Valley View Care Home Ltd

Valley View Care Home Ltd is a residential care home providing personal and nursing care to up to a maximum of 33 people. The service provides support to people who have care needs, such as, diabetes, epilepsy, Parkinson’s disease. Some people were living with dementia or had deteriorating mobility. At the time of our inspection there were 23 people using the service.

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

Although improvements had been made to the identification and mitigation of individual risk, further improvement was ongoing to ensure people’s safety.

There were improvements to how people were supported to make decisions and choices, however, people were still 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.

The provider had introduced new monitoring systems since the last inspection however; these were not always robust and required further improvement to make sure people received safe and good quality care. Monitoring systems introduced since the last inspection were not always robust to make sure people received safe and good quality care.

Staff understood their responsibilities in relation to keeping people safe, they felt confident in raising concerns. People could be assured their prescribed medicines were now managed better by staff. Staffing levels had improved, and safe staff recruitment practices continued to be in place. The levels of agency staff had reduced and the agency staff supporting people now were regular agency staff who were treated as part of the team. The management of fire safety had improved, staff had completed fire evacuation drills more regularly.

Staff continued to complete their training and the provider had a system to check this. Staff said they felt well supported. People received better care with their health needs and the advice of healthcare staff was now followed. People were happy with the food provided, and their meals, and told us they could choose other options if they wished.

Staff culture had improved, no staff reported concerns of bullying as they had at the previous 2 inspections. Staff said they felt listened to and were able to speak up if they needed to. Staff had only positive things to say about the provider and registered manager and were happy with the changes being made, such as the new electronic systems. The provider had engaged with people, relatives and staff, although improvements could be made around how they fed back the findings of surveys. The provider had submitted notifications to CQC as required since the last inspection.

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 (published 3 February 2023) and we found breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The provider had previously been served with a notice to impose conditions on their registration which continued following the last inspection.

At this inspection we found the provider remained in breach of some regulations, however improvements had been made.

This service has been in Special Measures since 2 February 2023. During this 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 inspection was carried out to follow up on action we told the provider to take at the last inspection. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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.

We have found evidence that the provider needs to make further improvements. Please see the Safe, Effective and Well-led sections of this full report.

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

Enforcement

We have identified breaches in relation to the assessment of risk, mental capacity, record keeping and 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 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 View Care Home Ltd is a residential care home providing accommodation for persons who require nursing or personal care to up to 33 people. The service provides support to older people, some of who lived with dementia. At the time of our inspection there were 32 people using the service.

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

Risks to people's safety had not always been identified. Risk assessments did not have all the information staff needed to keep people safe. Medicines management was poor. The provider could not be assured that people had received their medicines as prescribed.

The service was not always well led. Records were not always robust and accurate. The provider had failed to identify issues relating to risk assessments, staff recruitment, safeguarding, mental capacity and medicines management. Their quality monitoring processes had not identified issues with records that we found on inspection.

Assessments of staffing levels were undertaken by the registered manager. However, it was not clear how the data collected informed the staffing rota. There were not enough staff deployed to provide safe care in the afternoon and at night. People told us this meant they had to wait for care, and they were sometimes incontinent as a result.

Staff understood their responsibilities to protect people from abuse. Staff described what abuse meant and told us how they would respond and report if they witnessed anything untoward. However, staff had not always identified and reported potential abuse appropriately.

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 supported this practice.

Most staff had received training relevant to their roles, however some staff required training in catheter care and fire drills to make sure they could meet people’s needs effectively.

Despite the feedback above, people and relatives told us staff were kind, caring and friendly. Comments included, “I like them”; “Very friendly, I can’t complain”; “They are friendly, helpful and knowledgeable. If I am concerned about something, I can go to any of them and ask questions. I can ring as well”; “They are kind. They say hello and look after me”; “I have my privacy” and “They shut the door when changing me.”

Staff had been recruited safely to ensure they were suitable to work with people. People had regular staff who they knew well.

We were assured that the provider was admitting people safely to the service. We were assured that the provider was using personal protective equipment effectively and safely. The service was clean.

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 22 September 2021) and there were breaches of regulation. We took enforcement action and served the provider conditions on their registration. 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 has now been rated inadequate. This service has not been rated good for the last five consecutive inspections.

