CQC report explained · a residential care home
What the CQC found at Rother Valley View
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, November 2022
Rated Requires Improvement; the home has left Special Measures after improvements, but some incident and quality records were still inconsistent.
This was an unannounced follow-up inspection on 20 and 26 October 2022. Inspectors checked whether the home had acted on its improvement plan, focusing on Safe, Effective and Well-led. They spoke with staff and a relative, observed care, and reviewed records and information from other agencies.
The home had improved since its previous Inadequate rating. Inspectors found safe medicines support, enough staff, better training, person-centred care and improved support for people's choices and independence. The home was no longer in breach of the regulations identified at the previous inspection.
However, the overall rating is still Requires Improvement. Some incident records were incomplete, quality systems needed to become consistent in everyday practice, and one notifiable incident had not been reported to CQC promptly. The home was no longer in Special Measures.
People involved in safety
People were involved in decisions about risks and how to keep themselves safe. Staff understood people's risks and how to support them during emotional distress.
“People were involved in managing risks and in decisions about how to keep themselves safe.” from the report
Medicines support
Staff followed processes for prescribing, administering, recording and storing medicines. The home also monitored medicines that might be used to control behaviour.
“People were supported by staff who followed systems and processes to prescribe, administer, record and store medicines safely.” from the report
Person-centred support
Support plans included people's needs, backgrounds and preferences. They were reviewed to reflect changes, giving staff current guidance.
“People had individual and person-centred support plans which contained information about support needs, their background and history.” from the report
Staff training and support
Staff received training relevant to people's needs, regular supervision and opportunities to reflect on their practice.
“Staff received specialist training to ensure they could meet people's individual support needs.” from the report
Incomplete incident records
needs fixingIncidents were monitored and analysed, but some records were not completed consistently. This makes it harder to show that every incident has been fully recorded and reviewed.
“Accidents and incidents in relation to behaviours which may challenge others were being monitored and analysed, however, we found that some records were not always consistently completed.” from the report
Quality systems not yet embedded
needs fixingAudits and improvement plans had been strengthened, but inspectors said they were not yet consistently part of everyday practice. Record keeping still lacked consistency and detail.
“These systems had identified most areas of improvement but needed to be embedded into practice to ensure consistency.” from the report
One incident not reported promptly
needs fixingThe provider had not told CQC about one notifiable incident when it should have. It reported the incident after becoming aware of the omission.
“We identified one occasion where the provider had not informed us of a notifiable incident.” from the report
- 01How do you now make sure every accident, incident and behaviour-related event is recorded consistently?
- 02What checks show that your quality audits are being followed in everyday practice and that improvements are lasting?
- 03How do you make sure all notifiable incidents are reported to CQC and other agencies on time?
- 04How many staff vacancies are there now, and how are you maintaining safe staffing while recruiting?
- 05What recent feedback have you received about the caring and responsive aspects of the home, which were not assessed in this inspection?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and previous ratings for uninspected key questions were used in calculating the overall rating. This explanation was written from the published report of 15 November 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, May 2022
Rated Inadequate and still in special measures; inspectors found people at risk from unsafe care, poor management and missed safeguarding concerns.
This was an unannounced targeted inspection on 23 and 24 March 2022. Inspectors followed up concerns about safety and management, and checked whether the home had met a warning notice about its governance systems. They spoke with people, relatives and staff, observed care and checked records.
The home was rated Inadequate overall. Safe, Effective and Well-led were all rated Inadequate. Inspectors found unsafe risk management, missed safeguarding referrals, poor cleanliness, inconsistent staffing, outdated care records and ineffective checks by managers.
There were some improvements. Medicines were managed safely and recruitment checks had improved. However, the home remained in breach of regulations and people were still exposed to potentially high risks of harm and poor-quality support.
Medicines
Inspectors found that medicines were being administered and audited safely. Guidance was available for medicines prescribed as needed.
“Practices around medicines administration were appropriate and people's medicines managed safely.” from the report
Recruitment checks
Recruitment practices had improved since the previous inspection. The provider had strengthened its checks before staff started work.
“Safe recruitment practices had been followed. The provider had strengthened recruitment practices.” from the report
Personalised environment
People's rooms contained items that were meaningful to them, and the home had an enclosed garden.
“People's rooms had been personalised with items meaningful to them.” from the report
Risks and injuries
seriousRisks were not always assessed or reduced. Inspectors found an untreated environmental risk after a burn, unsupported bathing for a person with epilepsy and unexplained injuries that had not been recorded as incidents.
“We found evidence a person had been harmed due to a lack of risk management.” from the report
Safeguarding failures
seriousAllegations and possible signs of abuse were not always reported to the local authority or CQC. Inspectors made two safeguarding referrals during the inspection.
“During the inspection we made two safeguarding referrals to the local authority, which had not been previously identified or raised by the managers or staff at the service.” from the report
Cleanliness and infection control
needs fixingInspectors found food debris, spillages, dirty bathrooms and soiled bedding. Infection control procedures were not consistently followed, including checking visitors' COVID-19 test results.
“At this inspection, we found multiple areas of the home were unclean.” from the report
Care records and support
seriousCare plans, health records and behavioural support plans were not always current or accurate. Staff did not always follow professional advice, including support with food textures, fluids and mealtimes.
“The quality of information detailed in care plans did not meet people's needs.” from the report
Staffing and training
seriousStaffing levels were inconsistent and vacancies and sickness affected the service. Some staff said they lacked the skills and confidence to support people who could become distressed.
“We observed there were not always enough staff to meet people's needs.” from the report
Weak management checks
seriousAudits did not find or prevent problems, and managers did not always ensure identified risks were dealt with. The home was also without a registered manager.
“Where checks and audits were carried out, they had not always identified or prevented issues occurring or continuing at the service.” from the report
- 01What has been done to ensure every safeguarding concern, unexplained injury and incident is reported and investigated?
- 02How are risks such as bathing with epilepsy, burns and people's changing behaviours assessed and reviewed now?
- 03How many staff are on duty for each shift, and how are vacancies and sickness affecting staffing levels?
- 04How do you check that staff follow each person's current care plan, eating and drinking guidance and behavioural support plan?
- 05Who is managing the home now, and what evidence can you show that audits are identifying and fixing problems?
This was an unannounced targeted inspection following specific safety and management concerns and a warning notice about governance; inspectors reviewed Safe, Effective and Well-led, while no separate ratings were given for Caring or Responsive. This explanation was written from the published report of 31 May 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.
Every inspection of Rother Valley View
3 rated inspections over a year: the service has improved, from Inadequate to Requires improvement.
- November 2022Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2022Inadequatestayed InadequateSafe: InadequateEffective: InadequateWell-led: Inadequate
- August 2021InadequateSafe: InadequateEffective: Requires improvementWell-led: Inadequate
- October 2019
Registered with the Care Quality Commission on 19 October 2019.
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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