CQC report explained · a nursing home
What the CQC found at Culm Valley Care Centre
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors were assured that the home managed infection risks, including PPE, testing, vaccination, cleaning, visiting, admissions and outbreaks. The provider also had measures to reduce the effects of COVID-19 staffing pressures.
- Effective?
- Good
- This area was not assessed in this targeted inspection, which focused on infection prevention and control.
- Caring?
- Good
- This area was not assessed in this targeted inspection.
- Responsive?
- Good
- This area was not assessed in this targeted inspection. The report does describe visiting arrangements during COVID-19 outbreaks.
- Well-led?
- Good
- This area was not assessed in this targeted inspection.
What inspectors found, February 2022
Culm Valley Care Centre: Inspected but not rated; inspectors were assured about infection control and COVID-19 safety measures.
The CQC made an unannounced, targeted visit on 12 January 2022. It checked infection prevention and control, and asked about staffing pressures linked to COVID-19.
Inspectors were assured that the home used personal protective equipment safely, supported testing and vaccination, managed outbreaks, cleaned regularly and followed visiting and admission guidance.
The home had experienced several small COVID-19 outbreaks. Relatives were kept informed, and essential carers and people visiting relatives receiving end-of-life care were allowed to visit in line with guidance.
This was not a full inspection and the service was inspected but not rated. The report gives no ratings for the other four areas of care.
Infection control
The home had current infection control policies, cleaning schedules and audits. Inspectors were assured that infection risks were being managed.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Staff training
Staff had infection control and COVID-19 training, with regular updates to keep them informed.
“People were supported by staff trained and in line with government COVID-19 guidance.” from the report
Testing and vaccination
The home took part in regular testing and had systems to check vaccination requirements for staff and visiting professionals.
“The service was meeting the requirement to ensure non-exempt staff and visiting professionals were vaccinated against COVID-19.” from the report
Keeping relatives informed
Relatives were told about outbreaks, visiting restrictions and when outbreaks had ended.
“Relatives told us that they were kept informed about any Covid-19 outbreaks at the home.” from the report
Visiting could be difficult
minorRelatives gave mixed feedback about how easily they could visit. Visits sometimes had to be booked in advance and were restricted during outbreaks.
“Relatives gave us mixed feedback about being able to visit the home easily and others felt the provider was doing all they could to facilitate visits.” from the report
- 01How are you currently managing COVID-19 or other infection outbreaks?
- 02What visiting restrictions would apply if there was an outbreak, and how would relatives be kept informed?
- 03How do you manage staffing pressures when staff are absent because of COVID-19?
- 04How do you check that staff and visiting professionals meet the required vaccination or exemption rules?
- 05What has changed in the home since the new seven-bedroom extension and communal lounge were added?
This was an unannounced targeted inspection of infection prevention and control and COVID-19-related staffing pressures; it did not assess or rate the other areas of care. This explanation was written from the published report of 16 February 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2020
Rated Good; inspectors found kind, safe care, with some records and meal-choice practices needing improvement.
This was an unannounced, planned inspection. Inspectors spoke with people living in the home, relatives, staff and a health professional. They reviewed care, medicines, staffing and management records, and observed care and mealtimes.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People generally felt safe and said staff were kind, respectful and responsive. Medicines were managed safely, staffing was considered sufficient, and people could access health professionals.
Inspectors found some areas to improve. Care plans for people staying for respite care did not always contain enough detail about complex needs. Food and drink records were not always complete, and staff did not offer meal choices or second helpings clearly during the observed lunch.
The overall Good rating means inspectors found the home consistently provided good care and was well managed. The home had also improved its Responsive rating from Requires Improvement at the previous inspection and remained Good overall.
Kind and respectful staff
People and relatives praised the staff. Inspectors observed warm, friendly and professional interactions, with care given privately and respectfully.
“People were cared for by staff who knew them well and were kind and compassionate.” from the report
Safe medicines
Medicines were ordered and supplied on time, and records showed people received them regularly. Staff who gave medicines were trained and had their competence checked.
“Processes were in place for the timely ordering and supply of medicines and medicines administration records indicated people received their medicines regularly.” from the report
Good health support
The home referred people promptly to health professionals and followed their advice. Staff worked with GPs, community nurses, dieticians and other specialists.
“Staff supported people to maintain good health and well-being. Where necessary, they made prompt referrals to other health professionals and followed any recommendations made.” from the report
Strong management checks
The management team carried out regular quality audits and acted on issues they found. Staff meetings and feedback from people and relatives were also used.
“There were effective systems in place to monitor the safety and quality of the service.” from the report
Respite care plans
needs fixingCare plans for respite residents were sometimes only brief summaries and did not fully explain complex needs. Inspectors said this could affect health and wellbeing, and the manager agreed to develop fuller plans.
“The care plan for people staying for respite care was not detailed and did not fully reflect the person's needs.” from the report
Food and drink records
needs fixingRecords for people at risk of poor nutrition did not always show clearly whether they had eaten and drunk enough. Managers said they would investigate.
“The diet and fluid records kept for those at risk were not always completed with sufficient detail to confirm people had eaten and drank enough during the day.” from the report
Choice at lunchtime
minorDuring the observed meal, staff did not offer choices when serving food or ask whether people wanted a second helping. The deputy manager said this would be reviewed.
“Staff were not observed offering choice at the time of serving the meal and people were not asked if they wanted a second helping.” from the report
Night-time call bells
minorMost people said call bells were answered promptly, but one person reported slower responses at night. The report does not say that this was a widespread problem.
“However, one person told us that staff did not respond to call bells so quickly at night.” from the report
- 01How do you make sure people staying for respite care receive a full assessment and care plan that covers complex needs?
- 02How do you check that food and fluid records clearly show whether people at risk have eaten and drunk enough?
- 03What has changed to make sure staff offer meal choices and ask about second helpings?
- 04How do you monitor call-bell response times at night?
- 05How were the fire-door issues found at the inspection followed up and checked?
This was an unannounced comprehensive inspection covering all five key questions, and the previous ratings were reassessed. This explanation was written from the published report of 11 January 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Culm Valley Care Centre
4 rated inspections over 5 years: the service has improved, from Requires improvement to Good.
- February 2022Inspected but not ratedcurrent ratingSafe: Inspected but not rated
- January 2020Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- October 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- September 2014
Report published without a new overall rating.
- February 2014
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- May 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 10 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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