At our last inspection we recommended that the provider sought advice from a reputable source, to suitably assess the numbers of staff needed to meet people's needs and aid the deployment of staff. At this inspection we found the provider had not acted on the recommendation.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We received concerns in relation to the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led. As we found a breach of regulation in relation to mental capacity and DoLS we extended the inspection to include the effective domain.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. 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 View Care home Ltd on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safeguarding people from abuse, risk management, medicines management, staff deployment, mental capacity and DoLS, failure to provide care and treatment to meet people's assessed needs, continuous improvement, informing CQC about notifiable events and good governance 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 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 work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Valley View Care Home Ltd is a residential care home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service has two floors and is purpose built. The service can support up to 33 people.

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

People told us they were happy living at Valley View Care Home. Relatives told us, “I would recommend Valley View because the staff are friendly, and they will take time out with mum. For example, [activities staff] sat in the garden with mum so she could have her dinner out there” and “Valley View is really, really good due to the attention to detail of the staff. They are absolutely brilliant.”

Risks to people's safety had not always been identified. Risk assessments did not have all the information staff needed to keep people safe. Medicines management was poor. The provider could not be assured that people had received their medicines as prescribed.

We were not wholly assured that the provider was promoting safety through the layout and hygiene practices of the premises. Cleaning records did not evidence that additional cleaning of high touch areas such as switches and handrails had been cleaned in line with infection control guidance. Infection control audits had not been reviewed and amended to reflect the COVID-19 pandemic.

Staff had not always been safely recruited, the provider had not ensured that each staff member had a full employment history. Pre employment checks had been carried out, such as Disclosure and Barring Service (DBS) criminal record checks and reference checks.

The service was not always well led. Records were not always robust and accurate. The provider had failed to identify issues relating to risk assessments, staff recruitment, medicines management and records we had identified. Registered persons had not always notified us of incidents relating to the service. These notifications tell us about any important events that had happened in the service.

Assessments of staffing levels were undertaken by the registered manager. However, it was not clear how the data collected informed the staffing rota. Most staff said there was not enough staff in the mornings to meet people’s needs which included ensuring people had time to engage and participate in meaningful activities. We made a recommendation about this.

We were assured that the provider was admitting people safely to the service. We were assured that the provider was using PPE effectively and safely.

Staff understood their responsibilities to protect people from abuse. Staff described what abuse meant and told us how they would respond and report if they witnessed anything untoward.

People were treated with dignity and respect. People’s views about how they preferred to receive their care were listened to and respected. People and relatives told us staff were kind and caring.

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.

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 20 December 2019).

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 not been made and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 17 October 2019. Breaches of legal requirements were found in relation to safe care and treatment, dignity and respect and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led which contain those 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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings at this inspection.

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

Enforcement

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 to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, management of medicines, infection prevention and control, safe recruitment practice, good governance and notifying CQC of incidents that had occurred.

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 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 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.

Valley View Care Home Ltd is a residential care home providing nursing and personal care to older people and people living with dementia. Some people were cared for in bed. At the time of the inspection, 24 people were using the service. The service can support up to 33 people.

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

Medicines were not always well managed. Medicines stock did not always tally with records. Records did not always detail when people had been administered medicine. The process for medicines for disposal and return was not robust.

People were not always treated with dignity and respect. People’s views about how they preferred to receive their care were not always listened to and respected. Some people felt their dignity had not been upheld.

Fire safety risks had not always been assessed and well managed. Moving and handling equipment such as hoists and stand aids had been stored in the corridors on both floors on both days of the inspection. This restricted the width of the corridors which would hinder evacuation using emergency evacuation equipment if there was a fire. This is an area for improvement.

Complaints records did not always evidence what the outcome of the complaint was and how this had been communicated to the complainant. This had not followed the provider’s complaints procedure. This is an area for improvement.

There were systems in place to check the quality of the service. However, these systems were not always robust, they had not identified the concerns we raised in relation to management of medicines, fire safety and treating people with dignity and respect.

