We carried out a review of the data available to us about Cole Valley on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Cole Valley, you can give feedback on this service.
Cole Valley is a residential care home providing personal and nursing care to up to 45 people. The service provides support to older people, people with physical disabilities and people who are living with dementia. At the time of our inspection there were 15 people using the service.
The care home accommodates people in one adapted building over two floors, with bedrooms on the ground and first floor. People had access to three lounges, a dining room and a garden.
People’s experience of using this service and what we found
The new registered manager had made positive changes in the service and was supported by the provider and staff team. People, staff and relatives/representatives spoke positively about the management team and regular meetings were held so they could share their views on the home. Systems had been improved to ensure people’s care needs were being met and any areas for improvement were identified. These systems required time to embed into practice as the home grew in numbers.
People and relatives/representatives told us safe care was provided. Staff had received safeguarding training and concerns had been raised and acted on appropriately. Medicines were managed safely, and we observed good infection control measures. The provider had a robust recruitment process and there were enough staff to meet people's needs.
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 were happy with the quality of the food. Staff received training appropriate to people’s needs. People were supported to access healthcare professionals when required.
People told us they were supported by kind and caring staff who treated them with dignity and respect. People and relatives/representative were involved in decisions about their care and their independence was encouraged.
Care plans contained personalised information about people and staff knew people well. A variety of activities took place on a daily basis and staff spent time with people in their bedrooms. People were complimentary about the home and felt able to raise any concerns if needed. End of life care plans were in place and staff had received training.
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 (published 09 June 2022).
The provider was in breach of regulations and we held a meeting with the provider to discuss our concerns. 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 10 June 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 focused inspection of this service on 24 and 28 March 2022. Breaches of legal requirements were found in relation to how people were supported to consent and the governance of the service. We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements.
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.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Cole Valley is a residential care home providing personal and nursing care to up to 45 people. The service provides support to older people with physical disabilities and who are living with dementia. At the time of our inspection there were 18 people using the service.
The care home accommodates people in one adapted building over two floors with bedrooms on the ground and first floor. People had access to a garden.
People’s experience of using this service and what we found
Governance systems were in place but were not effective. The provider’s governance systems had failed to identify the concerns and shortfalls we found on inspection in relation to environmental risks, supporting people to consent and the quality of care. This concern about ineffective systems was a repeated concern over the previous five inspections. People and relatives spoke highly of the registered manager and felt able to approach them with concerns.
Where environmental risks had been identified, the provider had not always been proactive in addressing the concerns. Medicine management required improvement to ensure medicines were given at the correct time. Infection control practices had improved since the last inspection and people and relatives were happy with the cleanliness of the home. People told us they felt safe. We observed there were enough staff to meet people’s needs.
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. Mental capacity assessment and best interests’ decisions were not in place for all people who lacked capacity to make specific decisions. Oral hygiene assessments were in place, but support was not being carried out in relation to people’s assessed needs. People were happy with the food and improvements had been made to the environment since the last inspection. Staff completed training and competency assessments were in place.
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 05 August 2021) and there were breaches of regulation. The provider completed an action plan and sent monthly reports to show what they would do and by when to improve.
At this inspection we found improvements had been made to meet the previous breach in the regulations under safe care and treatment. However, enough improvement had not been made in the governance of the service and we identified a further breach of regulation. The provider has failed to achieve a good rating over the last six inspections.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 26 April 2021 and breaches of legal requirements were found in relation to safe care and treatment and governance. The provider completed an action plan and monthly reports after the last inspection to show what they would do and by when to improve.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We inspected and found there was a concern with how people were supported to consent, so we widened the scope of the inspection to include the key question effective.
This report only covers our findings in relation to the Key Questions safe, effective 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 Cole Valley on our website at ww.cqc.org.uk.
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 and Recommendations
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 monitor the service and will take further action if needed.
We have identified breaches in relation to how people were supported to consent. We identified a continued breach of regulation relating to the governance of the service. 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 continue to monitor information we receive about the service and will publish details of our regulatory response once this has been concluded.
