The inspection took place on 17 and 18 July 2017 and was unannounced. We last inspected the home in February 2017 and found the provider was breaching the regulations in relation to safe care and treatment; meeting nutritional needs; good governance and staffing. Following the inspection we issued warning notices for the breaches of regulation relating to staffing and good governance and requirement notices for the other breaches. The home was rated inadequate and placed in ‘special measures’. The provider did not submit an action plan in line with legal requirements following our inspection in February 2017 to show how they planned to meet the regulations. During this inspection we found the provider continued to breach the regulations in relation to safe care and treatment and good governance.

Valley View Residential Care Home is registered to provide accommodation for people who need personal care. It provides a service primarily for older people, including people living with dementia. There were 27 people living there at the time of this inspection.

The home did not have a registered manager. The deputy manager had taken up the post of acting manager with support from an external consultant. 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.

Due to a lack of management oversight at the home progress towards improving the service and meeting the regulation had been delayed. The provider had only just developed a comprehensive improvement plan for the home with most actions not yet commenced.

Quality audits were not completed regularly or consistently such as bedroom and kitchen audits and monthly checks of airflow mattresses and pressure prevention cushions had not been completed since March 2017. Medicines audits lacked scope and detail and not been effective. A new medicines policy was not specific to the home or fit for purpose. Safeguarding concerns, incidents and accidents were not monitored or analysed.

Medicines were not always managed safely. We found shortfalls with the storage and recording of medicines.

Medicines care plans were not in place to guide staff as to people’s support requirements to ensure people received their medicines as prescribed.

People, relatives and staff told us the home was safe.

Staff showed a good understanding of safeguarding adults and the provider’s whistle blowing procedure. They knew how to raise concerns but told us there hadn’t needed to.

There were sufficient staff deployed when we inspected the home. This was confirmed from feedback we received from people, relatives and staff and from our own observations. The provider had effective recruitment checks in place. Pre-employment checks were carried out to ensure new staff were suitable to work at the home.

There were regular health and safety checks in place to help keep the premises safe, such as checks of fire safety check; hot water temperatures, emergency lighting, gas and electrical safety. We observed that staff used equipment such as moving and handling equipment correctly.

Where potential risks had been identified, a risk assessment had been carried out. Risk assessments had been completed for a range of areas such as moving and handling, falls, malnutrition and pressure ulcers.

People and relatives were happy with the care they received and the staff providing it. We found a small number of times when staff weren’t as attentive to people’s needs as they should be.

Staff confirmed they felt supported, however formal one to one supervisions and appraisals were not being completed. Staff were undertaking training and apprenticeship programmes to develop the skills and knowledge they need in their role. This was on-going w

This was an unannounced inspection which took place over three days, 8, 10 and 17 February 2017. The service was last inspected in December 2015. Seven breaches of regulation were found at that time. These related to person centred care; consent; safe care and treatment; safeguarding service users from abuse and improper treatment; meeting nutritional and hydration needs; staffing and governance. Requirement notices were issued to the provider.

Valley View is registered to provide accommodation for people who need personal care. It provides a service primarily for older people, including people with dementia. There were 35 people living there at the time of this inspection.

There was a registered manager who had been in post since 2010. 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 had not always notified the CQC of all incidents as required. Six safeguarding alerts had been raised with the local authority but notifications had not been submitted as required to the CQC where possible harm occurred.

People, staff, external professionals and our observations told us that staff were not always able to respond quickly and consistently to people’s need for support. People’s care plans were not always updated promptly with any changes to their support needs.

Routine checks of the service’s safety had not always been completed consistently nor had they identified the issues we found at inspection. Records of people’s care did not demonstrate that people were receiving the support they required. People’s personal care and support records were not being used to consistently support people’s wellbeing.

People’s medicines were not safely managed. There had been a number of concerns raised about gaps in recording and failing to have adequate supplies of medicines.

Most people, relatives, staff and external professionals we spoke with told us there were not enough staff to meet people’s needs. Sufficient staff were not in place to support people throughout the day and night and to maintain accurate records. We had previously recommended the provider use a suitable staffing calculation tool and this had not been acted upon.

