Valley Court

Valley Court is a nursing home providing personal and nursing care to up to 69 people. The service provides support to older adults and people living with dementia. At the time of our inspection there were 56 people using the service. The home accommodates people on 2 floors. One floor specialises in the care of people with nursing care needs. The lounges and dining areas are situated on the ground floor.

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

There was a manager is post who had commenced the process to become a registered manager. However, they were on holiday at the time of the inspection. The deputy manager and quality manager were present throughout the inspection. The management team had made positive changes. Overall, people, staff and relatives spoke positively about the management team. Regular meetings were held so they could share their views on the home and help develop the support they received and the environment they lived in. Systems had been improved to ensure people's care needs were being met and any areas for improvement were identified. Some of these systems had recently been introduced and required time to become established to continue to drive improvement.

People and relatives told us they felt safe and cared for. Staff had received safeguarding training and concerns had been raised and acted on appropriately. Medicines were managed safely, and we observed good infection control practices. The provider’s recruitment process had not always been followed; however, this was being addressed by the quality manager. We saw there were enough staff to 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 and in their best interests; the policies and systems in the service supported this practice.

People were happy with the quality of the food and choices available. Staff received training appropriate to people's needs. People were supported to access healthcare professionals when required. Healthcare professionals we spoke to were complimentary about the staff team and support provided.

People told us they felt respected and had their privacy and dignity maintained. They also told us staff were kind and caring. People and relatives were involved in decisions about their care and their independence was encouraged. Overall, care plans contained personalised information about people and staff knew people well. End of life care plans were in place and staff had received training. People told us and we saw that activities took place daily including group sessions and one to one in people’s bedrooms. People told us they knew how to raise any concerns if needed and felt they would be listened to.

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 requires improvement (published 21 April 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection on 10 and 15 February 2022 when breaches of legal requirements were found in relation to; person centred care, safe care and treatment and good governance. Following this inspection, we asked the provider for an action plan to demonstrate how the governance issues found would be addressed and monitored.

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Valley Court is a nursing home providing personal and nursing care to up to 69 people. The service provides support to older adults and people living with dementia. At the time of our inspection there were 53 people using the service. The home accommodates people on two floors. One floor specialises in the care of people with dementia and nursing care needs. The lounges and dining areas for people on both floors are situated on the ground floor.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Many people and relatives did not know a new manager was in post as the change had been very recent. The manager had plans to ensure everyone was aware of the recent changes. We found systems and processes to ensure people’s safety and quality of care were not sufficient.

We found planning to support staff in an emergency was not sufficient. We saw some areas of carpet were causing a trip hazard. These issues were addressed by the manager and staff during the inspection. People and their relatives told us they felt safe. One relative told us; “I have no concerns at all, I know [my relative] is safe.”

We saw activities were limited for people living on the first floor. Staff had not always completed their refresher training. The manager assured us they were addressing both of these concerns. People and relatives told us they enjoyed the food and we saw that people had plenty of choice. One relative said: “The food is fantastic.”

We found that systems were not robust which meant that not everyone received good care. However people told us staff were kind and caring. One relative said; “The staff talk to us like family because [all the people living here] are treated like family.”

We found that people on the upstairs floor had not been consulted or their needs fully considered when their lounge and dining area were excluded from their use. The manager was taking steps to rectify this during our inspection. Relatives told us they felt confident to speak to staff about any concerns and they would be addressed.

People were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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 requires improvement (published 6 February 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

The inspection was prompted in part due to concerns received about health and safety issues in the home, the choice people had about daily activities and the quality of care plans. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider continued to need to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. During the inspection the manager and staff were already addressing the concerns raised and took steps to address concerns we found during the inspection.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care, safety of the environment and systems and processes to ensure safe and good quality care at this inspection.

Please see the action we have told the provider to take at the end of this report. 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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Valley Court is a nursing home providing personal and nursing care to 55 people aged 65 and over at the time of the inspection. The service can support up to 69 people.

The care home provides care for people in one adapted building. The home is split over two floors with access to both floors through the lift.

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

People received support from staff who understood how to recognise and escalate safeguarding concerns. People received safe support with their medicines. Improvements had been made to the way staff were recruited to ensure this was carried out safely.

We identified further improvement was needed around how staffing levels were worked out, in the monitoring of people’s fluid intake, and the analysis of accidents to prevent reoccurrence.

People had not received a service that was consistently well-led. We found improvements were needed in the way the quality and safety of the service were monitored. There was a recently appointed new manager at the service who had identified areas that needed improvement. These improvements had not yet been fully introduced or embedded into the service and more time was needed to enable this to happen.

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 requires improvement (published 27 November 2019). We found the provider was in breach of regulations 12 and 17. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had been made in one of the breaches which had been met. Sufficient improvement had not been made in the governance of the service and the provider was still in breach of regulation 17 (Good Governance).

Why we inspected

The inspection was prompted in part due to concerns received about people not receiving safe care and infection control concerns. We also looked at the intelligence we held about the service which indicated the need for us to inspect the service. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Valley Court on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Valley Court operates in a building that is designed to deliver care over two floors in three units.

