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.