CQC report explained · a nursing home
What the CQC found at Valley View Care Home Ltd
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Individual risks had been assessed better, but staff did not always have clear guidance to prevent harm. Incident records were also incomplete, although medicines, staffing, recruitment and infection control had improved.
- Effective?
- Requires improvement
- People received better healthcare support and staff training had improved. However, the home did not always follow the Mental Capacity Act, complete best-interest decisions or record conditions attached to liberty safeguards clearly.
- Caring?
- Good
- This question was not inspected during this focused inspection. Its previous rating was used in calculating the overall rating.
- Responsive?
- Good
- This question was not inspected during this focused inspection. Its previous rating was used in calculating the overall rating.
- Well-led?
- Requires improvement
- The provider had introduced new monitoring systems, but they were not yet robust. Audits did not always identify unclear care plans, missing records or risks that needed action.
What inspectors found, September 2023
Rated Requires Improvement; inspectors found better medicines, staffing and healthcare, but risks, consent and management checks were still not reliable.
This was an unannounced focused inspection on 16 and 17 August 2023. Inspectors spoke with people, relatives and staff, observed care, and checked care, medicines, recruitment and management records.
The home had improved since its last inspection, when it was rated Inadequate and placed in Special Measures. Medicines were managed more safely, staffing had improved, and people received better support with their health needs. Staff also described a more supportive culture.
However, the home was still not consistently safe, effective or well-led. Some risks were not clearly assessed or managed, mental capacity and best-interest processes were not always followed, and quality checks did not reliably find problems. The overall rating changed to Requires Improvement, and the home left Special Measures.
Medicines
The electronic medicines system had improved ordering, storage and administration. Inspectors found that medicine counts matched the records.
“People were now receiving their prescribed medicines safely.” from the report
Staffing
Staffing had improved and agency use was minimal. The regular agency staff knew people well, and people did not appear to wait for help.
“People told us they did not have to wait when they requested help.” from the report
Healthcare support
People were referred to health professionals more promptly when needed. Nursing staff also provided specialist care and arranged further advice.
“We found this had improved at this inspection and people had received the advice and healthcare they needed.” from the report
Staff culture
Staff no longer reported the bullying concerns found at the previous two inspections. They said management was approachable and teamwork had improved.
“Staff did not report this at this inspection and were now happier at work as this was not a concern anymore.” from the report
Unclear risk guidance
seriousSome important risks were not clearly highlighted for care staff. This included diabetes, choking and anxiety-related incidents, increasing the risk that staff might not prevent harm.
“The provider continued to fail to assess the risks to the health and safety of people or do all that was reasonably practicable to mitigate risks.” from the report
Consent and best interests
seriousThe home did not always complete mental capacity assessments or best-interest decisions for specific choices. This included decisions relating to CCTV and some conditions linked to liberty safeguards.
“The provider continued to fail to put into practice the requirements of the MCA.” from the report
Weak quality checks
seriousManagement checks did not reliably identify gaps in care plans, risk assessments and records. The provider had said care plans were audited monthly, but this was not happening.
“The provider continued to fail to operate a robust quality assurance process to understand and have oversight of the quality of the service and ensure any shortfalls were addressed.” from the report
Incomplete incident records
needs fixingSome falls and incidents involving anxiety or physical behaviour were not recorded fully. This limited the home's ability to spot patterns and prevent repeat incidents.
“Although accidents were recorded, such as falls, incidents were not always recorded to enable monitoring across the service, to learn lessons and prevent further occurrences.” from the report
- 01How will you make sure each person's key risks, including diabetes, choking and anxiety, are clearly highlighted for care staff?
- 02How will you complete and record mental capacity assessments and best-interest decisions for each specific decision?
- 03What consent process is now in place for CCTV in communal areas?
- 04How will you prove that care plans and incident records are being audited properly and that problems are acted on?
- 05How will staffing levels be checked before any new people are admitted?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 15 September 2023 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, February 2023
Rated Inadequate and placed in special measures; inspectors found serious problems with safety, medicines, staffing and management.
This was an unannounced focused inspection on 16 and 17 November 2022. Inspectors reviewed Safe and Well-led, then extended the inspection to Effective after finding concerns about mental capacity and Deprivation of Liberty Safeguards.
Inspectors found that risks were not always properly assessed, medicines were not managed safely, and there were not enough staff in the afternoon and at night. People sometimes waited a long time for care and could become incontinent while waiting.
The home’s records and quality checks were not reliable enough to identify or correct these problems. Inspectors also found that people's rights under the Mental Capacity Act were not always properly protected. Safe was rated Inadequate, Effective Requires Improvement and Well-led Inadequate.
The overall rating changed from Requires Improvement to Inadequate. The home was placed in special measures, which means CQC will keep it under review and normally re-inspect within six months if its registration is not cancelled.
Kind and friendly staff
People and relatives generally described staff as kind, caring and friendly. People also said staff respected their privacy.
“Despite the feedback above, people and relatives told us staff were kind, caring and friendly.” from the report
Safer recruitment
The home had improved its recruitment checks since the previous inspection. Staff were vetted through the Disclosure and Barring Service and nurses' registration checks were completed.
“At this inspection, the provider had carried out thorough recruitment checks.” from the report
Infection control
Inspectors were assured that the home was using protective equipment safely and had systems to prevent or manage infection outbreaks.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Food choices and dietary needs
People were offered meal choices and food and drinks were prepared to meet dietary needs and preferences.
“Meals and drinks were prepared to meet people's preferences and dietary needs.” from the report
Medicines were not consistently safe
seriousMedicines were sometimes unavailable, and one person went without medicines for several weeks. Handwritten records and instructions for medicines given when needed were not always clear enough.
“The provider could not be assured that people had received their medicines as prescribed.” from the report
Important risks were missed
seriousRisk assessments did not always explain how to keep people safe, including risks linked to epilepsy, choking, catheters, bed rails and call bells. Some people did not receive timely action for constipation or continence needs.
“The failure to ensure risks were robustly identified and managed to prevent harm so people received safe care is a continued breach of Regulation 12” from the report
Too few staff at some times
seriousThere were not enough care staff in the afternoon and at night to respond promptly to call bells and personal care needs. People told inspectors they sometimes waited for long periods.
“There were not enough staff deployed to provide safe care in the afternoon and at night.” from the report
Mental capacity processes were unclear
seriousCare records contained conflicting information about people's capacity. DoLS conditions were not recorded clearly in care plans, so staff did not always have the information needed to uphold people's rights.
“The failure to ensure people's rights were upheld within the basic principles of the Mental Capacity Act 2005 is a breach of Regulation 11” from the report
- 01What immediate changes have been made to ensure medicines are available, correctly recorded and given as prescribed?
- 02How many care staff are now deployed in the afternoons and at night, and how is this based on people's assessed needs?
- 03How are individual risks, including epilepsy, choking, catheter care, constipation and call-bell use, now assessed and communicated to all staff?
- 04How are Mental Capacity Act decisions and DoLS conditions recorded and checked?
- 05What action has been taken to make sure audits identify problems with care records, safeguarding, medicines and staffing?
This was a focused inspection of Safe and Well-led, extended to Effective; Caring and Responsive were not inspected and the report says ratings for uninspected questions were carried over from the last inspection. This explanation was written from the published report of 3 February 2023 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 Valley View Care Home Ltd
6 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- September 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2023Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementWell-led: Inadequate
- December 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Inadequate
- December 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementWell-led: Requires improvement
- November 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- February 2018Requires improvementSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2016
Registered with the Care Quality Commission on 23 December 2016.
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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