Vale View Heights

Vale View Heights is a residential care home providing personal and nursing care to 32 people at the time of the inspection. The service can support up to 55 people. The service provides accommodation over two floors in a large, extended building set in mature grounds with views over the Sid Valley. Many bedrooms have en-suite facilities, and some have patio areas or balconies overlooking the gardens.

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

There had been several changes within the management team since our last inspection. People’s relatives told us they had found the changes in management impacted the leadership of the service. One relative said, “There has been some lack of leadership and a high staff turnover.” A second relative told us, “They seem to change the managers a lot.” Health professionals told us communication issues had been causing concern for some months and were exacerbated by the changes in management and contact from additional support managers, because health professional were not clear who was responsible for what or who they should communicate with. At the time of this inspection staff were taking action to improve partnership working. One health professionals told us, “We are now starting to see some improvements.”

A new manager, who had already been working at the service for an extended trial period, was appointed during this inspection. People, relatives, staff, and health professionals all told us they had seen improvements over recent months. One member of staff said, “It’s going better now, we’ve got more staff and the new managers have bought a few changes so it’s so much better now.” Another staff member said, “The quality of the care is better now it is under new management, it’s going very well.”

People, staff and relatives told us the culture of the service was improving. One relative said, “It’s friendly and welcoming, [Name] always talks positively about the home.” A second relative said, “The atmosphere is a lot better, more friendly.”

Systems to monitor quality performance continued to develop and embed. There was evidence these systems were now identifying where improvements were required, and progress was being monitored in a systematic way.

People’s risks were assessed and regularly reviewed, and care plans accurately reflected people’s level of risk. People’s pressure areas were well managed and weekly clinical governance meetings were held to review people’s risks. Medicine administration systems were well managed, and people received their medicines as prescribed. People and their relatives told us they felt safe. One relative said, “I feel [name] is safe at the home.” Another relative said, “[Name] is safe, the carers are very nice.”

Incidents and accidents were regularly reviewed to identify any actions that could be taken to minimise the risk of the same thing happening again. Staff were recruited safely and there were enough staff to meet people’s needs. Systems were in place to ensure the safety of the premises was well managed.

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’s needs had been assessed and care plans contained information about people’s health needs, and how staff should support them. Care plans included a detailed summary which gave staff a good overview of people’s needs, for example if they needed assistance to mobilise or required a modified diet. We received positive feedback about the quality and variety of the food. One person said, “The food here is excellent.” Another person told us, “The food is excellent, and they ask us to recommend meals we like, for us to add them on the menu.”

Systems were in place to ensure staff completed appropriate training and new staff completed mandatory training prior to starting work. One staff member said, “The training is good, and quite exciting, they are all very helpful.” Staff were supported with regular supervision.

People were supported to stay active, to develop and maintain social relationships and to take part in a range of social activities. Organised group activities included exercise classes, music, bingo and a weekly quiz and equipment was provided for people to maintain personal hobbies, such as painting and pottery. Children from a local playgroup made regular visits during the school holidays. One person said, “I come alive when the little people visit.”

The home’s minibus was used for regular outings, and staff organised surprises and events around people’s individual interests. For example, one person had sung with a local chamber choir for many years before moving to Vale View Heights. Staff organised for the choir to visit the home and perform for the person’s birthday celebrations. Their relative told said, “It was amazing.”

People’s relatives told us care was provided in line with people’s personal preferences. One relative said, “[name] goes to bed and gets up when she prefers.” A second relative said, “They make their own choices.” A ‘resident of the day’ system was in place. Senior staff from each department completed an information return with the person which was collated and used to update care plans. This included information about food preferences, maintenance requirements or any person specific issues. People’s families were asked to contribute to the review and updated with any changes.

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 (25 January 2022).

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.

At our last inspection we recommended the provider ensure all care plans fully reflect people’s assessed needs and choices. At this inspection we found improvements had been made.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 17 and 25 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, consent, and good governance.

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, Responsive and Well-led.

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 good. 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.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Vale View Heights is a residential care home providing personal and nursing care to 32 people at the time of the inspection. The service can support up to 55 people. The service provides accommodation over two floors in a large, extended building set in mature grounds with views over the Sid Valley. Many bedrooms have en-suite facilities, and some have patio areas or balconies overlooking the gardens.

