Valeries Care Home and Valeries Home Care

Valeries Care Home and Valeries Home Care is a care home without nursing registered to provide accommodation and personal care for up to 15 older people. At the time of our inspection 10 people were living there. The home is a large, adapted building situated within a row of houses in a residential area of Crowthorne, Berkshire. The service offered ground and first-floor accommodation in individual bedrooms. The first-floor accommodation was accessed via a lift.

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

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. We considered this guidance as there was 1 person using the service who has a learning disability and or who are autistic.

People’s medicines were not always managed safely. Safeguarding incidents were not always investigated and managed effectively. The service did not always have effective infection prevention and control procedures in place. People were supported by staff who were suitable for the role. Feedback from people and relatives in relation to staff was positive.

People did not always receive person centred care. People’s mealtime experiences were not always positive. 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. Staff received training appropriate to their role and the service worked well with external health and social care professionals to achieve good outcomes for people. We made a recommendation in relation to people’s mental capacity assessments.

The provider had not ensured effective systems were in place to oversee the service and ensure compliance with the fundamental standards. This meant people were not always protected from the risk of harm. The provider failed to notify the CQC of allegations of abuse. Duty of candour is the requirement for the registered person to be open and honest with people when something goes wrong. The provider failed to demonstrate duty of candour was followed.

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 good (report published 11 March 2020).

Why we inspected

The inspection was prompted in part due to concerns received about people's safety, dignity, and infection control. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Enforcement and recommendations

We have identified breaches in relation to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, duty of candour and notification of incidents. We have made a recommendation to the provider regarding the assessment of people’s mental capacity. Please see the action we have told the provider to take at the end of this report.

We recommend the provider ensures staff have the knowledge and skills to complete and document accurate assessments of people’s consent to receiving care and support.

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

We found the following examples of good practice.

The provider followed current Government guidance to protect visitors from catching and spreading infection. For example, visitors were provided with personal protective equipment (PPE) to wear whilst visiting the home. Visitors, including health care professionals were asked to complete a lateral flow test and health care professionals were asked to provide evidence of their COVID-19 vaccination status before entering the home. Records demonstrated that all staff who worked at the home had been fully vaccinated against COVID-19.

People were admitted into the service safely. The provider ensured people had been tested for COVID-19 before admitting them into the home. Before the service admitted any new person whether from their own home, another care home, or hospital, the registered manager contacted the local authority task force, who provided an individual risk assessment, which staff then followed.

The registered manager highlighted the successful collaboration with the local authority task force as a major contributory factor in the effective management of infection prevention and control during the pandemic.

People and staff had risk assessments in place to identify their individual risks associated with COVID-19. We saw protective measures were in place to keep people and staff safe.

Staff had completed infection prevention and control training. During our visit we observed staff adhere to good practice in relation to PPE. The provider ensured sufficient stock of PPE and COVID-19 tests were available.

People consistently told us that staff made them feel safe. The provider had assessed the impact of staff wearing PPE on people's level of anxiety, particularly those who had limited or fluctuating mental capacity, and had implemented measures to provide reassurance to mitigate these concerns. Staff had adapted practice where required, for example; lowering PPE masks from an appropriate distance to aid communication via lip reading, to reduce the anxiety of a person who was hearing impaired.

The management effectively operated a ‘whole home’ testing programme, in line with national guidance, to ensure people and staff had adequate access to the COVID-19 testing. The provider had an infection prevention policy in place and contacted their local health protection team in a timely way in the event of a COVID- 19 outbreak.

Staff had a good understanding of COVID-19 symptoms that present in older people. The registered manager ensured the staff and people who presented with COVID- 19 symptoms were tested immediately.

The provider’s visiting policy ensured that individual risk assessments considered the human rights of people, as well as any vulnerabilities outlined in their care plan, and acknowledged the important role that visiting can play in this.

Valerie’s Residential Care Home is care home without nursing registered to provide accommodation and personal care for up to 17 older people. At the time of our inspection 13 people were living there. The home is a large adapted building situated within a row of houses in a residential area of Crowthorne, Berkshire. The service offered ground and first-floor accommodation in individual bedrooms. The first-floor accommodation was accessed via a lift.

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

People consistently told us they felt safe living in the home. Staff had completed required training and understood their responsibilities to safeguard people from discrimination, harm and abuse. Staff had identified risks to people and effectively implemented measures to ensure these were reduced and managed safely. All accidents and incidents were recorded and reviewed daily by the registered manager, who took prompt action to implement any lessons learned. People were supported by enough staff who knew them well and how to meet their changing needs. The provider completed thorough selection procedures to ensure staff were of suitable character to support older people and those living with dementia. People received their prescribed medicines safely, from staff who had completed the required training and had their competency to do so regularly assessed. People lived in a home which was clean, hygienic and well maintained.

