CQC report explained · a nursing home
What the CQC found at The Vale Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, March 2022
The Vale Care Home is rated Requires Improvement; inspectors found important improvements, but care records, call buttons and some medicines checks were not yet reliable.
This was an unannounced focused inspection on 8 February 2022. Inspectors spoke with people living in the home, relatives, staff and visiting professionals. They reviewed care records, medicines records, training information and quality checks.
The home had improved since its previous inspection, when it was rated Inadequate and in breach of regulations. Inspectors found enough improvement for those breaches to be removed. However, some improvements still needed to become consistent and lasting.
People were generally supported by enough staff, received their medicines as prescribed, and were protected by improved infection control arrangements. Risk assessments, skin care monitoring and emergency evacuation plans had also improved.
The overall rating is Requires Improvement. Safe and Well-led were both rated Requires Improvement. The inspection did not review the other three key questions, so their previous ratings were used in calculating the overall rating.
Progress since the last inspection
The provider had acted on the previous inspection findings. The home was no longer in breach of the regulations identified at that inspection.
“At this inspection we found improvements had been made and the provider was no longer in breach of regulations.” from the report
Staffing
Inspectors found enough staff to meet people's needs. The provider was also recruiting more staff to reduce reliance on additional hours and agency staff.
“There were enough staff deployed to meet people's needs. The provider used a dependency tool to identify staffing requirements.” from the report
Risk and skin care
Risk assessments and monitoring had reduced the impact of skin breakdown and some health conditions. Staff made referrals for professional advice when needed.
“Risk assessments were completed to reduce the risk of skin breakdown and manage the impact of sore skin.” from the report
Infection control
Inspectors were assured that the home was using protective equipment, testing and infection control measures in line with the guidance checked.
“We were assured that the provider was using PPE effectively and safely.” from the report
Incomplete electronic care records
needs fixingNot all information from previous care records had been transferred to the new electronic system. This could lead to care being missed or delivered inconsistently.
“People were at risk of care being omitted or receiving inconsistent care.” from the report
Call buttons
seriousAt least two people did not have reliable access to a call button. The home introduced an audit after the inspection, but this was a safety weakness at the time.
“One person did not have a call button in their room, another person was unable to reach their call button” from the report
Medicines checks
needs fixingSome instructions for as-required medicines did not contain enough detail. Audits also missed some errors, including a stock-control error and missing signatures.
“Not all errors had been picked up by the audit, for example, a stock control record error and missing double signing” from the report
Support for people with learning disabilities
needs fixingThe home could not yet show that it was meeting some expected principles for people with learning disabilities. The provider said it would review its statement of purpose and staff training.
“Based on our review of Safe and Well-Led the service was not able to demonstrate how they were meeting some of the underpinning principles” from the report
Care plan guidance
needs fixingSome care plans did not explain well enough how to communicate with people, identify triggers or record behaviour. Inspectors were not clear that the provider had proper oversight of these gaps.
“Support plans did not always include details of how best to communicate with a person or prompts to identify triggers” from the report
- 01How have you checked that all care information was transferred accurately to the electronic care system?
- 02How do you now make sure every person can reach a call button, or has a suitable alternative?
- 03What changes have been made to as-required medicine instructions and medicine audits?
- 04What training have staff received to support the five people with learning disabilities?
- 05How do you check that care plans contain clear guidance about communication, triggers and behaviour records?
This was a focused inspection of Safe and Well-led only; the other three key-question ratings were carried over from the previous inspection. This explanation was written from the published report of 30 March 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, November 2021
Rated Inadequate and placed in special measures; inspectors found serious safety and management failures despite some kind and responsive care.
Inspectors visited without notice on 31 August 2021. They spoke with three people, seven relatives or representatives and six staff. They reviewed care records, medicines records, recruitment files, training information and management records.
The home was not safe or well-led. Risks such as sore skin, falls, unsafe evacuation and behaviours that could cause harm were not managed properly. There were not enough staff, recruitment checks were incomplete, safeguarding concerns were not always reported, and training and supervision were not consistent.
Care was sometimes kind, and people enjoyed meals and activities. Staff supported healthcare, personal choices and mental capacity decisions. However, care plans were not always personal or up to date, and people's dignity was not always protected.
The overall rating was Inadequate. Safe and well-led were also Inadequate. Effective, caring and responsive were Requires Improvement. The home was placed in special measures, with CQC planning to monitor it and re-inspect it.
Kind staff
Inspectors observed kindness and patience in staff interactions. Relatives also described staff as caring and attentive.
“During the inspection we observed staff interactions with people which showed kindness, patience and a caring nature.” from the report
Healthcare support
People received regular health reviews and referrals when needed. Relatives and professionals were positive about communication with the home.
“People received prompt health care support. There was a weekly review with the GP to address any needs.” from the report
Meals and choices
People were involved in menu planning and could choose meals, drinks and snacks. Inspectors said people enjoyed the meals.
“People enjoyed the meals. We saw people had been included in the menu planning for the home.” from the report
Activities
People were offered group and individual activities and were asked what they wanted to do.
“The activities staff member involved people in decisions about day to day activities and offered group and individual sessions to suit people's needs.” from the report
Best-interest decisions
The home followed the Mental Capacity Act principles described in the report. Staff supported choices and recorded best-interest decisions where needed.
“The service worked in line with the MCA and people were not deprived of their liberty without legal authorisation.” from the report
Unmanaged health and safety risks
seriousSeveral people had sore skin, but action was not always taken and prescribed creams were not consistently monitored. Risk assessments and safe evacuation plans were also incomplete.
“The provider had failed to ensure that people were protected from the risk of harm.” from the report
Too few staff
seriousPeople had to wait for care and communal areas were left unsupervised. Inspectors found that staffing had not been increased after six new admissions.
“There were insufficient staff to support people's needs. We saw people had to wait for their care and this could have impacted on their dignity.” from the report
Safeguarding failures
seriousUnexplained bruises and incidents between people were not always recorded or referred. Staff did not consistently understand when safeguarding action was required.
“We identified some people had unexplained bruises, these had not been body mapped or reported as a concern.” from the report
Weak management checks
seriousAudits missed important problems and did not always lead to action. The provider had not given the registered manager enough support or oversight.
“The lack of governance oversight by the provider meant people were placed at risk of harm.” from the report
Dignity and personal care
needs fixingSome rooms were untidy and shared toiletries were used in bathrooms. A relative reported that staff sometimes did not have time to complete personal care consistently.
“We were not always assured people were always treated with dignity and respect.” from the report
Inadequate care planning
needs fixingPlans did not always describe people's individual needs, communication methods, behaviour support or end-of-life wishes. New residents' information was not always detailed or shared with staff.
“People's care plans were not always personalised to ensure they would meet their needs.” from the report
- 01How have you increased staffing levels since the inspection, and how do you check that staffing matches residents' needs?
- 02How are sore skin, falls, medicines and other risks now assessed, monitored and acted on?
- 03What changes have been made to safeguarding reporting, including recording unexplained bruises and incidents between residents?
- 04How do you make sure new residents have detailed, personalised care plans that all staff can access?
- 05What evidence can you show that audits and the provider's action plan are leading to lasting improvements?
This was an unannounced inspection covering all five key questions, prompted partly by concerns about infection control and whistleblower information; it was the first inspection of the new provider. This explanation was written from the published report of 19 November 2021 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 The Vale Care Home
4 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- March 2022Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- November 2021Inadequatedown from Requires improvementSafe: InadequateWell-led: Inadequate
- January 2020Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- April 2017GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Good
- October 2020
Registered with the Care Quality Commission on 8 October 2020.
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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