People felt safe living at Valley View Care Home. Staff had the knowledge and training to protect people from abuse and avoidable harm. Staff had received training to enable them to meet most people's specific health needs. People had choice over their care and support and their choice and privacy was respected by staff. Most people told us staff were kind and caring. Comments from people and their relatives included, “Feel is going well. It is lovely place”; “Staff are nice and very polite” and “Staff are kind and caring.”

People had access to a range of different activities throughout the week. People told us that they took part in these and that they were enjoyable. Activities were also provided for people who received their care and treatment in bed.

People received good quality care, support and treatment including when they reached the end of their lives. People had been involved in planning and discussions about their wishes and preferences in relation to their end of life care.

When people needed medical attention, this was quickly identified, and appropriate action was taken. For example, if people were losing weight referrals were made to dieticians, or if people fell regularly they were referred to a fall’s clinic. Nursing staff worked closely with the GP and advanced care practitioner who visited the service regularly.

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.

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 08 November 2018) and there were three breaches of regulation. 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 not been made sustained and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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 View Care Home Ltd is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Valley View Care Home Ltd is registered to provide accommodation, nursing and personal care for up to 33 people. It can accommodate older people and people who live with dementia. There were 25 people living at the service at the time of our inspection.

We last inspected Valley View Care Home Ltd on 19 December 2017 when five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. At the previous inspection we issued requirement notices in relation to the failure to assess or mitigate potential risks to people, failure to ensure people’s basic rights were promoted within the principles of the Mental Capacity Act 2005, care plans were not personalised, staff had not received the knowledge, skills and guidance to meet people’s needs, management of medicines and the auditing systems had not been effective.

The service was run by a company who was the registered provider. 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. In this report ,when we speak about both the company and the registered manager, we refer to them as being ‘the registered persons’.

At the last comprehensive inspection, the service was rated ‘Requires Improvement’ overall with safe rated as Inadequate and caring and responsive being rated as Good. We told the registered persons to send us an action plan stating what improvements they intended to make and by when to address our concerns and to improve the key questions of ‘safe', ‘effective’ and ‘.well-led' back to at least, 'Good'. After the inspection the registered persons sent an action plan and told us that they had made the necessary improvements.

At this inspection, some improvements had been made and two of the five breaches of regulations were now met. However, sufficient steps had still not been taken to address the three remaining breaches of regulations. This was because people had not consistently received safe care and treatment. In particular, potential risks posed to people had not been assessed and mitigated. Some staff had not received the appropriate support, training and supervision to carry out their roles. Furthermore, the registered persons had still not established robust systems and processes. As a result, they had not ensured the smooth running of the service so that people consistently received the high-quality care they needed and had the right to expect.

As a result of continuing breaches of regulations the overall rating for this service is ‘Requires Improvement’. This the was the second consecutive time the service has been rated as ‘Requires Improvement.’

Staff had not always received the training they required to meet people’s needs, including their specialist needs. Some staff had not received supervision in line with the provider’s policy. New staff completed an induction prior to working in the service. Safe recruitment procedures were followed to ensure staff were safe to work with people.

Care plans did not always contain up to date information to inform staff how to meet people’s needs. The systems in place for the review of people’s documentation were not effective. People’s needs were assessed before they moved into the service.

The governance and auditing systems were not effective. They had not highlighted the concerns we found during our inspection. There was a lack of systems to monitor and improve the quality and safety of the service that was provided to people.

There were shortfalls in the maintenance of the building relating to fire safety. People were protected from the risk of infection and contamination. The service was clean and odour free. The design and decoration of the service met people’s needs.

Medicines were observed to be administered safely by registered nurses. Systems were in place for the ordering, obtaining and returning of people’s medicines. Nurses had received training in the safe administration of medicines and their competency had been assessed by the registered manager.

People felt safe and were protected from the potential risk of harm and abuse. Staff understood their responsibilities for safeguarding people and followed the provider’s policy and procedure. There were enough staff to meet people’s needs.

People were encouraged to make their own choices about their lives. 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.

Staff were kind and caring towards people. Staff respected people’s privacy and dignity. Staff knew people well and had knowledge about people’s histories, likes and dislikes.

People were supported to maintain their nutrition and hydration. Appropriate referrals were made to health care professionals when concerns had been identified. People were supported to remain as healthy as possible.