Staff were not properly trained and supported to meet people’s needs. Staff were overdue essential training. Staff were not receiving regular supervision or appraisal of their future development needs.

The service did not always records best interests decisions in line with the principles of the Mental Capacity Act. We have made a recommendation to improve how this is recorded in future.

People were not always supported to maintain a suitable food and fluid intake, recording of intake was inconsistent and not in line with people’s needs. Due to limited staffing people told us they missed meals or were not supported to avoid malnutrition or de-hydration.

Staff were aware of people’s choices and how they preferred to be cared for. Where decisions had to be made about people’s care, they and their families were not always involved and consulted as part of the process. It was not always recorded how people’s consent had been agreed.

Staff were caring and valued the people they worked with. However staff told us they did not have ‘time to care’ due to limited staffing in place to meet people’s needs. Staff told us they missed breaks to support people and each other, but had negative feelings about how well they supported people as individuals.

The service supported people to access appropriate external healthcare services so the staff could keep them safe and well. External healthcare professionals expressed concerns about the services capacity to manage people’s needs.

The service did not have any regula

At the time of the inspection there were 37 people living at the home. Due to their health conditions and complex needs not all people were able to share their views about the service they received, but we did speak with twelve people. We observed their experiences to support our inspection. We spoke with the registered manager, seven care staff, two relatives, a district nurse and a doctor.

During the inspection five key questions were answered; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

All the people told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. One person told us, “Everything is fine here. If I need anything the staff will come, I feel I am looked after here.” All the relatives told us they felt people were safe and well looked after. They told us they would not hesitate to report any abuse and told us they had no issues or concerns.

We spoke with staff about Deprivation of Liberty Safeguards (DoLS). The registered manager told us there had been no applications and showed us the policy and procedures they followed. They told us staff had received relevant training and had access to the policy and procedures.

We saw the service was safe, clean and hygienic. The home had an effective infection control system. Equipment was well maintained and serviced regularly, so preventing any unnecessary risks. All the staff told us how they worked to prevent infection and told us how they would manage an outbreak at the home so the risk of infection spreading could be reduced.

Is the service effective?

People explained how their care and welfare needs were met. One person told us, “I’ve really improved in the home. They have really looked after me. I am walking now; I have come on leaps and bounds.” Another person told us, “Generally speaking it’s not bad. They have got to get you moving. The staff has helped me with my walking; I have a walking frame now which really helps.”

One relative told us, “I am absolutely delighted with the care. My mother did not settle at first. I was worried she would not be able to stay. They staff put in a special plan to support her, I can’t believe the difference. It has worked and she has settled.”

Is the service caring?

We saw staff communicated well with people and were able to explain things in a way which could be easily understood. We saw they did not rush people in the home and we saw the interactions were caring. All the relatives we spoke with said they felt the care was very good. One relative told us, “It’s brilliant. I find all the staff are good. I feel I can talk to them about anything and they will help.”

We saw people were treated with respect and dignity by the staff. We saw people were given choice in their care and all the relatives we spoke to told us they were very happy with the care. All the people we spoke with also told us they were happy with the care and support they received.

Is the service responsive?

All the people told us they were very happy with the service. One told us, “I like this quiet room, it’s nice and relaxing. It I want anything I just call the staff. They are good you know.” People told us if they were not well or needed support during the night the staff had responded straightaway. We saw staff responded to people's requests for help in a timely way.

Some of the people we spoke with told us they were involved in decisions about their care. They told us the staff were flexible and responded to their requests at times they had asked, for instance, in their rooms when they had pressed the buzzer for assistance or personal care tasks.

We saw there was a complaints policy at the home. People told us they found the registered manager very approachable and would not hesitate to raise any issues or complain.

People’s care needs had been reviewed at least every six months. We saw when people's requirements had changed the provider had responded and reviewed their care needs so they could meet their changed support requirements. A doctor who visited the home every week told us, “I have no concerns whatsoever about the home. We hold special meetings here every week with the manager. If people need a doctor we will see them. The arrangement works really well. In fact, it’s great to come to this home.”

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service well-led?