Staff received regular supervision and annual appraisals to ensure they were fully supported in their role. There was an effective training programme that staff felt was interesting and well delivered. Staff were well supported in their roles and found the management team open, honest and approachable. People's dietary needs and preferences were assessed and where needed, people received support to eat and drink. The service worked well with other agencies to achieve good outcomes for people, who were supported to access healthcare services and support when required. The provider had made improvements to make the environment more suitable for older people and those living with dementia.

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 received care from staff that knew them well and treated them with kindness, compassion, respect and dignity. People's care was tailored to their individual needs and maintained their independence as much as possible. Care plans were detailed, person centred and reviewed regularly to ensure they reflected people's needs.

The service had an activity programme for people to enjoy if they wished. People had support to take part in activities and remain in contact with those important to them to prevent social isolation. People and their relatives knew how to complain and were confident their views would be heard. The service worked closely with healthcare professionals and provided compassionate end of life care, which ensured people experienced a comfortable, dignified and pain-free death.

The registered manager effectively operated quality assurance and governance systems to drive continuous improvement in the service. Staff worked well in collaboration with key organisations to ensure the safe and effective delivery of people’s care.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (report published 5 September 2017).

At our last inspection we recommended that the service reviewed its resources with regard to how it enabled people to carry out person-centred activities and encouraged them to maintain hobbies and interests. At this inspection we found that the provider had increased resources to improve people’s opportunity to engage in stimulating activities of their choice.

Why we inspected

This was a planned inspection based on the date we registered the service.

What happens next?

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.

Valerie’s Residential Care Home is registered to provide a service for up to 17 older people. Some people have conditions associated with growing older such as sensory and physical difficulties. There were twelve people living in the home on the day of the visit. The service offered ground and first floor accommodation in individual bedrooms. The first floor accommodation was accessed via a lift.

At the last inspection, on 19 October 2015, the service was rated Good. At this inspection we found the service remained Good in four domains which meant it was still overall Good. However, one domain required improvement.

Why the service is rated Good:

There is a registered manager running the service. 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 staff team’s knowledge and understanding of how to keep people and themselves safe contributed to ensuring people lived in a safe and secure environment. People continued to be protected from any form of abuse or poor practice and any risks were identified and managed to keep people as safe as possible. Staffing ratios were adequate to meet people’s needs safely. The recruitment procedures ensured appointees were suitable and safe to work with people. People were given their medicines in safely.

The staff team usually responded effectively to people current and changing needs. However, some improvements were required in this area. They ensured people’s health and well-being needs were met in a timely way. However there were two occasions, identified, when care plans were not followed and action with regard to health needs was not taken as quickly as it should have been.

People continued to be supported to have maximum choice and control of their lives. Staff offer them care in the least restrictive way possible, the policies and systems in the service support this practice. However, there was some confusion and lack of understanding of the Mental Capacity Act 2005, specifically with regard to Deprivation of Liberty Safeguards.

The relatively small and stable staff team remained kind, caring and committed to caring for people. They were knowledgeable about people’s individual needs. The staff team respected people’s equality and diversity needs.

People received good care from a well led service. The registered manager was experienced and qualified and listened and responded to people, staff and others. The management team were described as open, approachable and supportive. Record keeping needed some improvement as did clarifying the actions taken as a result of quality audits and reviews.

At our inspection on 16 June 2014 we found the provider had taken action to address this breach of the regulations. We found they had completed all required recruitment checks for staff employed by the service in the five files we looked at.

A full employment history had been recorded for care workers in each of the recruitment files we looked at. We saw evidence that gaps in employment history had been identified and investigated, with an appropriate written explanation recorded. Evidence of previous good conduct in positions of employment in a health and social care environment had been sought and verified. This had not always been possible, for example if the previous employer was no longer operating, or did not retain information about employees who had left the service after a certain length of time. In these cases, the provider documented the actions they had taken to verify the employee's previous character as far as they were able.

We did not speak with people who use the service during this inspection. We spoke with the head of care and business manager on the day of our inspection. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of our inspection. Their name appears because they were still the Registered Manager for this service on our register at the time. The head of care and business manager explained actions in place to manage the service until a new manager was appointed.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found.

Is the service caring?