Special Measures
The overall rating for this service is ‘Requires improvement’. However, the service will remain in 'special measures' as the service has been rated as 'Inadequate' in a Key Question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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.
Cole Valley is a residential care home registered to provide personal and nursing care for up to 45 people. At the time of the inspection there were 23 people using the service.
People’s experience of using this service and what we found
The provider had developed a range of audits and quality assurance checks to assist with driving improvement within the service. We identified that these systems and processes were not robust and were not kept up to date. They had not ensured the quality and safety of care was sufficiently monitored and that appropriate action was taken to protect people from the ongoing risk of harm.
The registered manager was not aware of changes to the current infection prevention and control (IPC) guidance.
During the inspection we identified concerns with poor IPC standards. This placed people at risk of infection.
Although special dietary needs were shared with staff members by the registered manager, staff were observed to not always follow the correct guidance. People’s diverse cultural needs were not always met.
People were supported to have maximum choice and control of their lives. Staff were supporting people in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice although record keeping needed to be improved in relation to the use of the Mental Capacity Act 2005 (MCA).
People were involved in making choices around how they spent their time. Meaningful activities took place which people told us they enjoyed. However, people told us they would like more to do at the weekend. The activity team do not currently work weekends.
People were supported by a staff team who understood how to protect them from abuse. Staff also understood how to protect people from harm such as injury, accident and wounds.
People’s medicines were managed safely although some improvement was still needed.
People were supported by sufficient numbers of staff to keep them safe.
Staff were recruited safely.
People were supported by a staff team who were receiving support from the management.
People were supported by a staff team who were kind and caring and the quality of interactions with people was good. People were treated with dignity.
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 at the inspection we carried out on 06 August 2019 (report published 05 September 2019) and there were multiple breaches of regulation.
At this inspection enough improvement had not been made and the provider was still in breach of regulation.
At this inspection the overall rating for this service is ‘Inadequate’ and the service therefore is 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.
The service was rated as inadequate at the inspection we completed in February 2019 (report published 09 May 2019) and there were multiple breaches of regulation. The service was rated as inadequate at the previous inspection completed in August 2018 and entered Special Measures. Prior to this the service had been rated as requires improvement at inspections completed in 2017 and 2015.
Why we inspected
This was a responsive five key question inspection based on CQC receiving a Coroner’s report which identified concerns, that the provider had not sought to learn the lessons from the circumstances of a person’s death and as a consequence there is an ongoing risk to other people living at Cole Valley.
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 monitor the service and 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 and good governance at this inspection.
Since the last inspection we recognised that the provider had failed to notify CQC of a serious incident, which is a notifiable event. This was a breach of regulation. Full information about CQC’s regulatory response to this 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.
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
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.
We will meet with the provider to discuss how they will make changes to ensure they improve their rating and to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress.
We found the following examples of good practice.
¿ Furniture in communal areas had been arranged to support people to socially distance to keep themselves and others safe during the pandemic.
¿ Staff were observed wearing personal protective equipment (PPE) in line with guidance during our visit and were knowledgeable about what PPE they needed to use for different tasks.
¿ The home had a designated isolation area where people could be accommodated safely if they needed to self-isolate in line with current guidance.
¿ The registered manager had arranged for support from an infection control nurse to review the infection prevention systems and processes in place. The registered manager was open to learning lessons from the COVID-19 outbreak to improve infection control at the home.
Further information is in the detailed findings below.
Cole Valley is a residential care home registered to provide personal and nursing care for up to 45 people. At the time of the inspection there were 19 people using the service; whom were mostly older people living with dementia.
People’s experience of using this service and what we found
People were not yet consistenly supported to have maximum choice and control of their lives. Staff were however supporting people in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice although record keeping needed to be improved in relation to the use of the Mental Capacity Act 2005 (MCA).
People were not yet fully involved in developing their care plans and making choices around how they spent their time. Leisure opportunities and the use of meaningful activities needed further improvement.
People were supported by a staff team who understood how to protect them from abuse. Staff also understood how to protect people from harm such as injury, accident and wounds. People’s medicines were managed safely although some improvement was still needed.
