Archived: The Vale Care Home

The Vale care home is a care home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. The service can support up to 40 people. The home is set over two floors with communal spaces on each level. There were also bathing and bedrooms on each floor. There was an accessible garden.

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

People and staff felt there was not an open culture at the service. All the staff reflected on the registered manager not being a visual part of the home. Staff did not always feel supported and had not received supervision. Audits had been completed, however these had not always reflected in actions being taken to address errors or drive improvements.

There was not always enough staff to support people’s needs. We found some errors in the recording of medicines which raised concerns to the administration being done correctly. People’s dignity was not always respected, and this had an impact on their needs and well-being. For some people this also impacted on their independence.

Staff understood the importance of safeguarding people from harm and had investigated any which were raised. However, the staff had not raised concerns in relation to verbal or physical aggression which had occurred, so they could be investigated. Some lessons had been learnt, however other lessons in relation to people’s behaviour had not always been addressed.

The meal experience was chaotic and did not always encourage independence. Staff had received mandatory training, however there was no training for people’s specific conditions, which could impact on the care they required. There was limited signage around the home to support people who may have a cognitive impairment and require support to orientate themselves.

Care plans had been completed and included people’s preferences and needs. However, for some people these wishes had not been provided due to lack of equipment or changes in people’s needs. Activities or stimulation had been restricted by the staff member in this role being diverted to support care needs. Information was not always provided in formats to support peoples understanding and verbal concerns had not always been recorded to show how they had been addressed.

The provider had completed risk assessments for people and there was detailed guidance available for staff which we saw was followed. Staff maintained good standards in hygiene to reduce the risk of infection. Staff had been recruited safely.

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 had received support with their health care needs and staff had raised referrals when people’s needs required additional support or guidance. Family and friends were made welcome to the home.

People and relatives told us the staff were friendly and caring. We saw how relationships had been developed and these made a real difference to the support people received.

The provider worked in partnership with health and social care professionals. We saw the home had displayed their rating on site and on their website. Overall, we had received notifications to events at the home, however we reminded the registered manager to ensure all areas were reported.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection - The last rating for this service was Good (27 April 2017)

At this inspection we found improvements were required and the rating had deteriorated to Requires Improvement with four regulation breaches. You can see the action we have asked the provider to take at the end of the report.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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.

There was a registered manager at this service. 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. At our last inspection in January 2014 the provider was fully compliant in all areas inspected.

During our inspection visit we observed that staff were friendly and approachable. They spent time sitting with people to offer them comfort or stimulation. We observed staff delivering care which met people’s individual needs and which supported them in a respectful and appropriate way.

There was training and processes in place to keep people safe and staff followed these. However due to the mix of people some people felt a little anxious sometimes. People’s physical and mental health was promoted. Staff were trained to care for people living with dementia. Medicines were stored appropriately and were administered and recorded as prescribed.

We saw staff ensured people were comfortable. We saw people were supported in a relaxed and unhurried manner. Staff were caring and communicated well with people. People were offered choices at meal times and were seen to enjoy their food.

Staff focused on people they were caring for rather that the task they were carrying out. Staff spoke in a positive manner about the people they cared for and had taken the time to get to know people’s preferences and wishes. Staff had a good understanding of people’s needs and this was demonstrated in their responses to people and recognition of when people required additional support.

People’s privacy was respected. People had their independence promoted. Where possible they were offered choice on how they wanted their care delivered and were given choices throughout the day. Staff responded to the body language of people who were without fluent verbal communication.

People were supported to maintain relationships with family and friends. Visitors were welcomed at any time. Records we looked at were not always personalised and had not always included decisions people had made about their care including their likes, dislikes and personal preferences.

There was a varied activity programme for people based on individual and group preferences. Suitable occupation was offered to people using the service. Activities also included one-to to-one time and outings, or time in pursuit of personal hobbies or interests.

People, relatives and staff spoke very highly of the registered manager and felt the home was well-led.

The registered manager was relatively new in post and managed in an inclusive manner, this was starting to be reflected in the service in so far as people and staff had their wishes and their knowledge of people respected. Staff were aware of their roles and responsibilities for people’s care. The registered manager had systems in place to review the service and to ensure the service responded to the on going needs of people.

Is the service safe?

Detailed assessments had taken place and care has been planned and delivered in a way that maintained each person's privacy, dignity and independence.

Medicines were managed safely and effectively.

People told us that they felt safe at the home. One person told us, 'The staff are very good. I don't think that we could get a better place than this'. Another person said, 'I am happy here'.

The staff we spoke with told us that they had recently undertaken safeguarding training. They also were able to describe how they would report any suspected incidents of abuse.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This meant that the service could identify the risks to people and had an adequate system of service improvement.

Staff were supported to undertake training relative to the needs of the people they cared for.

Procedures for dealing with emergencies were in place and staff were able to describe these to us. This meant that staff understood what to do in an emergency.

Is the service effective?

Staff had access to up to date information to help them meet people's needs. Body maps had been completed when it was noted that people had problems with the integrity of their skin and daily care records had followed through the progress of any skin problems. This meant that staff were able to track whether people's skin conditions had improved or not.

Staff we spoke with told us that care plans were easy to access and they provided detailed information about how people liked to be cared for.

A visiting professional told us that the home was effective in contacting them if a person needed to be reviewed. They also said that the staff were helpful and knowledgeable and they treated the people living at the home with consideration.

Is the service caring?

We observed staff speaking with people in a respectful manner and people appeared relaxed and comfortable in their surroundings. When speaking with staff it was clear that they cared for the people they supported.

One person told us, 'They treat me well and help me to keep my independence'. 'They give me the choice about how I like to be looked after, which soap and shampoo's I like to use'.

Is the service responsive?

The people we spoke with knew how to make a complaint if they were unhappy. We reviewed the records of complaints and found that they had been investigated and responded to in a timely manner.

Meetings had been held for people using the service. Various issues had been discussed, including an outside smoking shelter, the hot water system, how to celebrate birthdays and what meals people would like. We also found that activities had been discussed and people's opinion had been sought in relation to this.

Is the service well-led?

The manager was new in post and was in the process of registering with the Care Quality Commission.

The service had a quality assurance system in place. Records showed that incidents identified had been investigated and the causes of the issues identified.

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

People told us they were treated with care and compassion and the staff responded well to their needs or concerns. One person said, 'I'm very happy here, the staff are good and caring'. A relative told us, 'I think it's marvellous. The staff are so kind and thoughtful.'

We saw information regarding capacity and consent was not always in place. This meant the home could not always demonstrate how arrangements to seek people's consent to care or treatment had been agreed in the person's best interests.

We found people received appropriate nutrition. We saw people received a varied and healthy diet. People using the service spoke well of the food and were suitably nourished and hydrated.

We looked at the suitability of the environment to ensure people lived in a home where the d'cor and infection control standards were appropriate. We found the home was clean, safe and well maintained. There were systems in place to ensure that the premises and equipment were suitable and remained in good condition.

Records were stored safely and correctly and systems were as required. This ensured people's confidential information was stored appropriately.

Our observations of staff interacting with people at The Vale showed that there was a level of respect and understanding, with staff taking the time to reassure people while talking to them in a friendly manner. We spoke with two people who live at the care home about their care, and they said they thought they were well cared for. One person said: 'The staff are very good, I have no complaints at all.' A second person said: 'The staff are lovely, they really care.'

Our observations during our inspection visit did not raise any questions or issues with regard to peoples' safety at the care home.