At the time of our inspection 11 people lived at the home. We saw staff spoke with people respectfully, and provided support and reassurance when this was required. One person told us 'Staff care for me well', and another person said care workers 'Ask me what I want'.

Care workers told us they were aware of people's needs as these were recorded in their care plans. They explained they talked with people to ensure they provided care and support as the person wished, and involved relatives where this was appropriate to help them understand people's preferences. We saw this reflected in the four care plans we looked at. We saw relatives were encouraged to visit their loved ones, and invited to join them for meals.

Is the service responsive?

People's needs were assessed and documented before they moved in to the home, and information was reviewed monthly or as needs changed. The manager asked people for feedback, for example regarding care provision, activities and the menu. We saw people's comments were acted on. At the time of our inspection new furniture was being placed in the lounge. A relative had previously commented in a survey that the lounge needed 'smartening up'.

Is the service safe?

We saw records were completed, reviewed, stored and disposed of appropriately. This ensured information was up to date, and confidential data regarding people and staff was protected in accordance with the Data Protection Act 1998.

Regular quality audits ensured the service was maintained safely. Checks and audits ensured servicing and training were completed in accordance with the manufacturers' guidance and provider's policies. For example, all staff had completed fire awareness training and conducted fire drills to ensure they could deal with a fire safely. Fire equipment was serviced regularly. Risks that may harm people were identified, and appropriate actions put in place to reduce the risk of harm. Monthly audits were in place to recognise trends.

Staff recruitment files did not contain all the information required to demonstrate that staff were suitable to work with vulnerable adults. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have had to be submitted, proper policies and procedures were in place. The manager was aware of when an application should be made, and how to do so.

Is the service effective?

We saw care workers supported people in accordance with their care plans. Care workers told us they worked well as a team, and communicated effectively. This ensured all staff were aware of updates to people's care and support needs. The people we observed during our inspection appeared comfortable with staff, and able to request support when they needed it. We saw requests for support were met promptly. People and their relatives told us they were satisfied with the care provided.

Is the service well led?

We spoke with three people who lived at the home, and three relatives of people. They all told us the manager and staff listened to their requests and responded appropriately. One relative told us 'I'm looking for humanity, not perfection. The home is well run, the manager is receptive to comments, it's calm and peaceful here'.

Staff told us they felt well supported by the manager, and could make suggestions to improve people's care and support in the home. They told us they felt part of 'a family'. The provider sought feedback from people through surveys and meetings, and informally chatted with people to ensure their views were gathered. Quality audits ensured the service provided appropriate and safe care for people.

We spoke with three care workers. They explained actions they took to encourage people to maintain their independence. One care worker said 'I requested an adapted mobility aid to provide more appropriate support for a tall person'. Another care worker explained how they assisted people with tasks they found difficult. For example they ran water for people to an appropriate temperature, but supported them to maintain their independence by encouraging them to attend to tasks they could manage themselves.

We looked at staff rotas, and observed the level of staffing at the time of our inspection. We found staffing levels sufficient to safely meet the needs of people who use the service. For example, staff numbers were sufficient to safely support people with specialised equipment to help them to mobilise. People who use the service told us their care needs were usually met promptly. Staff told us they could spend quality time with people, and felt appropriately trained and supported to deliver care safely.

We observed that actions had been taken to ensure the location was safe for people who use the service. We saw the manager had taken appropriate actions to address concerns raised in a previous fire and rescue authority inspection. We spoke with two care workers, who told us they had attended training for new fire evacuation equipment. They said they had used the equipment to carry out a mock evacuation of care workers, and acted as people in need of rescue, to ensure they were competent in its use.

We saw evidence the provider conducted service quality assessment audits, and the manager had implemented a system of reviews and audits to monitor service provision. When an issue was identified we saw appropriate actions were taken and recorded to ensure the safety of people who use the service.

People were at risk of infection because cleaning procedures were inadequate. We found some areas of the home, such as the kitchen, had not been sufficiently cleaned.

One person we spoke with told us maintenance was an issue for them. A relative of a person who uses the service confirmed they had concerns about the upkeep of the premises. We spoke with the fire authority regarding the fire risks at the premises. The fire authority told us about risks to people who use the service, such as evacuation ability, the fire stairs and the stair lift.

We asked to see people's individual risk assessments and associated care plans to check for accuracy and quality. The manager was not able to show us how they audited care documentation. Although review dates had been recorded in each person's file it was not clear what these were conducted against or what changes were made by the care staff as a result.

We found the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.