Archived: The Valleys Care Home

People’s experience of using this service: People did not always receive a service that provided them with safe care. The management of some people’s medicine was not safe. Staff did not consistently follow good infection prevention and control practices to maintain adequate standards of hygiene.

The provider used a range of audits to check quality and safety. There had not been consistent oversight to ensure all improvements were identified and made to the quality of the service people received. We recommend the provider implement a reliable and effective quality monitoring system.

Staff were safely recruited and enough staff were deployed to meet people’s needs. Staff had been trained to respond to safeguarding concerns. The registered manager was proactive investigating and responding to concerns to keep people safe. The service had taken action to address recommendations made.

A new electronic recording system for accidents and incidents had been put in place which showed action was taken to reduce risk when issues occurred. The management team were analysing the information to look for trends and patterns and there had been a reduction in the number of falls in recent months.

Care was planned around people’s choices and preferred routines. People and their relatives were supported to receive information in an accessible way to enable them to be involved in their care and support.

Staff were trained and their skills and knowledge checked through competency assessments. Staff worked closely with healthcare professionals and sought their advice, guidance and support on how to best meet people’s needs.

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 told us they felt safe and well cared for and staff afforded them respect and dignity. People were supported to maintain their independence and they accessed local facilities and activities.

Recent changes to the management of the home had been positive and resulted in better and consistent care being provided. Staff told us the registered manager was supportive and approachable. People knew the registered manager and told us they trusted them.

People and relatives had the opportunity to provide feedback about the service and there was a system to respond to any complaints.

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 Good (report published 8 February 2017).

Why we inspected: This inspection was brought forward in response to incidents that had occurred in the service and concerns that had been raised about the safety and management of the service. At the time of the inspection we were aware of incidents being investigated by another agency.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around safe care and treatment. Details of action we have asked the provider to take can be found at the end of this report.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

We undertook this comprehensive inspection on the 8 and 10 February 2017. At the last inspection on 18 and 19 May 2016 we found the registered provider was in breach of two of the regulations we assessed. We issued two requirement notices as some people were not provided with consistent person centred care and the application of the Mental Capacity Act 2005 (MCA) was inconsistently applied and the best practice principles of MCA regarding restrictions placed on people had not been followed for each person they applied to. We also wrote to the registered provider as we had not been notified of all incidents.

During this comprehensive inspection we found improvements had been made in three domains and have changed the rating for the domains ‘Effective’, ‘Responsive’ and ‘Well-led’ to Good. We have kept the rating for ‘Safe’ and ‘Caring’ as Good. The overall rating for the service has improved and changed to ‘Good’. At the time of the inspection there were a total of 57 people living in The Valleys Care Home and up to four people attended the service for day care support.

There was a registered manager in post. 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 found improvements in the quality of the care records. People had their needs assessed and detailed plans of care were developed which helped to guide staff in how to deliver individualised care to them in line with their preferences. They had been reviewed and updated on a regular basis.

We found the registered manager and staff better understood their responsibilities under MCA. They were aware of the need to gain consent when delivering care and support, and what to do if people lacked capacity to agree to it. People’s abilities to make decisions had been assessed and appropriate support had been provided to ensure that their views were taken into account when making decisions. Relatives and other professionals had been involved when important decisions about care had to be made.

We found the service was safe for people who lived there. Staff had received training in how to safeguard people from the risk of harm and abuse and knew how to raise any concerns. People had risk assessments which helped to guide staff in how to minimise risk whilst helping them to maintain their independence.

We saw people received their medicines as prescribed. Medicines were ordered in a timely way, stored safely and only administered by qualified nurses or staff who had completed training.

Staff were recruited safely and in sufficient numbers to ensure that people’s needs were met, however, the deployment of staff at lunchtime on Crosby unit could be improved to ensure people enjoyed a positive mealtime experience which the registered manager confirmed they would address.

Records showed us staff had access to training, support and supervision. This enabled staff to feel confident when supporting people and knowledgeable about meeting their needs.

People told us staff were kind and caring to them. We observed staff had developed good relationships with people who used the service and their relatives. People’s privacy and dignity were respected and confidentiality maintained. There were positive comments from relatives about the staff team. People who used the service and their relatives were provided with information on notice boards, in meetings and in newsletters. Personal records were stored securely.

There were activities for people to participate in and relatives told us they could visit at any time. We saw staff supported people who used the service to maintain relationships with their family.

People’s health and nutritional needs were met. We found staff contacted health professionals in a timely way for advice and treatment. The menus provided people with a varied and nutritional diet and any concerns about weight management or swallowing difficulties were discussed with dieticians and speech and language therapists. People told us they liked the meals. During the day, we observed people were served drinks and snacks between meals.

The environment had been adjusted to meet the needs of people living there. We found limited visual and sensory stimulation in the communal areas and some people’s bedrooms on the units which supported people who lived with dementia. The registered manager confirmed they were working with the estates team to improve the facilities, including the garden areas for people living with dementia.

The registered provider had a complaints procedure and people who used the service and their relatives felt able to raise concerns knowing they would be addressed.

We found improvements in the way the service was managed. Aspects of the quality monitoring system had been reviewed and strengthened, incidents were now reviewed and analysed each month with clear evidence of any action taken to protect people’s safety. We also found the standard of care records had improved through more robust auditing processes.