People were supported by sufficient numbers of staff to keep them safe. However, staff did not always have time to provide truly person-centred care. Staff were recruited safely.
People were supported by a staff team who were receiving appropriate training and received support from management.
People’s nutritional needs were met and special dietary needs were known and understood. People were supported to protect their health as far as reasonably possible.
People were supported by a staff team who were kind and caring although the quality of interactions with people was inconsistent. Some improvement was still needed to how people were treated with respect and how their dignity was protected.
The manager had developed a range of audits and quality assurance checks that were assisting with driving improvement within the service. The provider however continued to fail to ensure they understood the legal requirements and were completing appropriate checks against the compliance of the service.
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 at the last inspection we completed in February 2019 (latest report published 09 May 2019) and there were multiple breaches of regulation. The service was rated as inadequate at the previous inspection completed in August 2018. Prior to this the service had been rated as requires improvement at inspections completed in 2017 and 2015.
This service was entered into Special Measures following our August 2018 inspection. During the most recent 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
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to person-centred care 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 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 also request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.
People’s experience of using this service:
• People were not protected from the risk of serious harm due to inadequate risk management processes within the service. People were also not sufficiently protected from the risk of abuse and mistreatment.
• People were exposed to the risk of harm due to unsafe recruitment practices. Insufficient pre-employment checks and risk assessment meant staff members who were unsuitable to work with vulnerable people could be recruited.
• People’s rights were not upheld with the effective use of the Mental Capacity Act 2005 (MCA). People were not always fully enabled to make choices and to fully participate in the development of their care and support plans.
• People were not always supported in a caring environment where their privacy, dignity and independence was respected and promoted.
• The provider had not ensured complaints were managed effectively. They had also not ensure people’s views were proactively sought and used to improve the safety and quality of care provided.
• The provider had failed to ensure that sufficient and effective management, quality assurance and monitoring systems in place. As a result, they were not aware of the widespread concerns we found during our inspection. They had not ensured the quality and safety of care was sufficiently monitored and that appropriate action was taken to protect people from the ongoing risk of harm.
The overall rating for this service is ‘Inadequate’ and the service therefore remains 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.
Rating at last inspection: At the last inspection completed on 20 and 21 August 2018 the service was rated as inadequate and was entered into special measures. We published this report on 19 September 2018.
Why we inspected: This inspection was a scheduled inspection based on the previous rating. Prior to the inspection we were notified about a serious incident in which a person using the service died following an accident within the service. We looked at risks associated with this. Further information is in the full report.
Enforcement: 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 keep this service under review and will publish details of our regulatory response once this has been concluded.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Cole Valley is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 45 people who require nursing care. At the time of our inspection there were 41 people living at the service, many of whom were living with dementia. A registered manager was in post. 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.
People were not protected from the risk of accident or injury due to ineffective risk management processes. Accidents and incidents were recorded but these were not reviewed sufficiently and lessons were not learned to minimise risk and make improvements across the service.
While care staff could describe potential signs of abuse, issues were not always identified and reported meaning action wasn’t taken to protect people from potential harm.
Medicines management systems were not consistently safe. People’s creams were not stored securely. Staff were administering creams that had not always been prescribed or that had been prescribed for others. People were not always supported by sufficient numbers of staff.
People’s rights were not always upheld by the effective use of the Mental Capacity Act. People’s capacity to provide consent or make decisions had not been considered in line with the Act. Decisions were not being made appropriately in people’s best interests.
People were not always cared for by staff who had the skills and knowledge to support them effectively. People’s nutritional needs were met although some improvement to staff knowledge and the support people received was needed. People had access to healthcare professionals but not always in a timely way.
People did not consistently receive care that was kind and caring. People’s dignity was not always upheld and their independence was not always promoted. People were supported to receive visits from friends and family without unnecessary restrictions.
People were not fully involved with the planning of the care they received. People’s individual support needs were not always fully understood and met. People’s diversity was not embraced and their care needs personalised as a result. People’s needs in relation to any protected characteristics were not fully considered. People did not receive access to a sufficient range of leisure opportunities that met their individual needs.
