Archived: St Valery Care Home

St Valery is an adapted family run residential care home established in 1992. It provides accommodation and personal care for up to 16 older people aged 65 and over with dementia type conditions. The premises have three shared rooms, but the provider and registered manager have chosen to use two of these for single occupancy only. The number of people accommodated at any one time is therefore 14. At the time of the inspection the service was full. A small annexe (York House) located in the garden area of the service is registered separately with the Care Quality Commission for three people with lower dependency needs. People from the annexe are supported by staff from St Valery and make full use of the facilities at St Valery for their day to day support.

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

Since the last inspection the interim manager has become the registered manager. The registered manager and staff have continued to drive improvements in the service, maintaining the outstanding level of care people received and promoting and achieving exceptionally positive outcomes for people.

People and relatives spoke positively about the service. People told us that they felt safe and found the service homelike. “It’s like living at home really.” The provider had ensured that people lived in a safe well-maintained environment, risks were assessed and managed. Any improvements made were with a view of enhancing peoples experience. There were enough suitable staff available to meet people needs.

The registered manager fostered a culture of placing people at the centre of everything they do and aspire to do at St Valery. They and staff were passionate about the people they supported living their life to the fullest in the least restrictive way.

Staff were highly trained and motivated. The registered provider and manager fostered a nurturing and empowering environment so that staff could develop and feel confident in their knowledge and skills. Staff enjoyed working in the service and felt valued and supported. Staff retention was therefore very good and provided people with excellent continuity of high-quality care. Peoples dietary and health needs were managed well, and health professionals told us the service referred to them appropriately. 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 and their relatives universally told us that staff were kind and caring. Their support was compassionate and there was thought given to way in which they supported to uphold people’s dignity. There was a busy but relaxed atmosphere within the service with lots of chatter, laughter and smiles between people and the staff supporting them. The culture was open and friendly, and visitors were made welcome. There was a sense that people, their relatives and staff knew each other well. A relative told us they thought people in the service were “treated as equals by staff and given their self-respect.” This approach extended to relatives with one who visited many times in the week saying they were treated by staff “like a pal.”

Staff were very knowledgeable about people's needs and supported people to remain as independent as possible. The service had earned an excellent reputation with local health and social care professionals who described the service as “one of the best” and “I have always found this service as one that others should take notes from,” The registered manager was a strong advocate for people needing the service who were diagnosed with dementia type illnesses. They and their staff continued to find new ways in which to support people in little but important ways that made their day to day experiences and outcomes consistently good.

The registered manager was a visible presence in the service and knew all the people, their histories and their status well. Both relatives and professionals we spoke with were complimentary of the service and the registered managers leadership and caring values which she promoted across all staff. People received high-quality person-centred care that met their individual needs.

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. (Report published 22 December 2016)

Why we inspected

This was a planned inspection based on the previous rating.

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.

This service was last inspected in September 2015 when we found the provider was not meeting all the regulations inspected at that time in regard to staff recruitment and training, staffs understanding of safeguarding people from abuse, medicines management needed improvement and the quality monitoring and assessment of service quality was not effective. We asked the provider to send us an action plan of what they intended to do to address these shortfalls which they did. This inspection found that the provider had implemented all the improvements they had told us about.

There was a registered manager in post but for personal reasons they had delegated day to day operational management of the service to an interim manager who had worked at the service for 25 years, and had the appropriate knowledge and qualifications to take on this role. An application to register the interim manager was currently being processed by the Care Quality Commission. A registered manager is a person who is 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.

People were provided with a safe, clean environment that was maintained to a high standard, with all safety checks and tests routinely completed. There were enough skilled staff to support people and provide continuity. Recruitment processes ensured only suitable staff were employed. New staff were inducted appropriately into their role, they received training to give them the knowledge and skills they needed to meet people’s needs. Staff felt listened to and supported and were given opportunities to meet regularly with senior staff on an individual basis or within staff meetings.

Staff understood how to keep people safe and protect them from harm, they understood how to respond to emergencies that required them to evacuate the building quickly and safely. It was recognised that for people with behaviour that could be challenging some restrictive practices were necessary to maintain people’s safety for example, the use of bed rails; although there was a clear culture of least restrictive practice embedded in the service. Risks were appropriately assessed to ensure measures implemented kept people safe. Medicines were managed appropriately.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been authorised for some people and others were waiting to be processed by the local authority to ensure the people concerned were not deprived of their liberty unnecessarily. People were encouraged by staff to make everyday decisions for themselves, but staff understood and were working to the principles of the Mental Capacity Act 2005 (MCA) where people could not do so. The MCA provides a framework for acting and making decisions on behalf of people who lack mental capacity to make particular decisions for themselves.

People’s privacy and dignity was respected. Staff spoke to people in a dignified way and we observed them discreetly intervening if they thought people needed help or support without drawing undue attention to them, this approach ensured the person's dignity was maintained.

Staff demonstrated kindness and patience in their contacts and engagement with people. They took time to listen and interact with people so that they received the support they needed. We saw many positive interactions between people and staff.

People’s health needs were monitored and referrals to health professionals made where needed. People were provided with a varied nutritious diet that took account of any specialist requirements they may have. People referred to the service had their needs assessed prior to admission to ensure these could be met. Care plans were detailed and personalised to guide and inform staff about individual needs and how these were to be supported.

Staff were enabled to spend time with people and facilitate activities to provide stimulation; external entertainers provided variety to the activities offered. Relatives felt confident of raising concerns and that these would be acted upon, they felt consulted and informed about their relative’s wellbeing. Their views were sought about service quality to inform improvements and service development. A range of audits provided assurance to the provider and interim manager that service quality was being maintained.

At this inspection we found that people's capacity to make their own decisions about sharing a bedroom and about having a 'do not resuscitate' order in place had been assessed. Where people could consent to this they had done so. Where they were unable to consent a decision had been made on their behalf by the appropriate person. The policy of locking the lounge doors had been reviewed. One door had been opened and risk assessments carried out for locking the other door to keep people safe. Records showed that staff had responded appropriately to changes in people's health needs. We found that action had been taken to ensure the premises complied with fire safety regulations and that staff understood what they needed to do to keep people safe in the event of a fire.

We found that people had not been asked for their consent before they shared a bedroom with another person. Where people were not able to make their own decisions about this the provider had not followed the law to ensure decisions were made in the person's best interests. Two bedrooms were regularly being used for hairdressing purposes without the consent of the occupants. Some people had written orders in place for them not to be resuscitated in the event of a health emergency. The records stated that they had not been able to consent to the decision. It was not clear how the assessment of their capacity to make their own decision around this matter had been carried out or that the proper process had been followed.

People were restricted in their movement around the service as the lounge doors were kept locked during the day. This meant that people could not freely access their bedrooms when they wanted to without asking staff first. People had not been asked to give their consent to this restriction.

People generally had their health and care needs met, but there was a lack of guidance for staff to be able to respond to sudden changes in health.

The provider had not ensured that an appropriate and up to date fire risk assessment had been completed and we found that some outstanding work to comply with fire regulations had not been completed. Staff were not clear about the procedures for evacuating the building in the event of a fire.

There were sufficient numbers of staff employed to meet the needs of people that used the service. The staff were appropriately qualified, but lacked some understanding around issues relating to consent.