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

People’s individual risks were not always effectively monitored and managed, and some care plans lacked detail about how to manage people’s clinical conditions. Where people were being assisted to reposition, records were not consistently completed so it was not possible to know if they had been assisted at appropriate intervals. Application of people’s prescribed creams was not consistently recorded.

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 did not support this practice.

Systems had not been put in place to ensure people’s rights were protected under the Mental Capacity Act. At the time of inspection, staff and management were not clear who was being deprived of their liberty, which applications had been made and which had been approved. Audit systems had not identified inconsistencies and errors within care plans. No mental capacity assessments had been completed in advance of applications to deprive people of their liberty, nor had they been reviewed or completed since this was identified during our last inspection.

Some systems and processes had been introduced at both management and provider level to monitor quality performance. However, these were not yet embedded and were not robust. They did not always identify where improvements were required. Care records were not being consistently completed, and so it was not possible to audit them effectively. For example, one person had no care records recorded on a total of eight days in November 2021, and a second person had no care notes recorded for six days.

People living at Vale View Heights had care plans in place, however, these did not always contain sufficient detail and the care received did not always reflect their personal preferences. Four people we spoke to raised concerns that they were not able to have a bath or shower when they wanted one. Records showed that people were being assisted to have baths or showers and staff told us people would be assisted at a time of their choice. The manager told us they would address the feedback from people.

Care plans contained limited information about people’s wishes as they neared the end of their life, however, we had not received any concerns about the care people received at the end of their lives and the service worked with other health professionals where appropriate. One bereaved family thanked the staff for the care they gave their loved one at the end of their life. They said, “I cannot express how much you assisted at a very difficult time. He was kept comfortable and pain free.”

People and their families told us they felt safe at Vale View Heights. One person said, “I still have some of my independence but there’s help around if I need it. I feel very safe here.” Staff were recruited safely and there were enough staff to meet people’s needs.

New electronic systems had been introduced to assess risks to people, and assessments had been completed. Work was ongoing to ensure these risks were reflected in people’s care plans. There was up to date documentation related to the safety and suitability of the premises. This included fire, gas and electrical safety checks and water temperature checks. Equipment used to assist people had been serviced.

Improvements had been made to infection prevention and control, and we were assured that current UK Government guidance was being followed. Changes were being made to ensure it would be easier to reduce the spread of infection, such as caring for people with similar needs in the same part of the building, meaning staff could co-hort more effectively in the event of an outbreak.

Systems had been implemented to ensure staff completed appropriate training. Staff had completed a range of essential training to ensure they were able to meet people’s need safely. This was being supported with a developing programme of more specific and clinical training, such as diabetes management.

A new electronic care planning system had been introduced and went ‘live’ three weeks before our inspection. This system needed time to embed and to allow time for people’s care plans to be developed to reflect their assessed needs and individual choices. People were asked what they would like to eat immediately before the mealtime and were offered a range of options. We received mixed feedback about the quality of the food. One person said, “The quality of the food is okay, but I think it could be better with a bit of imagination.” Another person said, “It’s okay and there is choice, but it should be better.” People’s needs were met by the adaptation, design and decoration of the premises.

People were treated with respect and kindness, and their privacy was respected. Staff were responsive to people’s needs and addressed them promptly and courteously. Staff knew people well. For example, staff knew people’s daily routines without referring to documentation. We observed many instances of genuine warmth between staff and people. People’s families felt staff were caring. One told us, “All the staff seem friendly.” Another family member told us their loved one says, “you couldn't have found a better home for me.” We saw people being supported to express their views and make decisions regarding how they spent their day.

A new manager was in post and had applied to CQC to register. They had addressed a significant number of concerns identified at our last inspection in a relatively short period of time. The manager and provider had worked openly with both CQC and the Local Authority since the last inspection and were open and transparent about things that had gone wrong and the progress made. Quality assurance systems were being developed in order to maximise the effectiveness of the new care planning system. The regional operations manager, who was new in post, told us a system was being developed to ensure greater depth of regional and provider oversight. This included oversight of the quality and consistency of care plans.

