This inspection took place on 12 and 17 September 2018 and was an unannounced inspection.

Vale House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Vale House accommodates up to 40 people in one purpose built building. At the time of the inspection there were 38 people living at the service.

There was a registered manager in post. 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. The registered manager was not present on the main day of inspection.

Services that provide health and social care to people are required to inform the Care Quality Commission, (the CQC), of important events that happen in the service. The registered manager did not always notify the CQC of reportable events.

The service did not always take the necessary steps to minimise the risks associated with people’s care. Accidents and incidents were not always managed effectively to prevent reoccurrence and support future learning. The provider’s procedures to formally assess, review and monitor the quality of the service were not always effective.

The service was not always responsive to people’s changing needs. People were not always supported by staff who had the skills and knowledge to carry out their roles and responsibilities effectively and the service did not always follow the principles of the Mental Capacity Act 2005.

The home had not involved or sought the advice from a pharmacist to ensure that the decision to carry out covert medication was appropriate in relation to any impact that this could have on the medicine and its effects.

People told us they were safe living at Vale House. Staff were aware of how to safeguard people from harm and were aware of potential risks and signs of abuse. There were enough staff to meet people’s needs.

People were supported appropriately to eat and drink sufficient amounts to help maintain their health and well-being.

People were very complimentary about the staff and management at the home. They told us staff were kind, caring and compassionate. Visitors were welcomed at all times and people were supported to maintain family relationships.

The provider had systems in place to receive feedback from people who used the service, their relatives and staff members about the service provided. People were encouraged and supported to raise any concerns with staff or management and were confident they would be listened to and things would be addressed.

Staff told us, and records confirmed they had effective support. Staff received regular supervision (one to one meetings with their manager) and yearly appraisals. The provider had safe recruitment processes in place, which helped to ensure that staff employed were of good character and suited to the roles they were employed for.

Infection control measures were in place to help reduce the risks of cross infection.

This is the first time the service has been rated Requires Improvement.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We carried out this inspection over two days on first and third March 2016. The first day of the inspection was unannounced. At our last inspection of the service in June 2013, we found the provider had satisfied the legal requirements in all of the areas we looked at.

Vale House is registered to provide accommodation for up to 40 people who require nursing and personal care. On the day of the inspection, there were 40 people living at the home. Vale House provides a service for people living with advanced dementia.

There was a registered manager in post. 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. The registered manager was available throughout the inspection.

The service provided excellent and innovative person centred care that supported people to come to terms with difficult life changing events such as end of life care and bereavement. People were supported to maintain their interests by a staff and management team that not only respected the persons adult status, but also did not recognise any barriers in making things possible for people with dementia. Staff consistently demonstrated affection and warmth in their relationships with people.

The service was exemplary in responding to people’s needs and preferences. People were supported by a service that was devoted to getting to know the people and family’s they supported. Relatives told us the service was responsive and well managed. Relatives knew the registered manager. The service sought people’s views and opinions and acted upon them.

Relatives told us people were safe. People were supported by staff who could explain what constitutes abuse and what to do in the event of suspecting abuse. Staff had completed safeguarding training and understood their responsibilities. People received their medicines as prescribed. Staff administering medicines checked each person’s identity and explained what was happening before giving people their medicine. Where risks to people had been identified risk assessments were in place and action had been taken to reduce the risks. Staff were aware of people’s needs and followed guidance to keep them safe.

There were sufficient staff to meet people’s needs. Staff were not rushed in their duties and had time to chat with people. Throughout the inspection there was a calm atmosphere and staff responded promptly to people who needed support. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

Staff understood the Mental Capacity Act (MCA) and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves.

People were cared for by a service that was devoted to getting to know the people they supported. There was a clear focus on the importance of knowing peoples histories and involving relatives at every point of peoples care.

Relatives told us they were confident they would be listened to and action would be taken if they raised a concern. We saw complaints were dealt with in a compassionate and timely fashion. The service had systems to assess the quality of the service provided. Learning needs were identified and action taken to make improvements which promoted people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

Staff spoke positively about the support they received from the registered manager. Staff had access to effective supervision. Staff and the registered manager shared the visions and values of the service and these were embedded within service delivery.

We spoke with seven care workers who worked at Vale House and they told us they all enjoyed working at the home. One said "I love working with the people here, it is so rewarding". Another said "everyone is so friendly here". We spoke with the 'family support worker' who said "I build relationships with peoples' families. They often come to me with issues they would not speak to other family members about and I help them solve or come to terms with these problems. I think it is so important to support these people".

We conducted a Short Observational Framework for Inspection (SOFI) and saw that people living with dementia were treated in a genuine, caring and respectful way that encouraged engagement and promoted their well-being.

We spoke with a relative of a person who used the service. They said "I know my mother is happy here. It is so much better than where she was before".

We looked at care plans, staff files, surveys and quality assurance documents. We found that people and their families were involved in their care and that they were safe and well cared for. Records at the service were well maintained and all documents were correct and up to date. We found the service to be safe, caring, effective, responsive to peoples' needs and well led.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us of their experiences. We spoke to the relatives of five people who used the service. They told us that their relatives had moved from the smaller home in Botley to this larger modern home. They told us “ that they loved the new building “ They liked the fact that “ many of the staff from the previous home moved to the new home “. We were told that staff were “ kind and very caring “. One relative told us that it gave her “ peace of mind “. One relative contacted us to say that she was not happy with the care the home provided. We looked at the care plan for this person and found that the home had provided a high standard of care and had involved outside professionals and the family in all decisions.

Many people told us they “ liked the open spaces and the secure garden areas where people can walk around in safety “

During the visit we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people’s experiences and staff interaction during this session were like.