People were encouraged to maintain and increase their independence. People were supported to maintain relationships with people that mattered to them.

There were a range of activities available to people to meet their needs and interests.

People were supported to express their views and were involved in the development of the service they received. Complaints were investigated and responded to in line with the providers policy.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating on a notice board in the entrance hall and on their website.

You can see what action we have asked the provider to take at the end of the report.

Valley View Care Home Limited is registered to provide accommodation and personal care with nursing for up to 33 people. There were 30 people living at the service at the time of our inspection.

People living in the service required registered nurses and care staff to provide their nursing care and support needs. Some people were living with dementia and some people had medical conditions such as diabetes or respiratory conditions and some people were recovering from suffering a stroke. Most people living in the service needed some support to move around. Some required the support of one staff member to move around whilst others required the support of two staff. Some people needed staff to support them to move by using a hoist. Some people were unwell and nursed in bed and others chose to be cared for in bed.

The service was set out over two floors with a passenger lift to take people between floors. A large communal lounge was available for people to sit together if they wished and a spacious dining area where people could eat their meals if they chose to. A small conservatory was also accessible for people.

A registered manager was employed at the service and had been in their role for a number of 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.

The provider had previously been registered with the Care Quality Commission (CQC) at this location. However, they had changed the legal entity of this service and this required them to apply for a new registration with CQC, which commenced on 23 December 2016. The service had continued within the same premises and with the same staff team and registered manager. This was the first inspection under the new registration. However, you can find previous inspection reports on the CQC website.

We found there were areas of the care and support at the service that required improvements to be made.

Some elements of how the administration of people’s medicines was managed needed improvement. Prescribed thickeners to add to people’s drinks to prevent choking were not stored or administered safely. Medicines audits did not highlight concerns found.

Individual risks had not always been fully assessed with the steps and guidance required to keep people safe. Accidents and incidents were not always recorded appropriately by following the processes in place. There were areas of concern regarding security within the premises to ensure people remained safe.

Nurses and staff did not always have the training required to carry out their role. Many staff had not completed the mandatory training required. Some important training had not been undertaken by nurses and staff. Staff had not always had the opportunity to take part in regular supervision sessions to aid their personal development.

People had not been supported appropriately to make decisions and choices when they may lack the capacity to do so. Any decisions made had not been made in their best interests.

Nurses and staff did not keep consistent records of people’s care. Daily recording charts were not always completed. Care plans were in place but not always up to date or consistently capturing people’s individual care and support needs or preferences.

The provider had monitoring and auditing processes in place to check the quality and safety of the nursing care provided. However, these audits were not completed robustly or regularly. They did not identify concerns we had found during the inspection and did not always record the action required when areas for improvement had been found.

Suitable numbers of staff were employed to provide the care and support required. Some parts of the day did not appear to have the numbers of staff required to ensure people always received the care they needed and wished for in a timely way. We have made a recommendation about this.

Effective recruitment procedures were in place to check that staff applying for positions were of good character and suitable to provide care and support to people living in the service before they were employed.

The premises were clean and well maintained providing a pleasant environment to live in. All areas of the home were accessible to people no matter what their mobility needs. All essential servicing of utilities and equipment were carried out at appropriate intervals as advised by the relevant professional bodies. Fire testing, servicing and evacuation drills had been completed and recorded.

People were supported to gain access to health care professionals when their health needs changed and they became unwell and to maintain their health and well-being. People were very complimentary about the food and the choices they had at mealtimes. People’s specific dietary requirements were met and kept up to date.

People and their relatives had very positive comments to make about the staff and their caring attitude. Staff clearly knew people well and created an environment where people felt safe and comfortable.

Activities were provided to suit the preferences of people living in the service. An activities coordinator planned activities and external entertainers were also regular visitors to the service.

Complaints were dealt with by the registered manager and they shared outcomes with the staff team to make sure lessons were learned. The registered manager had a range of initiatives in place to gain the views of people in order to improve the service provided. The provider carried out an annual satisfaction survey with people and their relatives. They analysed the results and comments made to improve areas identified.

We received many positive comments from people, relatives and staff about the registered manager and how they managed the service. They were seen to be approachable with an open door culture to listen to views and concerns.

During this inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report.