People understood how to make a complaint when required. Some relatives did not feel their complaints had been appropriately addressed.
People were not living in a service where a culture of quality improvement had been developed. Quality assurance systems were either not in place or were inadequate. Areas of improvement needed and risk had not been identified. Action was not being taken to drive improvements and the registered manager had not recognised where improvements were needed.
People were not enabled to be fully involved in the development of the service they lived in. People were not cared for by a staff team who were well supported and consistently motivated in their roles.
We found the provider was not meeting the regulations around providing person-centred care, obtaining appropriate consent, safeguarding, staffing, safe care and treatment and the overall governance of the service. You can see what action we told the provider to take at the back of the full version of the 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.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.
We undertook a comprehensive inspection of this home in February 2015. We found that the home had steadily improved since our last inspection. We found that the home was compliant with the requirements of the law and meeting people’s needs well in four of the five key questions we looked at. The registered manager needed to continue to make improvements to ensure people had the support they needed to eat and drink and to ensure that people’s human and civil rights were upheld. This inspection identified that while people received mainly safe care that they were satisfied with, improvements had not all been maintained and continued.
The home has a registered manager who has been in post for 13 years. 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.
People told us that they felt safe. However we identified some incidents had occurred between people where people had hurt each other. These incidents had not been identified by staff as possible abuse, and the required support had not been obtained and no review of people's care had taken place. This meant people were not fully protected from the risk of a similar event re-occurring. Since our inspection we have received feedback about the action taken to improve on this.
Staff had been trained in adult safeguarding and when we spoke with them they showed a good level of knowledge about possible signs of abuse and the action they would take in reporting any concerns. However staff had not applied this knowledge into practice as they hadn’t identified and reported the incidents identified during our inspection.
People received their medicines safely and there were effective systems in place to monitor medicines administration.
The feedback we received about staffing was mixed. For the majority of the time we observed adequate numbers of staff on duty, and saw people's needs and requests being met promptly. People were not left for long periods of time without access to staff. However feedback from people and relatives was that this was not always the case, and we were informed that sometimes people did have to wait for care and support, which at times caused them distress. Staff told us they had received induction, sufficient training and on-going support. There were handovers between staff at each shift change.
Staff had some knowledge of the Mental Capacity Act (MCA) (2005) and described how they supported people with making choices. Restrictions to people's liberty had been identified. When necessary the relevant applications had been made and kept under review. Further work was needed to ensure the required legal notifications were sent to the commission, and that alternative, 'less restrictive' options were considered when making decisions with people.
People had access to regular healthcare and specialist healthcare advice. The nursing care provided was generally good and followed published good practice guidelines.
People’s feedback about the food provided was mostly positive. Some people really enjoyed the food and other people thought it was acceptable. We observed that people were supported in a dignified and respectful way when they required help to eat and drink. The provider was taking part in a local good practice project that promoted fluids for people at risk of not drinking enough.
We received consistent feedback that the quality of care provided by individual staff was good and people told us that staff were kind and caring. People told us they appreciated the friendship and relationships they had developed with nurses and care staff as well as the domestic and housekeeping team, kitchen staff and the home management team. Relatives told us with pleasure about the relationship they and their loved ones had with members of staff. Staff told us that they enjoyed working at the home. Many of the staff we met had been in post for a long time and they demonstrated that they knew the people they supported well. During our observations we saw some good staff practice that ensured people were treated with dignity and respect.
People told us that they had some opportunities to be involved in planning their care to meet their individual needs.
People and their relatives were supported to think about and plan the care they would like to receive at the end of their life. Staff were experienced at supporting people with compassion, and they received good support from other local health professionals.
There were opportunities for people to join in group activities held in the homes lounges. People were also able to sit in their bedrooms, and quieter lounges. There were some opportunities for people to have one to one time with staff.
People were generally satisfied with the service and there had been a low number of complaints. Feedback was that the management team were very approachable and that people could approach them at any time if they had concerns.
People and their relatives all told us the management team were approachable and that they led the home well. They told us they felt able to approach them with concerns or feedback. The systems in place to monitor the quality and safety of the service had not been entirely effective. Whilst numerous developments and improvements had been achieved since our last inspection the checks failed to identify certain improvements that were required within the home.
