This inspection took place on 17 and 19 December 2018 and was unannounced.

Loose Valley Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, both were looked at during this inspection.

Loose Valley Nursing Home is registered to provide accommodation and personal or nursing care for up to 39 older people. Accommodation is provided on two floors; a passenger lift provides easy access between floors. Situated just outside Maidstone town centre, Loose Valley Nursing Home enjoys easy access to local amenities and public transport links. There is a garden to the rear of the building. At the time of our visit there were 18 people living in the service. People had a variety of needs including dementia, communication difficulties, physical health and mobility difficulties.

At our last full inspection on 10 May 2016, the service was rated as Good overall and Requires Improvement in the ‘Safe’ domain. We revisited the service on 2 March 2017. This was a focused inspection, looking at the ‘Safe’ domain. At that inspection, we found improvement had been made in the 'Safe' domain and it was rated as Good following that inspection.

At this inspection, on 17 and 19 December 2018 the evidence seen continued to support the rating of Good, there was no evidence or information from our inspection or ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

A registered manager was in post. A registered manager is a person who has registered with the care Quality Commission to manage the service. 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.

Care and nursing needs were assessed before people moved to the service. People received consistent care from trained nurses and care staff, their specific health care needs were met with the support from health care professionals. Care records were up to date, comprehensive and reviewed on a regular basis. People were always treated with dignity and compassion. The care team worked alongside health care professionals to ensure people could remain at Loose Valley and have a comfortable and pain free death.

People received a service that promoted their safety whilst encouraging their rights and choices. Potential risks to people were identified and mitigated. People were protected from the risk of infection by appropriate control measures. The premises and equipment were maintained with due regard to people’s safety.

People were supported to eat and drink enough. Kitchen staff ensured people had access to a variety of food choices. People who required specific diets or additional support with their meals were catered for and supported in a safe way.

Nurses and care staff were trained to meet people’s needs including any specialist needs. Staff received regular support and guidance from the management team.

People were supported to have maximum choice and control of their lives, staff supported them in the least restrictive way possible and policies and systems in the service supported this practice.

People were treated with kindness and compassion. Staff understood the importance of promoting and respecting people’s privacy and dignity. People were supported to maintain independence.

People had the opportunity to raise and concerns or make suggestions about the service they received and systems were in place to monitor and improve the quality of the service.

Further information is in the detailed findings below.

The inspection was carried out on 02 March 2017 was unannounced.

Loose Valley Nursing Home is registered to provide nursing care for up to 39 older people. Most bedrooms are for single use, but shared rooms are available. Accommodation is provided on two floors, with a passenger lift providing easy access between floors. It is situated just outside Maidstone town centre, and offers easy access to local amenities and public transport links. There is a garden to the rear of the building. At the time of our visit, there were 29 people living in the service. People had a variety of complex needs including communication difficulties, physical health needs and mobility difficulties.

Rating at last inspection.

At the last Care Quality Commission (CQC) inspection on 10 May 2016, the service was rated overall Good and Requires Improvement in the ‘Safe’ domain.

Why we inspected.

We carried out an unannounced focused inspection of this service on 10 May 2016. We found a beach of legal requirements. The breach was in relation to failure of management and staff in the proper and safe management of medicines. We asked the provider to take action.

We received an action plan on 14 July 2016 from the provider following the inspection, which detailed what action they would do to meet legal requirements in relation to the breaches of Regulation 12 of the Health and Social Care Act Regulated Activities Regulations 2014 Safe care and treatment. They told us that they would meet the breaches by 30 September 2016. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Loose Valley on our website at www.cqc.org.uk.

At this inspection, we found the service remained good and is now rated good in the 'safe' domain.

Why the service is rated Good.

At this inspection, we found that the service had improved since the last inspection. Medicines had been generally well managed, stored securely and records showed that medicines had been administered as they had been prescribed.

The provider and registered manager had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the provider’s whistleblowing policy. They were confident that they could raise any matters of concern with the registered manager, or the local authority safeguarding team.

People’s safety had been appropriately assessed and monitored. Each person’s care plan contained individual risk assessments in which risks to their safety were identified.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs.

They had robust recruitment practices in place. Applicants were assessed as suitable for their job roles.