We spoke with the registered manager. They showed us there was an effective system to regularly assess the quality of service people received. We found the views and opinions of people using the service and their carers, family and relatives were also regularly recorded. The manager showed us activities had been arranged in response to the views and opinions they had received.

We saw the home had systems in place to make sure managers and staff learnt from any accidents, complaints, whistleblowing or investigations. This reduced the risks to people and helped the service to continually improve.

Staff also told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure people received a good quality care service at all times.

This was an inspection to follow up areas of concern we found when we last inspected. We found the provider had taken steps to improve the arrangements to help people with getting around. This was because they had obtained equipment to help people who found it difficult to move from place to place, such as their chair to a wheel chair. This meant the risk of injury when being transferred had been reduced.

We found the provider had also taken steps to improve staff recruitment processes. We saw that robust checks were in place before people were offered a job. This ensured they had taken reasonable measures to reduce the risk of unsuitable staff being employed.

We found the provider had taken measures to improve medicine management arrangements. This was because they had implemented regular competency checks of staff practice and received medicine supplies from an alternative pharmacist who could provide a greater level of support to the home’s staff.

People using the service told us they were happy at the home and with the care provided. They told us they felt safe at the home.

Comments included “It’s great, fabulous. You’re well looked after”; “I feel safe here. I have no issues”.

On 30 November 2010, we received a statutory notification from the home informing us of a drug error which had occurred and led to the hospitalisation of someone living at the home. We did not visit the service and did not meet with the person involved or speak with their family or representative.

This was an unannounced inspection which took place over two days on 8 and 18 December 2015. The service was last inspected in April 2014 and was meeting the regulations in force at the time.

Valley View is registered to provide accommodation for people who need personal care. It provides a service primarily for older people, including people with dementia. Nursing care is not provided. The service had 42 beds, and there were 35 people living there at the time of this inspection.

There was a registered manager who had been in post since 2010. 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.

People told us they felt safe living at the service and that staff knew how to act to keep them safe from harm. The building and equipment were well maintained and there were regular health and safety checks undertaken by staff. Not all safeguarding alerts were raised with external agencies and there was limited review and learning after incidents. Not all risks to people’s health and wellbeing were being effectively evaluated by staff.

The registered manager did not have a dependency tool to assess how staffing was deployed. There were enough staff on duty to meet people’s care needs but relatives told us that at times staff appeared rushed, and staff confirmed this to us. Records did not show us that staff were properly trained and supported to meet people’s needs. Staff were overdue essential refresher training.

Medicines were managed well by the staff and people received the help they needed to take them safely. Where people’s needs changed the staff sought medical advice and encouraged people to maintain their well-being. External healthcare professionals’ advice was sought quickly and acted upon, but not always recorded on updated care plans.

People were supported by staff who knew how best to support them. Staff were generally aware of people’s choices and how they preferred to be cared for. Families felt the service was effective and offered them reassurance that their relatives were being well cared for. Where decisions had to be made about people’s care, families and external professionals were not always involved and consulted as part of the process. It was not always recorded how people’s consent had been agreed.

People were not always supported to maintain a suitable food and fluid intake, recording of intake was inconsistent and not in line with people’s care plan goals. Staff responded flexibly to ensure that people maintained their physical wellbeing and worked with people as distinct individuals.

Staff were caring and valued the people they worked with. Staff showed kindness and empathy in responding to people’s needs. Families felt their relatives were cared for by a staff team who valued them and would keep them safe.

Privacy and dignity were carefully considered by the staff team, who ensured that people’s choices and previous wishes were respected. Our observations and conversations with staff confirmed there was genuine empathy and warmth between staff and people living at the home.

People who were receiving end of life care had their needs appropriately assessed and managed. Professional advice was sought where needed to promote advance care planning.

The service did not always respond to people’s needs as they changed over time, and reviews of care plans lacked detail. The service supported people to access appropriate external healthcare support so the staff could keep them safe and well.

The registered manager's system to make sure the service was audited and learnt from events had not been used formally for a period of five months.  There was limited evidence of formal communication with the staff team, of formal resident/ relatives meetings, or of learning and feedback from satisfaction surveys.