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

We received mixed feedback from people about feeling safe with the care and support they received. Some people told us they did not always feel safe. Risks to people's safety had not always been assessed and mitigated individually and within their environment. We received mixed feedback from people about staffing levels. Staff were aware of the procedure for reporting any concerns to help keep people safe. Although there were recruitment processes in place, we found that the process was not always followed, and pre-employment checks were inconsistent. Whilst some incidents and accidents had been recorded the service were unable to note trends that may be present in order to prevent comparable occurrences in the future.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Whilst staff told us they received regular training, the manager and the systems in place could not confirm this. Generally, people told us they enjoyed their meals but were not involved in the planning of the menus. People’s health care records did not contain sufficient information and guidance for staff to follow.

People told us they were not always treated with kindness and compassion by staff who supported them. People were not consistently supported to make choices about their lives. We saw instances when people’s privacy, dignity and confidentiality were compromised.

People did not receive personalised care that was responsive to their needs. People told us they did not contribute to the planning and reviewing of their care. People were given information in an accessible way, so it was easier for them to understand. People could not be confident that their wishes during their final days and following death would be understood and followed by staff.

The oversight and governance of the home was not always effective in resolving areas which required improvement. The audits and systems in place had failed to highlight a number of areas for action that were identified on inspection. People’s experiences of the service were not consistently sought and feedback that was gathered had not been used to drive improvement. The provider did not carry out robust checks to ensure that care was being delivered safely and effectively.

Rating at last inspection

The last rating for this service was good (published 11 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Valley Court on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and the governance of the service.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

This inspection of Valley Court took place on 1 March 2017 and was unannounced. At the time of our inspection 66 people were using the service. At our last inspection in August 2016 we found the provider was meeting all the regulations but we identified that some areas in the key questions of safe and well-led required improvement. We found on this, our most recent inspection; the provider had made the necessary improvements in relation to the issues we previously identified.

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.’

Recruitment practices in relation to criminal records checks were not consistently undertaken in line with the Health and Social Care Act regulations. Staff understood their responsibility to protect people from the risk of abuse and appropriate action was taken in response to any incidents. Risks to people's health and safety were regularly assessed and action taken to reduce the risks. Staff were organised and well deployed and were available in sufficient numbers to meet people's needs in a timely manner. People received their medicines when they needed them and medicines were in the main stored and administered appropriately.

Staff were well supported by the provider in relation to the level of supervision and the quality of the induction provided to them. Systems in place ensured people were not deprived of their liberty unlawfully. People were supported to provide consent for the care they received. Staff were provided with relevant training to effectively meet people's needs. People had access to a good range of food and drink. People were supported to access a range of healthcare services.

There were caring and friendly relationships between staff and the people living at the home. People made decisions about how they lived their lives and staff enabled them to achieve these. People were treated with dignity and respect by staff and their right to privacy was upheld.

People felt that care was person-centred and staff responded well to any changes in people's needs. People’s diversity was embraced and met with sensitivity. Care plans provided up to date and relevant information about people's support needs. Activities were provided that were in line with people’s likes and preference’s. People felt comfortable raising concerns or making a complaint and knew how to do so.

There was an open and transparent culture at the home, people and staff felt comfortable speaking up if they wanted to. The registered manager ensured that staff were provided with clear leadership. People were able to provide their opinion on the quality of the service through surveys, suggestions and meetings. Effective quality monitoring systems were in place and areas requiring improvement were acted upon accordingly.

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 found that medicines management within the service was lacking in some areas, including guidance for staff in the administration of medicines directly into the stomach. The provider had systems in place to protect people from abuse and harm. Staff had a clear knowledge of how to protect people and understood their responsibilities for reporting any issues of concern. The provider had a suitable number of staff on duty. Systems in place for recruitment ensured staff working at the service had the right skills, experience and qualities to support the people who used the service.

Staff had access to a range of training to provide them with the level of skills and knowledge to deliver care safely and efficiently. Staff were able to give an account of what a Deprivation of Liberty Safeguard (DoLS) meant for people subject to them. Staff were knowledgeable about how to support people to maintain good health and accessed professional healthcare support for people when necessary. People gave varied feedback about the quality of food; however we observed that the standard and choice of food provided was good.

People were supported in a caring way and reassured in times of distress or discomfort. Staff interacted with people in a positive manner and used encouraging language whilst maintaining their privacy and dignity. People were involved in the decision making about their care. Staff provided support to people in a way that helped them to remain as independent as possible.

People’s needs were assessed and care was planned with them or their representative in line with their preferences. Staff were knowledgeable about people’s personal preferences and what was important to them, including their spiritual or religious needs. Activities available to people were based on the individuals preferences and abilities. The provider responded to complaints received in line with their own policy.

People and staff spoke positively about the leadership skills of the registered manager. Feedback was actively encouraged through surveys, suggestions and meetings; which allowed people and staff to be involved in the development of the service. Systems for monitoring the quality and safety of the service were in place but had failed to identify issues in relation to medicines management.