This inspection took place on 10 May 2016 and was unannounced.

Loose Valley Nursing Home is registered to provide nursing care for up to 39 older people. Most bedrooms are for single use, but shared rooms are available. Accommodation is provided on two floors, with a passenger lift providing easy access between floors. It is situated just outside Maidstone town centre, and offers easy access to local amenities and public transport links. There is a garden to the rear of the building. At the time of our visit, there were 29 people who lived in the home. People had a variety of complex needs including communication difficulties, physical health needs and mobility difficulties.

There was a registered manager at the home. 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.

Medicines had not always been given to people as prescribed by their doctors and adequate records were not always kept.

One to one staff supervision had not been consistent. There were gaps in supervisions which showed that staff had not sometimes had supervision for six months or more. Yearly appraisals were inconsistent. We have made a recommendation about this.

There were sufficient numbers of qualified, skilled and experienced staff to meet people’s needs. However, staff felt hurried or rushed and when people requested care or support, this was not delivered quickly. We have made a recommendation about this.

Systems were in place to enable the registered manager to assess, monitor and improve the quality and safety of the service. However, some shortfalls identified in medicine management had not been identified by the registered manager.

The provider had systems in place to manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. All of the people who were able to converse with us said that they felt safe in the home; and said that if they had any concerns they were confident these would be quickly addressed by the registered manager. Relatives felt their people were safe in the home.

Safe recruitment processes were in place. Staff files contained all of the information required under Schedule 3 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The home had risk assessments in place to identify risks that may be involved when meeting people’s needs. The risk assessments showed ways that these risks could be reduced. Staff were aware of people’s individual risks and were able to tell us about the arrangements in place to manage these safely.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the home complied with these requirements.

The food menus offered variety and choice. They provided people with nutritious and a well-balanced diet. The chef prepared meals to meet people’s specialist dietary needs.

People were involved in their care planning, and that staff supported people with health care appointments and visits from health care professionals.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Staff encouraged people to make their own choices and promoted their independence.

People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider’s complaints policy.

People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the p

The inspection was carried out by one inspector over a period of four hours. There were 29 people living at the home at the time of our inspection. They had a range of nursing and residential care needs. This report is based on our observations and review of records during the inspection. We also talked with four people who used the service, three staff who were working in the home, and observed four people in the home.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty with the appropriate skills and experience to meet the needs of the people living at the home. Staff provided care and support during the day and night. People also had access to the call buzzer system in their rooms and in shared areas.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have been submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service effective?

People told us that they were happy with the care they received. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. One person told us "The staff help me the way I want them to; they help me do my hair”. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to make their own choices in their everyday lives. Our observations confirmed this. One person told us “The staff look after me well". We observed staff providing care and noted that people were offered drinks regularly.

Is the service responsive?

People’s needs had been assessed before they moved into the home. There was evidence that staff regularly discussed any changes related to people’s care with them. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. One person told us that staff had acted quickly to treat a cut after an accident.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they were asked for their feedback on the service they received and that they had also filled in a quality survey. Staff told us they were clear about their roles and responsibilities. The manager confirmed that there was a comprehensive programme of training for staff, which covered mandatory subjects such as health and safety and safe guarding, as well as broader subjects for professional development.

Some people using the service had dementia. This meant they were not always able to tell us their experiences. We observed how people interacted with the staff and management of the service. We spoke with three relatives, the manager and staff.

Visitors we spoke with told us that they were happy with the care provided to their relatives. They told us, “They understand people’s needs and know what they are doing”. “They give personalised care here”. "They treat people with respect”.

We found that people or their representatives had been involved in decision making and giving their consent for care and treatment.

People were provided with appropriate care and support that met their needs.

People received the medication they needed at the time they needed it.

There were adequate numbers of staff on duty to meet the needs of the people who lived in the home.

There was an effective system to regularly assess and monitor the quality of service that people received.

Overall we found that Loose Valley Nursing Home had achieved compliance but have made some comments that the provider may find useful to note.

People told us they enjoyed living at the home. They said that staff supported them to

make decisions, and listened to them if they were worried about something. People said

they felt safe and well cared for.