The culture of the service had improved, and we received positive feedback from people, their families and staff. One person told us, “I think it’s improved lately.” A family member said, “The home seems in a better place now [manager] is there.” And another said, “Compared to how it was before they have made wonderful changes.” Comments from staff members included, “It’s better now, it feels better going to work.” “It's a happy home, nothing is too much trouble [for the manager], I think the residents are happier.” “It's a great place to work, the atmosphere is great. It's a happy home” and, “I think [manager] is amazing, she's putting in the right plans, stepping in the right direction, she really cares about what goes on here. It feels like she's really trying to build a team.”

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

This service was registered with us on 02/09/2019 and this is the first five key question inspection.

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 sustained and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 improvements. Please see the safe, effective and well led sections of this full report.

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 inspection, by selecting the ‘all reports’ link for Vale View heights 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 breaches in relation to safe care and treatment, need for consent and good 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 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.

Holmesley Care Home is a residential care home providing personal and nursing care to 47 people aged 65 and over at the time of the inspection. The service can support up to 55 people. The service provides accommodation over two floors, with access provided by a passenger lift. There is office and training space on the third floor. Many bedrooms have en-suite facilities and patios leading to the mature gardens.

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

Shortly after our second day of inspection, the home reported an outbreak of Covid-19. As the outbreak progressed most of the people living at the home tested positive for Covid-19; some people died both at the home and following admission to hospital. Many of the staff team were also affected. Effective measures to prevent the spread of infection were not put in place at the beginning of the outbreak. We received concerns highlighting poor leadership decisions in relation to the management of Covid-19. There is a current Police investigation into the circumstances of the outbreak of Covid-19. No conclusions have yet been drawn.

Once it became clear there was an outbreak of Covid-19, the provider worked closely and openly with the local authority and CQC to ensure people’s safety. A Senior Infection Prevention Control Nurse visited Holmesley Care Home on 11 March 2021 to provide support and advice regarding management of the outbreak. They told us that they “found no major grounds for concern in current practice but was able to make some suggestions as to making things closer to best practice in challenging circumstances. Holmesley Care Home was not found to be an outlier in safe practice, at this stage, having addressed a number of significant issues in advance of the visit (isolation and PPE use).

People were at risk of neglect and abuse because systems were not in place, or not operated effectively, to identify concerns. Systems and processes were not robust enough to identify where things had gone wrong, so lessons could be learnt. People’s needs were not always fully assessed, and poor record keeping meant the home was unable to demonstrate care delivery. However, people told us they felt safe, responded well to staff and looked relaxed and at ease with them.

There were widespread and significant shortfalls in the way the service was led. Systems and processes to monitor quality performance were either not in place or not effective, and the structure and responsibilities of the staff team were not always clear.

Some care plans frequently lacked specific detail and instructions, others contained good information. Daily records and charts were not sufficiently detailed to demonstrate what care had been provided or how that person’s day had been. Some people’s records indicated they had not been checked for long periods of time.

Staff had a lack of understanding of their roles and responsibility under the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) procedures and decisions were being made for people outside of the framework of the MCA.

Systems that had previously been in place to review risks to people such as falls, accidents and incidents had not been maintained.

There were process in place to monitor staffing levels and staff were recruited safely. Some staff told us they felt the atmosphere in the home was positive. One said there was a "good atmosphere", another told us they "instantly fell in love with the atmosphere."

The service worked well with other professionals. Whilst records relating to partnership working were not always correctly completed, visiting professionals were complimentary about the home and the registered manager. One said "Holmesley work in partnership with any cases I am managing and the [registered] manager's knowledge of residents likes, dislikes, family dynamics and this information is so important."

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

Rating at last inspection

This service was inspected but not rated (published 30 October 2020)

Why we inspected

We undertook this targeted inspection to follow up on specific concerns we had received about the service. These included concerns about low staffing levels, staff not treating people with dignity and respect, people not receiving care in a timely way (or at times that suited them), a lack of staff training and unsafe moving and handling practice. A decision was made for us to inspect and examine those risks.

During this inspection we found concerns about people not receiving care in a timely way (or at times that suit them) and people waiting long periods of time for assistance were partly founded. This was because records did not demonstrate that appropriate care had been provided. Concerns over a lack of staff training were founded, however, we were satisfied that staff had sufficient training in moving and handling and we did not identify any unsafe practice. Concerns about staff not treating people with dignity and respect were not founded at the time of the inspection. We did not find concerns around low staffing levels.

