Archived: Valley View Residential Care Home

Following the last inspection, we met with the registered provider to discuss their action plan which showed what they would do and by when to improve the key questions, safe, effective, responsive and well-led. The registered provider employed the services of a consultant to provide support to the management team. At this inspection, we found improvements had been made in all areas.

Valley View Residential Care Home 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.

Valley View is a purpose-built residential care home. The accommodation provides single rooms with en-suite toilet and shower facilities for up to 59 people. At the time of our inspection, 50 people were living at this home. There are four units; Rose, Poppy, Bluebell and Orchid unit. Poppy unit is dedicated to caring for people living with dementia.

Without exception, people told us they felt safe living at this home. Staff had received safeguarding training and appropriate action was taken in response to allegations of abuse. One safeguarding incident had not been reported to the Care Quality Commission (the Commission), although this had been reported to the local safeguarding authority and all other notifications had been submitted to the Commission. Safe recruitment practices had been followed which reduced the risk of unsuitable staff being employed.

The storage, administration and disposal of medicines was safely managed at this inspection. We discussed an exception with the registered manager and they took immediate action.

Individual risks to people had been identified, assessed and were regularly reviewed. Risk assessments included guidance for staff to follow. The management of infection control, the building and equipment staff used was effective.

Staffing levels had increased since our last inspection and a dependency took was used to ensure this continued to be a valid assessment of need. Extra staff were suitably deployed to areas of the home where people had greater needs.

Lessons were learned from events which did not go as planned and these outcomes were discussed with staff.

A dedicated training and development coordinator was responsible for the training programme which showed high levels of completion. Staff had received a recent supervision and appraisal and spot checks were taking place to ensure good standards of care were provided.

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. The registered manager used a tracker to ensure these authorisations continually remained up-to-date.

Care plans we looked at showed advice was sought from healthcare professionals when required. People confirmed staff made medical appointments for them as needed.

Staff knew how to maintain people’s privacy and dignity at all times and people confirmed this happened. Staff were seen working at eye level with people, communicating effectively with them and providing reassurance where it was needed. Staff knew people well including their care preferences. People’s equality, diversity and human rights were respected and their religious needs were being met.

Care plans were being developed and improvements had been made to make these easier to use. People and their representatives had been invited to be part of care plans and reviews.

Complaints were dealt with effectively through investigation and formal responses being provided. The registered provider sought feedback through their satisfaction survey and through meetings. We saw action had been taken in response to the feedback provided.

Activities were regularly taking place both inside and outside the home. People, including those who stayed in their own room, received a variety of activities, which helped them avoid social stimulation.

The registered manager’s audits were effective in identifying concerns and demonstrating appropriate action had been taken.

The management team were approachable and since our last inspection, the registered manager had been able to focus on their oversight of the home as they were capably supported by their senior team.

Strong links had been made with a number of organisations from the local community which we were able to see positively affected people’s lives.

People had a positive mealtime experience and drinks and snacks were available throughout the day. We recommended the home calculates fluid targets for people based on guidance from the National Institute for Health and Care Excellence (NICE).

The home had previously been inspected on 25 August 2015 and was rated good overall and in the key questions we inspect against. The registered provider was found to be compliant with the regulations at this service.

Valley View is a purpose built residential care home. The accommodation comprises of single rooms with en-suite toilet and shower facilities for up to 59 people. There are four units on separate floors known as Rose, Poppy, and Bluebell providing accommodation for between 16 to 18 people and Orchid unit for eight people. Poppy Unit is dedicated to caring for people living with dementia. On the day of our inspection there were 49 people living in the 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 service had a registered manager in place. 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.

Most people we spoke with told us they felt safe living at this service. Staff were able to recognise abuse and knew who to report this to and most staff had received up to date safeguarding training. Staff training records showed staff were overdue refresher training in subjects such as fire safety, infection control and basic food hygiene. Supervision records we looked at required strengthening to evidence personal development of staff.

Risks to people had not been sufficiently assessed, managed and reviewed. Risk assessments relating to falls and choking were not in place where people were at risk of harm. The management of medicines was not found to be safe as medicines were not always stored and administered appropriately. Medication training and staff competency checks were not completed for all staff responsible for the administration of medicines. Staffing levels were not found to be sufficient to meet the needs of people living in this home. The registered provider did not use a tool to assess people’s dependency levels in order to determine the number of staff support hours needed.

Mental capacity assessments were not kept with care plans. These were kept separately where staff did not have access to these records. These assessments were not specific to a range of decisions. Records of Deprivation of Liberty Safeguards were appropriately managed. This meant 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 as the policies and systems in the service did not support this practice.

Care plans did not always accurately reflect people’s care. People’s end of life care wishes were considered. People looked well dressed and cared for and warm interactions were seen during our inspection. People’s privacy and dignity was usually respected.

Quality assurance audits and provider reports were not fully effective as although they identified concerns, these lacked action plans with timescales and records of actions completed. Records relating to the management of complaints required improvement.

People told us they enjoyed the food they were served and the mealtime experience was seen to be positive. People received access to healthcare and visiting healthcare professionals were complimentary about the care provided at this home. A programme of entertainment and activities was in place.

The registered provider held regular meetings for people, relatives and staff and satisfaction surveys were used to gather feedback. We saw actions had been taken in response to feedback.

The service worked in partnership with other organisations and local commissioners.

People and relatives knew the registered manager and staff we spoke with said they found the manager approachable.

We have made recommendations regarding sharing information relating to current legislation with staff, the recording of dietary needs and formally recording concerns.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

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

We found that when people required care and treatment from another provider, such as a doctor or hospital, the provider obtained these services in a timely way. Relatives of people who used the service told us their relatives were supported by staff to have health checks with other providers such as dentists, opticians and doctors. This was confirmed by records we saw in people's care plans.

Medicines were handled appropriately. We inspected medication storage and administration procedures in the home. We found that medicine trolleys and storage cupboards were secure, clean and well organised.

We saw that the provider of service was employing effective staff recruitment and selection systems. We saw there was a clear process that ensured appropriate checks were carried out before staff began work. Our observations and scrutiny of records showed that a robust recruitment process operated at the home.

The provider had a complaints policy for ensuring that complaints were recorded and fully investigated. The policy gave information about how to make a complaint, the timescales for responses and who to go to if the complainant remained dissatisfied.