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Cole Valley Requires improvement

Reports


Inspection carried out on 6 August 2019

During a routine inspection

About the service

Cole Valley is a residential care home registered to provide personal and nursing care for up to 45 people. At the time of the inspection there were 19 people using the service; whom were mostly older people living with dementia.

People’s experience of using this service and what we found

People were not yet consistenly supported to have maximum choice and control of their lives. Staff were however supporting people in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice although record keeping needed to be improved in relation to the use of the Mental Capacity Act 2005 (MCA).

People were not yet fully involved in developing their care plans and making choices around how they spent their time. Leisure opportunities and the use of meaningful activities needed further improvement.

People were supported by a staff team who understood how to protect them from abuse. Staff also understood how to protect people from harm such as injury, accident and wounds. People’s medicines were managed safely although some improvement was still needed.

People were supported by sufficient numbers of staff to keep them safe. However, staff did not always have time to provide truly person-centred care. Staff were recruited safely.

People were supported by a staff team who were receiving appropriate training and received support from management.

People’s nutritional needs were met and special dietary needs were known and understood. People were supported to protect their health as far as reasonably possible.

People were supported by a staff team who were kind and caring although the quality of interactions with people was inconsistent. Some improvement was still needed to how people were treated with respect and how their dignity was protected.

The manager had developed a range of audits and quality assurance checks that were assisting with driving improvement within the service. The provider however continued to fail to ensure they understood the legal requirements and were completing appropriate checks against the compliance 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 (and update)

The last rating for this service was inadequate at the last inspection we completed in February 2019 (latest report published 09 May 2019) and there were multiple breaches of regulation. The service was rated as inadequate at the previous inspection completed in August 2018. Prior to this the service had been rated as requires improvement at inspections completed in 2017 and 2015.

This service was entered into Special Measures following our August 2018 inspection. During the most recent inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to person-centred care and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 19 February 2019

During a routine inspection

About the service: Cole Valley is a residential nursing home that provides accommodation and nursing care to up to 45 people. At the time of the inspection there were 24 older people living at the service, many of whom were living with dementia.

People’s experience of using this service:

• People were not protected from the risk of serious harm due to inadequate risk management processes within the service. People were also not sufficiently protected from the risk of abuse and mistreatment.

• People were exposed to the risk of harm due to unsafe recruitment practices. Insufficient pre-employment checks and risk assessment meant staff members who were unsuitable to work with vulnerable people could be recruited.

• People’s rights were not upheld with the effective use of the Mental Capacity Act 2005 (MCA). People were not always fully enabled to make choices and to fully participate in the development of their care and support plans.

• People were not always supported in a caring environment where their privacy, dignity and independence was respected and promoted.

• The provider had not ensured complaints were managed effectively. They had also not ensure people’s views were proactively sought and used to improve the safety and quality of care provided.

• The provider had failed to ensure that sufficient and effective management, quality assurance and monitoring systems in place. As a result, they were not aware of the widespread concerns we found during our inspection. They had not ensured the quality and safety of care was sufficiently monitored and that appropriate action was taken to protect people from the ongoing risk of harm.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

Rating at last inspection: At the last inspection completed on 20 and 21 August 2018 the service was rated as inadequate and was entered into special measures. We published this report on 19 September 2018.

Why we inspected: This inspection was a scheduled inspection based on the previous rating. Prior to the inspection we were notified about a serious incident in which a person using the service died following an accident within the service. We looked at risks associated with this. Further information is in the full report.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will keep this service under review and will publish details of our regulatory response once this has been concluded.

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

Inspection carried out on 20 August 2018

During a routine inspection

This inspection site visit took place on 20 and 21 August 2018 and was unannounced. At the last inspection completed in February 2017 we rated the service as ‘requires improvement’. We found improvements were needed in the areas of risk management, the application of the mental capacity act and the overall governance of the service. At this inspection we found the required improvements had not been made and further improvements were also needed.

Cole Valley is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 45 people who require nursing care. At the time of our inspection there were 41 people living at the service, many of whom were living with dementia. A registered manager was 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.

People were not protected from the risk of accident or injury due to ineffective risk management processes. Accidents and incidents were recorded but these were not reviewed sufficiently and lessons were not learned to minimise risk and make improvements across the service.

While care staff could describe potential signs of abuse, issues were not always identified and reported meaning action wasn’t taken to protect people from potential harm.

Medicines management systems were not consistently safe. People’s creams were not stored securely. Staff were administering creams that had not always been prescribed or that had been prescribed for others. People were not always supported by sufficient numbers of staff.