This inspection took place on 25 February and 04 March 2015, and was unannounced. The service was last inspected in October 2013 and at that time we found the home had breached four regulations of the Health and Social Care 2008, and in these areas was failing to meet the needs of the people living at Cole Valley Nursing Home. In October 2013 the home was not providing the support people needed to meet their social care needs, the premises were not well presented or maintained, staff had not been provided with the supervision and training they required to meet the needs of people living at the home and systems in place to assess and monitor the quality and safety of the service were inadequate.
Following the inspection in October 2013 we met with the provider and they submitted an action plan. This detailed how they would improve the service to meet the requirements of the law and the needs of the people living in the home. At this inspection we found that significant improvements had been made in all areas. We found that the provider was now meeting the requirements of the law and people we met and spoke with reported favourably about the care and support they were receiving.
Cole Valley Nursing Home is registered to provide nursing care and accommodation for up to 44 older people. At the time of our inspection 39 people were residing at the home. Most people had their own bedroom, and the one shared room was occupied by a married couple. People shared communal facilities including three lounges, a dining room, and assisted bathrooms. The home is located over two floors and there is a passenger lift to enable people without full mobility to transfer around the home.
There was a registered manager in post. 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.
People were supported by staff who had received training on how to protect people from abuse. Safeguarding procedures were in place which the manager was following. Staff we spoke with were able to explain a variety of actions and checks they took both individually and as a team to ensure people received the support they needed and were protected where ever possible from harm.
The Mental Capacity Act 2005(MCA) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to a supervisory body for authority to deprive someone of their liberty. We found that some training had been delivered and that staff had started to undertake work on capacity assessments and DoLS applications where needed. The inspection identified that the manager and staff team did not fully understand their roles and responsibilities, but were taking further action to increase their knowledge and get the support they required.
People were being supported to maintain and improve their health. The manager had developed strong links with a wide variety of health care professionals and medical staff to ensure people were assessed and treated when they were ill.
People told us they enjoyed the food served and we observed people in the dining rooms getting good support to eat a wide variety of foods. We found further support and planning was required to ensure people choosing to eat a meal in their rooms also got the support they required.
We observed and heard caring and compassionate interactions between staff and people throughout our inspection. Staff were quick to notice people required support or to intervene if people became distressed.
The manager had developed systems to respond to concerns and complaints. People we spoke with told us they had been happy with the home and had been able to get any grumbles or concerns dealt with promptly by speaking directly with the manager.
The activities and opportunities available to people had increased, and we found that people were supported to attend events that were important to them in the local community. A wider range of opportunities were available for all people in the home, including the people being cared for in bed.
The systems in place to check on the quality and safety of the service had improved since our last inspection. We found the checks and audits had been effective at identifying issues that required improvement and this had resulted in the home running more smoothly and improved the experience for people living at the home.
People did not experience care and support that met their needs. People's social and welfare needs were not being met adequately by the service. One visitor told us: 'My relative needs more stimulation.'
Health care and treatment needs were met and were responsive to people's needs
People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.
The premises were well designed but not maintained to meet people's needs. The premises required some updating. The design ensured that people's privacy was maintained.
Staff were not supported to access training promptly to inform their practice. Where training that had been received had expiry dates and required updates, staff had not been provided with updated training.
People did not receive care from a service that was continually assessing and monitoring to improve the quality or care and treatment provided. The auditing and checking arrangements failed to identify the training needs of the staff. The monitoring also failed to identify some maintenance works that were required around the premises and the monitoring systems failed to take into account peoples' dissatisfaction with the activities on offer.
During this inspection we observed food and drink being offered late morning,lunch time and mid afternoon snacks . Most of the people using the service had conditions which made it difficult for them to communicate with us. However, we spoke with three people who were able to give their opinions about the food. People told us that they were happy with the quality and choice of food provided and that meals were served at the correct temperatures. A person told us 'The food is very good, there is plenty of variety, and meat and vegetables.'
