never anything wrong but if there was the manager would sort it out'.

Staff records and other records relevant to the management of the services were accurate and fit for purpose, including care records, staff records and records of checks carried out on the building and facilities which kept people safe.

We asked some of the people about their care and treatment. Most people we spoke with made positive comments about their care they were being provided with. One person told us 'I am going home today, but I can't praise them enough for the way they have looked after me' a relative commented 'My mother is thriving since she has moved into this home, she is eating, she has put weight on and she is much happier than she was'.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The people we spoke with told us they felt safe with their care workers and the care they were provided with. One person commented about their care workers, 'I do feel safe here'.