People’s rights were not always upheld by the effective use of the Mental Capacity Act. People’s capacity to provide consent or make decisions had not been considered in line with the Act. Decisions were not being made appropriately in people’s best interests.

People were not always cared for by staff who had the skills and knowledge to support them effectively. People’s nutritional needs were met although some improvement to staff knowledge and the support people received was needed. People had access to healthcare professionals but not always in a timely way.

People did not consistently receive care that was kind and caring. People’s dignity was not always upheld and their independence was not always promoted. People were supported to receive visits from friends and family without unnecessary restrictions.

People were not fully involved with the planning of the care they received. People’s individual support needs were not always fully understood and met. People’s diversity was not embraced and their care needs personalised as a result. People’s needs in relation to any protected characteristics were not fully considered. People did not receive access to a sufficient range of leisure opportunities that met their individual needs.

People understood how to make a complaint when required. Some relatives did not feel their complaints had been appropriately addressed.

People were not living in a service where a culture of quality improvement had been developed. Quality assurance systems were either not in place or were inadequate. Areas of improvement needed and risk had not been identified. Action was not being taken to drive improvements and the registered manager had not recognised where improvements were needed.

People were not enabled to be fully involved in the development of the service they lived in. People were not cared for by a staff team who were well supported and consistently motivated in their roles.

We found the provider was not meeting the regulations aro

Inspection carried out on 15 February 2017

During a routine inspection

We carried out this unannounced inspection on the 15 and 16 February 2017. Cole Valley Nursing Home provides nursing care and support for up to 44 older people who may also live with dementia. At the time of our inspection 41 people were residing at the home.

We undertook a comprehensive inspection of this home in February 2015. We found that the home had steadily improved since our last inspection. We found that the home was compliant with the requirements of the law and meeting people’s needs well in four of the five key questions we looked at. The registered manager needed to continue to make improvements to ensure people had the support they needed to eat and drink and to ensure that people’s human and civil rights were upheld. This inspection identified that while people received mainly safe care that they were satisfied with, improvements had not all been maintained and continued.

The home has a registered manager who has been in post for 13 years. 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.

People told us that they felt safe. However we identified some incidents had occurred between people where people had hurt each other. These incidents had not been identified by staff as possible abuse, and the required support had not been obtained and no review of people's care had taken place. This meant people were not fully protected from the risk of a similar event re-occurring. Since our inspection we have received feedback about the action taken to improve on this.

Staff had been trained in adult safeguarding and when we spoke with them they showed a good level of knowledge about possible signs of abuse and the action they would take in reporting any concerns. However staff had not applied this knowledge into practice as they hadn’t identified and reported the incidents identified during our inspection.

People received their medicines safely and there were effective systems in place to monitor medicines administration.

The feedback we received about staffing was mixed. For the majority of the time we observed adequate numbers of staff on duty, and saw people's needs and requests being met promptly. People were not left for long periods of time without access to staff. However feedback from people and relatives was that this was not always the case, and we were informed that sometimes people did have to wait for care and support, which at times caused them distress. Staff told us they had received induction, sufficient training and on-going support. There were handovers between staff at each shift change.

Staff had some knowledge of the Mental Capacity Act (MCA) (2005) and described how they supported people with making choices. Restrictions to people's liberty had been identified. When necessary the relevant applications had been made and kept under review. Further work was needed to ensure the required legal notifications were sent to the commission, and that alternative, 'less restrictive' options were considered when making decisions with people.

People had access to regular healthcare and specialist healthcare advice. The nursing care provided was generally good and followed published good practice guidelines.

People’s feedback about the food provided was mostly positive. Some people really enjoyed the food and other people thought it was acceptable. We observed that people were supported in a dignified and respectful way when they required help to eat and drink. The provider was taking part in a local good practice project that promoted fluids for people at risk of not drinking enough.

We received consistent feedback that the quality of care provided by individual staff was good and people told us that s

Inspection carried out on 25 February 2015 and 4 March 2015

During a routine inspection

This inspection took place on 25 February and 04 March 2015, and was unannounced. The service was last inspected in October 2013 and at that time we found the home had breached four regulations of the Health and Social Care 2008, and in these areas was failing to meet the needs of the people living at Cole Valley Nursing Home. In October 2013 the home was not providing the support people needed to meet their social care needs, the premises were not well presented or maintained, staff had not been provided with the supervision and training they required to meet the needs of people living at the home and systems in place to assess and monitor the quality and safety of the service were inadequate.