People told us that they enjoyed meal times and efforts were made to promote a social and inclusive environment for people during these times. Within the dining room during the meals, music was playing and we saw that people were talking to each other and commenting on the food being served.
People could choose where to eat there meals, some people ate in their bedrooms.. Arrangements were in place so that they too received their meals at the correct temperatures and were supported to eat them where needed.
People using the service had recently participated in a survey in order to put forward their views and suggestions for meals provided at the home. The management was looking to add these to the menu in the near future.
We looked around the home, and found it was clean, and free from unpleasant odours. People told us it was always "Spotlessly clean" and three people had ticked a questionnaire we viewed confirming that the home was clean, tidy and odour free. We found that work was needed to refresh the decor, replace some worn items of furniture and ensure bedroom doors protect people in the event of a fire.
Feedback from people about food was good and one comment at lunchtime included, "It was lovely. Thank you."
We observed that the staff team were very busy throughout the day, but people told us they had a good relationship with the staff and that they did not have to wait long for care. One person said, "They are very good, would do anything for you. Even clean my mucky glasses!" One person when asked about staff gave a big smile and said " The staff are marvellous."
On the day of our visit, we saw positive staff interactions with people living at the home. Care staff were polite, respectful and demonstrated that they were able to communicate in a way that people could understand. We observed that care staff were very busy across the morning, but appeared more rushed once preparations for lunchtime commenced.
We spoke with visitors to the home on the day, who were complimentary about the care provided.
We spoke to three people in private, and their feedback about the home was positive.
Where possible staff asked people before they offered them care or moved them, and staff we spoke to had a good understanding about getting consent.
We received some very positive comments about the care offered which included, "They are doing a marvellous job here, her clothes are clean on every day"
"We feel mum is safe here, that is a weight off our minds"
"I have had my hair done, I was pleased about that"
"I had a bad place on my leg, it has healed now, I am grateful to them for that"
"It is brilliant really, you get all you need"
"I like it here because dad is kept clean, washed and fed"
Some people were not so happy with the care and felt staff neglected every day things such as cleaning peoples teeth, fitting glasses or hearing aids.
We spoke with people about the food and drinks they are served. Again the comments were positive and included," have porridge for breakfast, it is very tasty"
"The food is always edible"
"The food has been good, I only eat a little but I had a lovely ham salad at lunch time"
"The food is alright, too much really"
"Food is alright thank you, although I think it gets a bit predictable when you have been here for a while"
We observed the lunch time meal-the main meal of the day and did not see that it was an enjoyable experience for most people, or that everyone got the support they need to eat as independently as possible.
We talked to people about if they felt safe, and what they would do if they were unhappy regards the way someone was supporting them. We were pleased that all the people we spoke with did feel safe, and that they felt very able to approach the manager if they had concerns.
We found that there was a low turn over of staff in post and that this has a positive impact for people, who are supported by staff they have got to know, and who know their needs.
We spoke with people and their relatives about the staff. Most found that for most of the time staff were friendly and helpful. A few people made negative comments.
"I have some problems with the staff, but this one is very good"
We spoke to a person recently admitted to the home, when asked about staff they said, "Yes, they are very nice"
"Staff are alright, they come as quickly as they can, and most enjoy a good banter"
One person said to us, "She (the manager) is friendly, things get done when she is here, on her days off things are chaotic, staff are bitchy and there is a divide between nurses and carers"
Another person said, "Most staff are golden, but some think they run the place, and that gets up my nose"
We did not find that the home was supporting staff in supervision, that they had offered all the training people need or that they had reviewed peoples suitability to work in a care home as thoroughly or often as they should.
We found that the manager was held in high regard by the majority of people who live in or visit the home. We were told, "Michelle-the manager, she is very good"
"She is nice, straight forward"
"Michelle, she is friendly, things get done when she is here. On her days off things are chaotic, there is a big divide between nurses and carers"
"The manager is assertive, she works well with all grades of staff and relatives and visitors"
"If I am unhappy about something, I go straight to Michelle"
This positive information about the manager gave us confidence that the shortfalls we identified during our visit would be acted upon.