The Vale Care Home

The Vale Care Home is a residential care home providing personal and nursing care for up to 40 people aged 65 and over. At the time of the inspection 26 people were being supported. The home provides accommodation over two floors, communal areas, bedrooms and bathrooms were on each floor.

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

Improvements had been made in response to our last inspection findings. These improvements needed to be embedded and sustained by the provider.

Systems had been improved to reduce the risk of harm to people. Most people or their representative knew how to raise a concern and who to.

The impact of people’s health conditions, skin breakdown and harm had been reduced through assessment, support and monitoring by staff.

Measures were in place for the safe emergency evacuation of people.

People were supported by enough staff to meet their needs. The provider was recruiting more staff to work at the service to reduce the impact on staff working additional hours and to reduce the need of agency staff.

People received their medicines as prescribed. Some improvements had been made in 'as required' medicine protocols. Medicine audits took place and action was taken when errors were identified.

The management of infection prevention and control practice had been improved. Personal protective equipment (PPE) was used by staff following the current guidelines to reduce the risk of cross contamination and transmission of COVID-19.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of Safe and Well-Led the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

The service provided support to five people with a learning disability. The provider took action immediately after the inspection to review the home’s statement of purpose and submit a notification to add people with a learning disability as a service user band. The registered manager had identified to the provider training to raise staff awareness and understanding in supporting people with a learning disability.

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 19 November 2021) and there were breaches of regulations. 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.

This service has been in Special Measures since 19 November 2021. 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

We carried out an unannounced comprehensive inspection of this service on 31 August 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. We identified breaches in relation to safe care and treatment 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 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.

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

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.

About the service

The Vale Care Home is a residential care home providing personal and nursing care to 36 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

The service lacked provider and management oversight, audits which had been completed had not identified where actions should be taken. Some areas had not been identified as requiring audits. The provider had not ensured good oversight of the home in maintaining people's care and safety. The registered manager was not supported in their role. Staff and people’s views were not always responded to, to show how improvements were being made.

The provider had not always worked with partners to maintain the environment, leaving some areas at risk of not being repaired to meet best practice or regulations.

Risk to people were not always assessed and actions taken to mitigate the impact. Measures were not in place for safe emergency evacuation. Staff recruitment was not robust to ensure staff were safe to work with people. There were not enough numbers of staff to support people’s needs.

Training was not in place for all areas to support the staff in their role. Staff supervisions were not always in place to support new starters or to review ongoing support needs. Safeguarding concerns were not always reported and people may not be protected from harm.

Infection prevention and control was not always well managed, some areas of the environment required attention to ensure it was kept clean and in good repair. Medication was not always managed safely, and some areas were not monitored effectively to ensure ongoing measures were put in place.

Care plans were not always up to date or did not contain important information about people’s life choices and ongoing care. Where people had behaviours which challenged, there were no consistent care plans or guidance for staff to know how to manage a difficult situation.

We found some areas were people’s dignity was compromised and this had not been recognised and audits of the recording charts had not been completed.

Staff were kind and committed to providing good care, however, felt restricted by the lack of support, training and organisation.

People enjoyed the meals and had been involved in the menu planning. Social activities were provided, and people had an opportunity to choose how to spend their day.

People’s health care had been monitored and referrals had been made to the required professionals to support health conditions. Good partnerships had been established with health and social care professionals.

There had been no complaints, and relatives and representatives felt able to contact the registered manager if required.

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 the service under the previous provider was rated Requires Improvement (Published 23 January 2020).

This was the first inspection with the new provider registered with us on 8 October 2020. At this inspection improvements had not been made/sustained, and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about infection control and whistle blower concerns. A decision was made for us to inspect and examine those risks.

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.

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 safeguarding, safety, staffing levels, training, and good governance at this inspection.

The provider responded swiftly to our concerns and has put an action plan in place to address the concerns raised and are working with us to monitor the service.

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.

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.