We carried out a review of the data available to us about Vale House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Vale House, you can give feedback on this service.
Vale House is a residential care home providing personal and nursing care to 39 people aged 65 and over at the time of the inspection. The service can support up to 40 people in one adapted building. The service supports older people and includes support for people living with dementia.
People’s experience of using this service and what we found
People living at Vale House received safe care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place which incorporated their values.
Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Medicines were managed safely, and people received their medicines as prescribed. The provider had made significant changes and ensured there were clear processes and procedures to manage all aspects of medicines safely.
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 home was well-led by a registered manager who was committed to improving people's quality of life. We received positive feedback about the management of the home from people, relatives, staff and healthcare professionals. The provider and registered manager had made significant changes to improve people’s care. They had invested in an electronic recording system and were developing a more effective quality assurance process. The registered manager now had hands on support from the board of trustees’ members which allowed them better oversight of the service. The service had a clear management and staffing structure in place and staff worked well as a team. Staff worked well with external social and health care professionals.
Rating at last inspection and update
The last rating for this service was requires improvement (Published 16 March 2021) and there was a breach in relation to quality assurance systems. 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 improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
We carried out an unannounced focused inspection of this service on 15 January 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their quality assurance systems.
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 and well-led which contain those requirements.
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 changed from requires improvement to good. 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 Vale House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Vale House is a residential care home that provides personal and nursing care to 40 people in one adapted building. The service supports older people and includes support for people living with dementia. At the time of our inspection 40 people were being supported.
People’s experience of using this service and what we found
Medicines were not always managed in line with good practice guidance. Relatives were positive about the service and felt people were safe. People were supported by sufficient staff who were knowledgeable about their needs and had time to spend with them. There were effective infection prevention and control systems in place to ensure the risk of infection was managed.
Governance systems were still not always effective in identifying and addressing quality concerns. Everyone we spoke with was positive about the new registered manager and the improvement and changes they were making. Relatives told us they had regular contact with the service throughout the COVID-19 pandemic and they felt confident to raise any concerns. There was an open culture and staff felt supported.
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 19 December 2019) and there was a breach 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 not 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
We carried out an unannounced comprehensive inspection of this service on 19 December 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the systems designed to provide oversight and governance of the service.
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 and Well-led which contain those requirements.
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 from requires improvement.
We found no evidence that people had been harmed however, systems were either not in place or robust enough to demonstrate effective oversight of the service. We spoke with trustees following our inspection who gave reassurance as to how these concerns would be addressed. We will meet again with the registered manager and provider to discuss the next steps.
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 coronavirus and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Vale House 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 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 one breach in relation to quality assurance systems. 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 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.
Vale House is a residential care home providing personal and nursing care to 38 older people at the time of the inspection. The service can support up to 40 people.
People’s experience of using this service and what we found
Medicines were not always managed safely. The provider did not always ensure there were effective systems in place to monitor medicine stocks and storage of medicines where they needed refrigeration.
Vale House was not always well-led. The provider’s quality assurance systems were not always effective and not used to drive improvement. The provider’s internal processes and procedures did not always reflect the current good practice. There was the lack of evidence that meaningful staff supervisions took place and these did not provide identification of staff development opportunities.
We have made a recommendation about the provision of staff supervisions.
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 were supported to maintain good health and to meet their nutritional needs. However, the registered manager and staff were not aware of and had not implemented the current good practice around food textures. This is when people need thickened food or fluids due to swallowing difficulties.
People living at Vale House and their relatives told us they received safe care from staff that knew people well. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place.
Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs.
People and relatives told us staff were caring. Staff consistency enabled people to receive good care from staff who had a good rapport with people. People had access to activities to prevent social isolation.
Why we inspected
This was a planned inspection based on the previous rating.
Rating at last inspection and update
The last rating for this service was requires improvement (report published 14 November 2018) and there were multiple breaches of regulation identified. 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 some improvements had been made. However, some improvements made were not fully effective.
We have identified one breach of regulation in relation to quality assurance systems at this inspection. Please see the action we have told the provider to take at the end of this report.
The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Vale House 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. Vale House accommodates up to 40 people in one purpose built building. At the time of the inspection there were 38 people living at the service.
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. The registered manager was not present on the main day of inspection.
