Archived: Valentine Lodge

The Care Quality Commission met with the registered provider on 3 February 2016 and 14 March 2016 to discuss our on-going concerns. Although during these meetings and other exchanges the provider gave assurances that things would improve, information of concern continued to be shared with us from the Local Authority. Despite visits by the Local Authority and local Clinical Commissioning Group to ensure peoples’ welfare, they continued to have significant concerns and were not seeing improvements and stability at the service.

We undertook a focused inspection on 30 March 2016 to check compliance with the warning notices and to confirm that the provider now met legal requirements. At the time of this inspection there were 14 people using the service.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by the Care Quality Commission. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

On 30 March 2016, in response to the seriousness of their level of concern regarding the safety of the service provided to people, the Local Authority terminated their contract with the registered provider and steps were taken to move people living at Valentine Lodge.

Valentine Lodge provides accommodation, personal care and nursing care for up to 20 older people and people living with dementia.

A registered manager was not in post at the time of our focussed inspection on 30 March 2016. The deputy manager was in day-to-day charge of the service and they were supported by the provider’s personal assistant. 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.

This report only covers our findings affecting requirements relating to the medicines management and assessing and monitoring the quality of service provision. You can read the report of our last comprehensive inspection by selecting the ‘all reports’ link for Valentine Lodge on our website at www.cqc.org.uk

The standard of medicines management at the service was not safe and medicines had not always been administered in line with the prescriber’s instructions or effectively recorded for the protection of people living at Valentine Lodge. Actions as outlined within the registered provider’s action plan received by the Care Quality Commission on 6 November 2015 to ensure safe medicines management had not been addressed and these remained outstanding.

We found that the registered provider’s arrangements so as to ensure that an effective system was in place to regularly assess and monitor the quality of the service provided was ineffectual and unproductive. The registered provider was unable to demonstrate how they measured and analysed the care provided and how this made sure that the service was operating effectively and safely so as to ensure good outcomes for people living at Valentine Lodge. The registered provider did not have regard to our previous inspection reports, the information contained within them and the significant improvements required so as to improve the service by learning from adverse events and incidents to establish what caused them.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found.

Is the service safe?

When we arrived at the service the manager asked us to sign in the visitor's book. Appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

We saw that care workers had been provided with training in safeguarding vulnerable adults from abuse, the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) as part of their induction and also on going training. Training had been booked for those care workers who still needed to attend. This meant that staff had been provided with the information they needed which would help to ensure that people were safeguarded.

People told us they felt safe. Care workers had received training and guidance on identifying the possible signs and risk of abuse and were aware of how to raise any concerns they may have.

On the day of our visit the service had sufficient care workers on duty to provide the care people required. The service also had other staff available to provide assistance with the day to day running of the home and the manager and deputy manager to oversee this.

Is the service effective?

People's care records showed that care had been planned and records had been regularly reviewed and updated. Since our visit the manager has also re-organised people's files to ensure information is easier to find. Care workers had been provided with information about people's needs and how these were to be met.

Is the service caring?

We spoke with five people who received support from the service. We asked them for their opinions about the staff that supported them. Feedback from the people was positive and they found the staff to be very caring.

We saw that the care workers interacted with people who lived at the service in a caring and respectful manner. We observed that care workers treated people with respect and encouraged them to be involved in decisions about their care.

Is the service responsive?

Care records showed that where concerns about people's wellbeing had been identified, the care workers had taken appropriate action to ensure that they were provided with the support they needed. This included seeking support and guidance from health care professionals.

Is the service well-led?

The manager of the service was registered with the Care Quality Commission and had knowledge of the regulations.

The service worked well with other agencies and services to make sure people received the care they needed.

There were clear lines of accountability and systems in place for people to raise any concerns they may have. We spoke with two relatives of people who used the service and they confirmed that they were happy with the care. They both felt the management of the service was good and it ran well.

Staff told us they were clear about their roles and responsibilities. Staff agreed the service was well led and added they received regular supervision and support. They told us the manager had always dealt with any issues they had raised.

The file of a newly recruited staff member was viewed and all the required checks had been completed.

Care staff were observed treating people with dignity, speaking to them respectfully and involving them in their care. People appeared relaxed and staff were seen helping them to make choices on how they wanted their care provided. During our visit at no time were people seen waiting for staff to support them.

People told us they knew how to raise any concerns they may have. Relatives spoken with stated that they found the manager to be approachable and felt they could take any concerns to them. Staff spoken with also added that they felt that they could raise any concerns with the manager. Comments taken from the home's quality assurance included, 'The staff are very helpful,' 'The food is always piping hot and plenty on the plate,' 'The care mum receives is second to none' and 'The best home I have found. My father is very happy here. I know he is well cared for and I have no worries.'

There was a relaxed atmosphere within the home and care staff and people were seen chatting and laughing. There was general conversation in the lounge and care staff were seen and heard encouraging people to interact with them. It was clear that the care staff knew the people well and how they wanted their care provided.

Since our last visit the manager had been sending in regular action plans to show what work had been completed. The action plans set out decorating and improvements that were planned for the next 12 months. This included the decorating of bedrooms, the replacement of broken furniture, changing a bathroom into a wet room and general health and safety improvements.

During this visit it was clear that this had commenced and some areas had already been completed. Essential health and safety work had been carried out, new radiators had been fitted throughout the home, a new hot water system had been installed, new showers fitted where needed, the sluice room had been refurbished, a new wet room installed and work was now being done on the decorating of the home.

At the last visit on 15 April 2013 it was found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. At this visit improvements had been put in place, but it was an area that still required further development.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Relatives spoken with stated that they found the manager to be approachable and felt they could take any concerns they may have to them. Comments included, 'The manager is amazing ' you can go to them about anything.' Staff stated they were a 'Very close team' and the manager was, 'Very supportive' and ensured any equipment they needed was always there.

During our inspection of 28 January 2013 and 06 February 2013 some concerns were raised that people who use the service did not live in a home that was comfortable, safe and met their needs. There was also no evidence to show that there was an on-going maintenance programme for the service.

Some concerns were also raised with regard to the provider's infection control procedures. It was found that effective prevention and control of infection measures were not part of everyday practice at Valentine Lodge.

The provider did not have effective systems in place to enable the provider and manager to identify, assess and manage risks relating to the health, welfare and safety of service users.