The service had a registered manager in post as required by a condition of registration. 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 undertook this unannounced inspection on the 18 and 19 May 2016. At the time of the inspection there were a total of 61 people living in The Valleys Care Home and four people receiving day care. At the last inspection on 9 February 2015, the registered provider was compliant with all areas assessed.

We found there was inconsistency regarding the application of the Mental Capacity Act 2005. The registered provider and registered manager had not always followed best practice regarding assessing people’s capacity and discussing and recording decisions made in their best interests. You can see what action we have asked the registered provider to take at the back of the full version of the report.

We found not everyone had a full and up to date care plan and risk assessment to guide staff in how to meet them in a person-centred way. You can see what action we have asked the registered provider to take at the back of the full version of the report.

We found the previous registered manager had not de-registered with the Care Quality Commission (CQC) even though they had left the service in 2014; their certificate was on display in the entrance and the current registered manager did not have their certificate on display. The registered manager is to address this as it is important correct registration details are displayed.

The CQC had not received all notifications for incidents which affected the safety and wellbeing of people who used the service as required by registration regulations. This had been a misunderstanding by the registered provider and registered manager and they told us they would forward all required notifications in future. We have written to the registered provider to remind them of their responsibilities in this area.

We found there was a quality assurance system in place which consisted of audits and seeking people’s views. The registered manager told us they would review some of the audits in place to make sure they were more robust and enabled an analysis of specific areas such as incidents between people who used the service.

We found people who used the service were protected from the risk of harm and abuse. Staff had received safeguarding training and knew what to do if they witnessed abuse or if it was disclosed to them. Staff knew what to do in cases of emergencies and each person who used the service had a personal evacuation plan.

We observed kind and caring approaches from the staff team. People’s privacy and dignity were respected and staff provided people with explanations and information so they could make choices about aspects of their lives. There were positive comments from relatives about the staff team. People who used the service and their relatives were provided with information on notice boards, in meetings and in newsletters. Personal records were stored securely.

We found people’s health care needs were met. Health professionals were contacted to ensure people received treatment and advice when required. People received their medicines as prescribed. Some recording issues and more robust guidance for staff when supporting people to take ‘when required’ medicines is being addressed by the registered manager.

People enjoyed the meals provided to them. The menus enabled people to have choice and special diets when required. We saw people’s weight, their nutritional intake and their ability to eat and drink safely was monitored and referrals to dieticians and speech and language therapists took place when required for treatment and advice. During the day, we observed people were served drinks and snacks between meals.

There were activities for people to participate in and relatives told us they could visit at any time. We saw staff supported people who used the service to maintain relationships with their family.

We found staff were recruited safely with appropriate employment checks carried out to ensure staff were suitable to work in care settings. New staff received an induction and all staff had access to training, supervision and support to ensure they felt confident when supporting people who used the service. We found there were sufficient staff on duty on each unit, however, the deployment of staff at lunchtime on Ashby unit could be improved to ensure people who used the service received appropriate support to eat their meal.

The registered provider had a complaints procedure on display. Relatives told us they would feel able to complain and any concerns would be looked into and addressed.

We found the service was clean and tidy. Staff had cleaning schedules, and equipment used within the service was maintained so it remained safe to use. The environment had been adjusted to meet the needs of people living there.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service and the staff who supported them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

' Is the service caring?

Staff were aware of people's preferences and diverse needs; care and support had been provided in accordance with people's wishes.

' Is the service responsive?

People received care according to their needs and wishes.

People's care plans were personalised and people had been involved in reviewing them to ensure they were still relevant.

' Is the service safe?

Staff had been recruited safely.

People were protected from the risk of infection because appropriate guidance had been followed.

' Is the service effective?

Staff were well trained and had the necessary skills to carry out their role. Staff had been trained in the safe administration and handling of medicines.

' Is the service well led?

The acting manager had introduced a new medicines stock control system to ensure people did not run out of medicines.

A new reporting system designed to ensure people received all of their medicines as prescribed had also been introduced.

You can see our judgements on the front page of this report.

We found that audits of medicines were completed but actions to address shortfalls had not always been implemented. We also found staff were not clear about when to report incidents to the manager. This meant that the quality monitoring process was not effective and there was limited opportunity for learning and improvement from incidents.

A visitor to the home told us, "I visit most days, the care is excellent, staff let me know about any issues. We had a review of the care plan two weeks ago, everything is fine."

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan and delivered in a way that was intended to ensure people's safety and welfare.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

There were effective systems in place to reduce the risk and spread of infection. We toured the premises and saw that the environment was being kept clean.

We looked at the systems in place for managing medicines in the home and found that there were shortfalls and poor practice in recording, administration and safe handling of medicines.

There was enough equipment to promote the independence and comfort of people who used the service.

Appropriate checks were undertaken before staff began work and effective recruitment processes were in place. One person told us, 'The staff are good.'

We found comments and complaints people made were not always responded to appropriately.

We found that people received care as planned and their care needs were met. A visitor told us their relative was well cared for and that staff understood their needs. Staff and visitors told us they felt that there were sufficient staff employed in the home to meet peoples needs. We found that care in one area of the home could be more individualised, the manager had identified this and had addressed working patterns to improve this area.

We found the home to be to be very clean, well maintained and free from unpleasant odours.