Services that provide health and social care to people are required to inform the Care Quality Commission, (the CQC), of important events that happen in the service. The registered manager did not always notify the CQC of reportable events.
The service did not always take the necessary steps to minimise the risks associated with people’s care. Accidents and incidents were not always managed effectively to prevent reoccurrence and support future learning. The provider’s procedures to formally assess, review and monitor the quality of the service were not always effective.
The service was not always responsive to people’s changing needs. People were not always supported by staff who had the skills and knowledge to carry out their roles and responsibilities effectively and the service did not always follow the principles of the Mental Capacity Act 2005.
The home had not involved or sought the advice from a pharmacist to ensure that the decision to carry out covert medication was appropriate in relation to any impact that this could have on the medicine and its effects.
People told us they were safe living at Vale House. Staff were aware of how to safeguard people from harm and were aware of potential risks and signs of abuse. There were enough staff to meet people’s needs.
People were supported appropriately to eat and drink sufficient amounts to help maintain their health and well-being.
People were very complimentary about the staff and management at the home. They told us staff were kind, caring and compassionate. Visitors were welcomed at all times and people were supported to maintain family relationships.
The provider had systems in place to receive feedback from people who used the service, their relatives and staff members about the service provided. People were encouraged and supported to raise any concerns with staff or management and were confident they would be listened to and things would be addressed.
Staff told us, and records confirmed they had effective support. Staff received regular supervision (one to one meetings with their manager) and yearly appraisals. The provider had safe recruitment processes in place, which helped to ensure that staff employed were of good character and suited to the roles they were employed for.
Infection control measures were in place to help reduce the risks of cross infection.
This is the first time the service has been rated Requires Improvement.
We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. 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.
Vale House is registered to provide accommodation for up to 40 people who require nursing and personal care. On the day of the inspection, there were 40 people living at the home. Vale House provides a service for people living with advanced dementia.
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. The registered manager was available throughout the inspection.
The service provided excellent and innovative person centred care that supported people to come to terms with difficult life changing events such as end of life care and bereavement. People were supported to maintain their interests by a staff and management team that not only respected the persons adult status, but also did not recognise any barriers in making things possible for people with dementia. Staff consistently demonstrated affection and warmth in their relationships with people.
The service was exemplary in responding to people’s needs and preferences. People were supported by a service that was devoted to getting to know the people and family’s they supported. Relatives told us the service was responsive and well managed. Relatives knew the registered manager. The service sought people’s views and opinions and acted upon them.
Relatives told us people were safe. People were supported by staff who could explain what constitutes abuse and what to do in the event of suspecting abuse. Staff had completed safeguarding training and understood their responsibilities. People received their medicines as prescribed. Staff administering medicines checked each person’s identity and explained what was happening before giving people their medicine. Where risks to people had been identified risk assessments were in place and action had been taken to reduce the risks. Staff were aware of people’s needs and followed guidance to keep them safe.
There were sufficient staff to meet people’s needs. Staff were not rushed in their duties and had time to chat with people. Throughout the inspection there was a calm atmosphere and staff responded promptly to people who needed support. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.
Staff understood the Mental Capacity Act (MCA) and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves.
People were cared for by a service that was devoted to getting to know the people they supported. There was a clear focus on the importance of knowing peoples histories and involving relatives at every point of peoples care.
Relatives told us they were confident they would be listened to and action would be taken if they raised a concern. We saw complaints were dealt with in a compassionate and timely fashion. The service had systems to assess the quality of the service provided. Learning needs were identified and action taken to make improvements which promoted people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.
Staff spoke positively about the support they received from the registered manager. Staff had access to effective supervision. Staff and the registered manager shared the visions and values of the service and these were embedded within service delivery.
We conducted a Short Observational Framework for Inspection (SOFI) and saw that people living with dementia were treated in a genuine, caring and respectful way that encouraged engagement and promoted their well-being.
We spoke with a relative of a person who used the service. They said "I know my mother is happy here. It is so much better than where she was before".
We looked at care plans, staff files, surveys and quality assurance documents. We found that people and their families were involved in their care and that they were safe and well cared for. Records at the service were well maintained and all documents were correct and up to date. We found the service to be safe, caring, effective, responsive to peoples' needs and well led.
Many people told us they ' liked the open spaces and the secure garden areas where people can walk around in safety '
During the visit we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences and staff interaction during this session were like.