Archived: Valley View Residential Care Home

Updated 30 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 17 and 18 July 2017. The first day of inspection was unannounced. The second day was announced. This meant the provider knew we would be coming.

On 17 July 2017 the inspection was carried out by two inspectors. On 18 July 2017 the inspection was carried out by one inspector, a pharmacist inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed the information we held about the home. This included the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally required to let us know about. We also had contact with the local authority commissioners of the service and the clinical commissioning group (CCG). During the inspection we spoke with a GP, two district nurses and an external vocational training assessor.

We did not ask the provider to complete a provider information return (PIR) prior to the inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We spoke with eight people who used the service and nine relatives. We also spoke with the acting manager, the provider’s representative, a senior care worker, a team leader, seven care workers and a member of domestic staff. We looked at a range of records which included the care records for five people, medicines records, recruitment records for five care workers and other records relating to the management, quality and safety of the service.

Updated 30 January 2019

The inspection took place on 17 and 18 July 2017 and was unannounced. We last inspected the home in February 2017 and found the provider was breaching the regulations in relation to safe care and treatment; meeting nutritional needs; good governance and staffing. Following the inspection we issued warning notices for the breaches of regulation relating to staffing and good governance and requirement notices for the other breaches. The home was rated inadequate and placed in ‘special measures’. The provider did not submit an action plan in line with legal requirements following our inspection in February 2017 to show how they planned to meet the regulations. During this inspection we found the provider continued to breach the regulations in relation to safe care and treatment and good governance.

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.