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.

On the first inspection visit we found concerns with infection prevention and control procedures, records relating to the delivery of care and people’s needs and choices not being assessed in line with current legislation. Because of these shortfalls we widened the scope of the inspection to become a focused inspection which included the key questions of Safe, Effective and Well-led.

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

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

This service had not previously been rated following the CQC comprehensive inspection process of rating all five domains. Therefore, for the purposes of this inspection, we have rated three key questions but have not given an overall rating.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Holmesley Care Home 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 breaches in relation to safety of care, safeguarding, person-centred care, the need for consent and governance at this inspection. We took urgent action to impose conditions on the providers registration.

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.

Please see the action we have told the provider to take at the end of this report.

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

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.

Holmesley Nursing Home is a 'care home' providing personal and nursing care to 42 people aged 65 and over at the time of the inspection. The service can support up to 55 people. The service provides accommodation over two floors, with access provided by a passenger lift. Many bedrooms have en-suite facilities and patios leading to the mature and well planted gardens.

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

This focused inspection was the first inspection of this service since it was newly registered on 30 August 2019. We do not look at all five key questions at a focused inspection. At this inspection we looked at Safe and Well-led.

People living in the home, staff and most relatives we spoke with praised the provider and management team for the improvements they had made. Comments included, “I have nothing but deepest, heartfelt praise for Holmesley. I cannot find enough adjectives to thank them”, and “It’s wonderful. It’s the only place in the world that would be good for her. They understand her”.

There were sufficient staff employed to meet people’s needs safely. There had been a higher than usual staff turnover in the first half of 2020. New staff had been carefully recruited and trained. Staff we spoke with said there was a very happy and positive attitude among the staff team. Comments included, “It’s lovely. We’ve come out the other end – it’s super. You can tell – the atmosphere is happy” and “I feel blessed to work in this home. We work as a team”. Relatives felt the staff team were now stable, and were satisfied there were sufficient staff, Comments included, “I am really happy, the carers there are lovely. They seem to maintain staff. There’s not a quick turnover”.

Improvements had been made to the admissions procedures, care planning and risk assessments. Staff understood the risks to each person’s health and personal safety and the actions they needed to take. A relative told us, “I have seen evidence of better recording. For example, lists on the bathroom door about checks made of oral hygiene”. We found medicines were stored and administered safely. The home had worked with the local pharmacy and health professionals to ensure people’s medicines were regularly reviewed.

Communication with people and their families had increased. This was particularly appreciated by relatives during the Covid-19 pandemic. A visitors’ room had been set up with a Perspex screen to enable visitors to enter from the outside and sit and talk with their loved-ones safely. This facility was widely appreciated by people in the home and their relatives. A relative told us, “They communicate individually with people. We got an explanation of the set-up, so they’ve been exceedingly safe”.

The home was well managed. Staff and relatives told us the new management team were approachable, willing to listen and open to suggestions and ideas on how to improve the service. Comments included, “Wonderful changes under {registered manager} and {deputy manager}. They are brilliant. When I say something, they will listen to me”.

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 We found care was taken to ensure people were safeguarded from the risk of infection. There was a team of housekeepers who took a pride in their work. All areas of the home were regularly cleaned. There were sufficient stocks of personal protective equipment and staff took all precautions needed to keep people safe.

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

Rating at last inspection

This service was registered with us on 30/08/2018 and this is the first inspection. The last rating for the service under the previous provider was Requires improvement, published on 10/01/2019

Why we inspected

The service was due to be inspected in the spring of 2020 as part of our regular planned inspections. However, due to the Covid-19 pandemic the inspection was postponed. During the first few months of 2020 we received concerns about falls, staffing, care planning and risk assessment. The service was the subject of a whole service safeguarding investigation led by the local authority and involving a range of health and social care professionals. We were given assurances that actions were being taken to improve the service. A decision was made for us to inspect and examine those risks at the earliest opportunity, when it was safe for us to visit the home.

We undertook a focussed inspection to review the key questions of Safe and Well Led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them

We found no evidence during this inspection that people were at risk of harm from the concerns raised earlier in the year. Please see the Safe and Well-led sections of this full report for further details of our findings.

The overall rating for the service remains unrated.

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.