We spoke with seven people that lived there, seven relatives and observed how people were supported by staff. We also spoke with the registered manager and six other members of staff that were on duty. We reviewed records relating to the management of the home which included, care plans, daily care records, accident and incident records, complaints records, audits, and staff records. We also spoke with the local commissioners of the service.

Our conversations with people helped us to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? and, Is the service well led?

Below is a summary of what we found. The summary is based on our findings during the inspection.

The detailed evidence supporting our summary can be read in our full report

Is the service safe?

Everyone that we spoke with said that they thought the care they were receiving met their needs. They all said they were being looked after, felt safe and well cared for. One person told us, 'They are treating me very well. We have different carers, but they are all very nice. They go out of their way to help you.'

We saw that people's care was planned and any risks associated with providing the care was assessed and managed appropriately. We saw that people's changing needs were identified and the appropriate medical advice sought to ensure they were cared for in the safest way.

Systems were in place to make sure managers and staff learnt from complaints and concerns and events such as accident and incidents. This reduced the risks to people and helped the service to continually improve.

People were cared for in a clean, hygienic environment where systems for managing the control of infections were well maintained.

Staff were appropriately recruited to ensure they were safe to care for people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. The manager was aware of the process for seeking guidance from the approving authority and polices were in place to guide staff.

We found that the provider was meeting the requirements of the regulations that we looked at to ensure that people were cared for safely.

Is the service effective?

All of the people and their relatives spoken with told us that they were receiving the care that they needed. There was a full time activities coordinator in post and people were supported to be involved in social activities if they wished.

We saw that the home sought the views of people that lived there and their relatives and staff to help in improving the care provided. We saw that meetings were held with people that lived at the home, so that they were involved in making decisions about the day to day management of the home and things that affected them.

Care plans were kept under regular review, so that staff had up to date information on how to care for people.

We found that the provider was meeting the requirements of the regulations that we looked at to ensure that people received an effective service.

Is the service caring?

All of the people and their relatives spoken with told us that they felt that the service was caring. One person that lived at the home told us, 'Oh yes its' wonderful. Very caring staff and they will do the simplest thing for you.'

We walked around the home and watched to see how staff treated people. We saw good interactions between people and staff. We saw and people told us that call bells were responded to promptly.

We saw that people were dressed in clothing appropriate to their age, gender and the weather and were well groomed, so that their dignity was maintained.

Is the service responsive?

All the visitors spoken with said they visited the home whenever they wanted to and were kept informed about changes to their relatives care. A relative told us, 'To be honest X looks really well and she has put weight on. They did get a dietician out to see her and they keep me informed if things changes.'

All the people that we spoke with were confident that they could speak with the manager about their concerns and they would be acted upon.

We saw from care records looked at and staff told us that the home involved other professionals in supporting people's care as required.

We found that the provider was meeting the requirements of the regulations that we looked at to ensure that people received a service that was responsive to their needs.

Is the service well led?

All the people and their relatives that we spoke with had no concerns about the service. A relative told us, 'They have been marvellous; I can't see anything better that they can do.' People were confident that their concerns would be listened to and investigated.

People and their relatives were consulted about the quality of service they received. We saw that comments and concerns were analysed and improvements were put in place where they had been identified.

Systems for monitoring the quality of the service were well maintained.

We saw that the home had a staffing structure that enabled the service to be managed appropriately. This included a manager that was registered with us and was responsible for the day to day running of the service. All staff spoken with told us they felt that the home was well managed and they were able to raise concerns about people's care with the managers.

We found that the provider was meeting the requirements of the regulations that we looked at to ensure that the service was well led.

All the people living at the home that we spoke with told us that on a daily basis staff always sought their consent before providing care. We found that where people did not have the capacity to consent to their care, the provider did not act in accordance with legal requirements.

Everyone living at the home and their visitors told us that the care met their needs. One person told us, 'I am being cared for well, no complaints. Plenty to eat and drink, enough staff to care for me and if I press the buzzer they come.' We found that people experienced care, treatment and support that met their needs.

People told us that they received their medication when they need it. We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Everyone living at the home told us that they were treated well by the staff. One person told us, 'They are all as good as gold.' We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

All the people living at the home and their visitors told us that they were happy with the quality of care provided. One person said, 'My mom looks better now than she has looked in the last 18 months. The care is right.' We found that the provider had an effective system to regularly assess and monitor the quality of service that people received.

We found that the provider had taken the appropriate action to ensure that people that used the service was safeguarded from abuse.

We found that the provider had taken action to ensure that we would be notified of all allegations of abuse and significant incidents that affect the welfare of people that lived at the home.

People told us that they had choices and that their privacy and dignity was respected. One person said 'I choose to have a bed bath and a shower once a week. If I want anything I tell the nurse what I want.'

We saw that people were cared for and people and their relatives told us they had no concerns about the care they received. One person said 'I love it here, a home from home and the staff do anything for you'.

People said they felt safe living at the home. However we found some concerns with the way staff followed the procedure for safeguarding people living at the home.

Systems were in place for people to raise concerns. People told us they had no concerns about the home and felt that staff would listen to and act on their concerns.

We found that the provider was not keeping us informed about incidents that affected the welfare of people living at the home.