Following the inspection in October 2013 we met with the provider and they submitted an action plan. This detailed how they would improve the service to meet the requirements of the law and the needs of the people living in the home. At this inspection we found that significant improvements had been made in all areas. We found that the provider was now meeting the requirements of the law and people we met and spoke with reported favourably about the care and support they were receiving.

Cole Valley Nursing Home is registered to provide nursing care and accommodation for up to 44 older people. At the time of our inspection 39 people were residing at the home. Most people had their own bedroom, and the one shared room was occupied by a married couple. People shared communal facilities including three lounges, a dining room, and assisted bathrooms. The home is located over two floors and there is a passenger lift to enable people without full mobility to transfer around the home.

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.

People were supported by staff who had received training on how to protect people from abuse. Safeguarding procedures were in place which the manager was following. Staff we spoke with were able to explain a variety of actions and checks they took both individually and as a team to ensure people received the support they needed and were protected where ever possible from harm.

The Mental Capacity Act 2005(MCA) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to a supervisory body for authority to deprive someone of their liberty. We found that some training had been delivered and that staff had started to undertake work on capacity assessments and DoLS applications where needed. The inspection identified that the manager and staff team did not fully understand their roles and responsibilities, but were taking further action to increase their knowledge and get the support they required.

People were being supported to maintain and improve their health. The manager had developed strong links with a wide variety of health care professionals and medical staff to ensure people were assessed and treated when they were ill.

People told us they enjoyed the food served and we observed people in the dining rooms getting good support to eat a wide variety of foods. We found further support and planning was required to ensure people choosing to eat a meal in their rooms also got the support they required.

We observed and heard caring and compassionate interactions between staff and people throughout our inspection. Staff were quick to notice people required support or to intervene if people became distressed.

The manager had developed systems to respond to concerns and complaints. People we spoke with told us they had been happy with the home and had been able to get any grumbles or concerns dealt with promptly by speaking directly with the manager.

The activities and opportunities available to people had increased, and we found that people were supported to attend events that were important to them in the local community. A wider range of opportunities were available for all people in the home, including the people being cared for in bed.

The systems in place to check on the quality and safety of the service had improved since our last inspection. We found the checks and audits had been effective at identifying issues that required improvement and this had resulted in the home running more smoothly and improved the experience for people living at the home.

Inspection carried out on 3, 4 October 2013

During a routine inspection

At this inspection we looked at seven people�s care records. We spoke to four people and eight staff including management. We also spoke to family members to help form our opinions.

People did not experience care and support that met their needs. People�s social and welfare needs were not being met adequately by the service. One visitor told us: �My relative needs more stimulation.�

Health care and treatment needs were met and were responsive to people�s needs

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The premises were well designed but not maintained to meet people�s needs. The premises required some updating. The design ensured that people�s privacy was maintained.

Staff were not supported to access training promptly to inform their practice. Where training that had been received had expiry dates and required updates, staff had not been provided with updated training.

People did not receive care from a service that was continually assessing and monitoring to improve the quality or care and treatment provided. The auditing and checking arrangements failed to identify the training needs of the staff. The monitoring also failed to identify some maintenance works that were required around the premises and the monitoring systems failed to take into account peoples� dissatisfaction with the activities on offer.

Inspection carried out on 15 May 2013

During an inspection to make sure that the improvements required had been made

During this inspection we looked at four people�s care files. All of whom had additional nutritional needs. We spoke with three people using the service and four relatives who visited that day.

During this inspection we observed food and drink being offered late morning,lunch time and mid afternoon snacks . Most of the people using the service had conditions which made it difficult for them to communicate with us. However, we spoke with three people who were able to give their opinions about the food. People told us that they were happy with the quality and choice of food provided and that meals were served at the correct temperatures. A person told us �The food is very good, there is plenty of variety, and meat and vegetables.�

People told us that they enjoyed meal times and efforts were made to promote a social and inclusive environment for people during these times. Within the dining room during the meals, music was playing and we saw that people were talking to each other and commenting on the food being served.

People could choose where to eat there meals, some people ate in their bedrooms.. Arrangements were in place so that they too received their meals at the correct temperatures and were supported to eat them where needed.

People using the service had recently participated in a survey in order to put forward their views and suggestions for meals provided at the home. The management was looking to add these to the menu in the near future.

Inspection carried out on 28 November 2012

During a routine inspection

People we met told us they were very happy with the care and support they receive from the staff at Cole Valley Nursing Home. People told us "They take good care of us here" and "They are all very kind." We spoke to three health care professionals who support people at the home. Their comments included, "I think her needs are well met there. I have no concerns" and " I think everyone is safe and very settled."

