Valley Lodge Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last inspection, this key question was rated requires improvement, at this inspection our judgement remains the same. This meant some aspects of the service were not always safe. There was an increased risk that people could be harmed.

The provider and registered manager have since the last inspection, made improvements in relation to medicines and we found most of the issues identified at the last inspection had been addressed.

However, we did identify some new issues in relation to medicines and infection control. Therefore, there is a continuing breach of safe care and treatment.

The provider has now met the previous breach from the last inspection in relation to safeguarding.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated safety events. Lessons were learnt to continually identify and embed good practice.

People and relatives told us they felt able to raise any safety concerns and they would be listened to. The provider’s survey confirmed relatives felt they could raise any issues.

Staff understood the reporting procedures and requirements and told us people's needs were then re-assessed if required. A person confirmed that following a fall, staff had installed equipment to alert them, when they were up.

The provider kept a tracker of incidents and staff told us this was reviewed monthly for trends and to enable any required actions to be taken. Staff told us as a result, spot checks were increased earlier in the year to ensure they were proactively monitoring people.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The registered manager told us about the processes which were in place to ensure any relevant information was shared about people when they were admitted to hospital or moved to another care home.

A relative told us their loved one had recently been admitted to the home, and they found the process had been smooth. The relative told us they received an update on their loved ones welfare and knew when their care was to be reviewed. Partners confirmed staff sought any required support for people as needed.

The provider had processes in place such as the staff shift handover, to ensure staff were updated when people moved in or out of the home and about any changes to people’s care. The provider had policies and flow charts in place to guide staff when people were admitted or discharged.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that.

The provider and registered manager have made sufficient improvements since the last inspection and the service is no longer in breach of safeguarding.

People and relatives said staff treated people well and they were safe in their care. The providers resident’s survey confirmed people felt safe with staff. We observed people were relaxed and happy with the staff who supported them. Staff had completed the provider’s safeguarding training and understood what safeguarding meant and their role in keeping people safe. Staff had access to relevant guidance.

Staff had completed training on the Deprivation of Liberty Safeguards (DoLs) and processes were in place to assess their knowledge. People had a DoLS in place where required and their capacity to consent to any required restrictions had been assessed prior to the application being made.

The provider had processes to ensure incidents were documented and reviewed to identify if any actions under safeguarding processes were required. However, we noted one incident where the cause of a person’s bruise had not been established and a referral to the local authority as the lead agency for safeguarding had not been made. The registered manager took immediate action when we brought this to their attention.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Relatives told us staff assessed risks to people and managed them, whilst also respecting people’s rights to take risks. A relative said, “[Person] is still very independent and that can sometimes pose unexpected risks but they [staff] seem to err on the side of keep an eye on [person] but let [person] do what [person] feels [person] can.”

Staff felt people’s care plans identified potential risks to them and the measures in place to manage them. People’s care plans we reviewed showed risks to people had been assessed and any measures to mitigate them had been discussed with them wherever possible. Staff had discussed with a person how the risks from spending time in their wheelchair were to be mitigated.

Staff had received training on risks to people such as tissue viability, choking, modified diets, moving and handling and falls prevention. We saw people had any equipment they needed such as air mattresses, pressure relieving cushions, hoists and walking aids. Staff explained the safety checks completed on equipment and were seen to transfer people safely.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development.

People and relatives felt there were sufficient numbers of well-trained staff. Relatives told us if people were cared for in bed, then there were enough staff to check upon them frequently.

The registered manager monitored the required staffing levels for the home. The provider had processes in place to ensure staff were recruited safely.

Overall staff felt there were sufficient staff rostered, but they felt more staff were required for both the kitchen and housekeeping. The registered manager told us these posts were being advertised, and measures had been taken to minimise the impact of any shortfall whilst staff were recruited. We observed there seemed to be sufficient staff to support people and staff were present in the communal areas.

Staff said they felt supported in their role and were provided with supervision and both online and face-to-face training. Staff supervisions we saw had taken place but would benefit from being more frequent. The registered manager was aware of this need and was taking action to address this.

Staff did not carry out delegated tasks which they had not been trained to complete such as the administration of insulin. Staff told us there was always a medicine trained member of staff on duty overnight if required.

The service did not always assess or manage the risk of infection as not all aspects of the premises were always kept sufficiently clean.

People and relatives provided mixed feedback about the cleanliness of the service. Not everyone spoken with felt spills were always cleaned up promptly or that the cleaning was always completed sufficiently thoroughly. We saw a person had an accident and although staff assisted them to change, the chair they were sat on was not then immediately cleaned. A relative reported there were sometimes malodours, which we also noted.

People’s toiletries had been left in some bathrooms, which was an infection control risk. We saw a laundry bag for soiled items was tied but overflowing and another was overfilled so could not be closed, which risked any infections spreading. Staff did not always wipe tables clean before the next person sat down to eat. Staff were not always completing people's records in order show people's bedrooms had been cleaned daily.

Staff had however completed infection prevention training, and they had access to the provider’s policies. We saw there were plentiful supplies of personal protective equipment. The registered manager demonstrated they understood when people might need to be cared for in isolation and why in order to prevent the spread of infection.

The service did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

At the previous inspection we were concerned that medicines records lacked sufficient detail, and covert medicines administered occurred without the relevant safeguards in place. At this inspection, covert medicines administration was not occurring, and medicines storage was secure, and the controlled drugs records contained sufficient detail. We found further improvements were required where people had prescribed transdermal patches. For example, records indicated where patches were applied, however records were not available to provide assurance that the patches remained attached until they were replaced.

At this inspection we were not assured medicines with a reduced expiry date once opened and those requiring refrigeration were stored within the manufacturer's recommendations due to a lack of or incomplete records.

We were also concerned that protocols to support staff to administer "when required" and or "variable dose" medicines were not sufficiently individualised, personalised, or cross referenced to the relevant care plans to support staff administer these medicines consistently.

Creams administered as part of personal care or used as soap substitutes were recorded via handheld devices on the care records system. These records recorded the cream applied and when. However, a few creams were used as an emollient and soap substitute, however the exact use was not recorded. The service undertook weekly medicines audits and commissioned an external audit by their preferred community pharmacy provider. Both audits had identified some but not all, of the concerns we had identified.