We looked around the home, and found it was clean, and free from unpleasant odours. People told us it was always "Spotlessly clean" and three people had ticked a questionnaire we viewed confirming that the home was clean, tidy and odour free. We found that work was needed to refresh the decor, replace some worn items of furniture and ensure bedroom doors protect people in the event of a fire.

Feedback from people about food was good and one comment at lunchtime included, "It was lovely. Thank you."

We observed that the staff team were very busy throughout the day, but people told us they had a good relationship with the staff and that they did not have to wait long for care. One person said, "They are very good, would do anything for you. Even clean my mucky glasses!" One person when asked about staff gave a big smile and said " The staff are marvellous."

Inspection carried out on 29 December 2011

During an inspection in response to concerns

We carried out this review because we received information that indicated that staffing arrangements did not meet the levels of support that people needed. Many of the people who lived at Cole Valley were not able to tell us much about their experience of living at the home, because of their health needs.

On the day of our visit, we saw positive staff interactions with people living at the home. Care staff were polite, respectful and demonstrated that they were able to communicate in a way that people could understand. We observed that care staff were very busy across the morning, but appeared more rushed once preparations for lunchtime commenced.

We spoke with visitors to the home on the day, who were complimentary about the care provided.

Inspection carried out on 3 August 2011

During an inspection to make sure that the improvements required had been made

We met a large number of the people who live at Cole Valley Nursing home, and observed the care and support staff offered them. We saw lots of examples of staff speaking to people in a calm, friendly and reassuring way, that was respectful of the person's dignity.

We spoke to three people in private, and their feedback about the home was positive.

Inspection carried out on 21 February 2011 and 18 September 2012

During a routine inspection

We spoke to many of the people who live at Cole Valley Nursing home, and their relatives. We observed the way staff supported people and spoke to them, and generally we saw this was sensitive and respectful.

Where possible staff asked people before they offered them care or moved them, and staff we spoke to had a good understanding about getting consent.

We received some very positive comments about the care offered which included, "They are doing a marvellous job here, her clothes are clean on every day"

"We feel mum is safe here, that is a weight off our minds"

"I have had my hair done, I was pleased about that"

"I had a bad place on my leg, it has healed now, I am grateful to them for that"

"It is brilliant really, you get all you need"

"I like it here because dad is kept clean, washed and fed"

Some people were not so happy with the care and felt staff neglected every day things such as cleaning peoples teeth, fitting glasses or hearing aids.

We spoke with people about the food and drinks they are served. Again the comments were positive and included," have porridge for breakfast, it is very tasty"

"The food is always edible"

"The food has been good, I only eat a little but I had a lovely ham salad at lunch time"

"The food is alright, too much really"

"Food is alright thank you, although I think it gets a bit predictable when you have been here for a while"

We observed the lunch time meal-the main meal of the day and did not see that it was an enjoyable experience for most people, or that everyone got the support they need to eat as independently as possible.

We talked to people about if they felt safe, and what they would do if they were unhappy regards the way someone was supporting them. We were pleased that all the people we spoke with did feel safe, and that they felt very able to approach the manager if they had concerns.

We found that there was a low turn over of staff in post and that this has a positive impact for people, who are supported by staff they have got to know, and who know their needs.

We spoke with people and their relatives about the staff. Most found that for most of the time staff were friendly and helpful. A few people made negative comments.

"I have some problems with the staff, but this one is very good"

We spoke to a person recently admitted to the home, when asked about staff they said, "Yes, they are very nice"

"Staff are alright, they come as quickly as they can, and most enjoy a good banter"

One person said to us, "She (the manager) is friendly, things get done when she is here, on her days off things are chaotic, staff are bitchy and there is a divide between nurses and carers"

Another person said, "Most staff are golden, but some think they run the place, and that gets up my nose"

We did not find that the home was supporting staff in supervision, that they had offered all the training people need or that they had reviewed peoples suitability to work in a care home as thoroughly or often as they should.

We found that the manager was held in high regard by the majority of people who live in or visit the home. We were told, "Michelle-the manager, she is very good"

"She is nice, straight forward"

"Michelle, she is friendly, things get done when she is here. On her days off things are chaotic, there is a big divide between nurses and carers"

"The manager is assertive, she works well with all grades of staff and relatives and visitors"

"If I am unhappy about something, I go straight to Michelle"

This positive information about the manager gave us confidence that the shortfalls we identified during our visit would be acted upon.

Reports under our old system of regulation (including those from before CQC was created)