About the service: Cole Valley is a residential nursing home that provides accommodation and nursing care to up to 45 people. At the time of the inspection there were 24 older people living at the service, many of whom were living with dementia.

People’s experience of using this service:

• People were not protected from the risk of serious harm due to inadequate risk management processes within the service. People were also not sufficiently protected from the risk of abuse and mistreatment.

• People were exposed to the risk of harm due to unsafe recruitment practices. Insufficient pre-employment checks and risk assessment meant staff members who were unsuitable to work with vulnerable people could be recruited.

• People’s rights were not upheld with the effective use of the Mental Capacity Act 2005 (MCA). People were not always fully enabled to make choices and to fully participate in the development of their care and support plans.

• People were not always supported in a caring environment where their privacy, dignity and independence was respected and promoted.

• The provider had not ensured complaints were managed effectively. They had also not ensure people’s views were proactively sought and used to improve the safety and quality of care provided.

• The provider had failed to ensure that sufficient and effective management, quality assurance and monitoring systems in place. As a result, they were not aware of the widespread concerns we found during our inspection. They had not ensured the quality and safety of care was sufficiently monitored and that appropriate action was taken to protect people from the ongoing risk of harm.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

Rating at last inspection: At the last inspection completed on 20 and 21 August 2018 the service was rated as inadequate and was entered into special measures. We published this report on 19 September 2018.

Why we inspected: This inspection was a scheduled inspection based on the previous rating. Prior to the inspection we were notified about a serious incident in which a person using the service died following an accident within the service. We looked at risks associated with this. Further information is in the full report.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will keep this service under review and will publish details of our regulatory response once this has been concluded.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection site visit took place on 20 and 21 August 2018 and was unannounced. At the last inspection completed in February 2017 we rated the service as ‘requires improvement’. We found improvements were needed in the areas of risk management, the application of the mental capacity act and the overall governance of the service. At this inspection we found the required improvements had not been made and further improvements were also needed.

Cole Valley 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. The care home accommodates up to 45 people who require nursing care. At the time of our inspection there were 41 people living at the service, many of whom were living with dementia. A registered manager was 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.

People were not protected from the risk of accident or injury due to ineffective risk management processes. Accidents and incidents were recorded but these were not reviewed sufficiently and lessons were not learned to minimise risk and make improvements across the service.

While care staff could describe potential signs of abuse, issues were not always identified and reported meaning action wasn’t taken to protect people from potential harm.

Medicines management systems were not consistently safe. People’s creams were not stored securely. Staff were administering creams that had not always been prescribed or that had been prescribed for others. People were not always supported by sufficient numbers of staff.

People’s rights were not always upheld by the effective use of the Mental Capacity Act. People’s capacity to provide consent or make decisions had not been considered in line with the Act. Decisions were not being made appropriately in people’s best interests.

People were not always cared for by staff who had the skills and knowledge to support them effectively. People’s nutritional needs were met although some improvement to staff knowledge and the support people received was needed. People had access to healthcare professionals but not always in a timely way.

People did not consistently receive care that was kind and caring. People’s dignity was not always upheld and their independence was not always promoted. People were supported to receive visits from friends and family without unnecessary restrictions.

People were not fully involved with the planning of the care they received. People’s individual support needs were not always fully understood and met. People’s diversity was not embraced and their care needs personalised as a result. People’s needs in relation to any protected characteristics were not fully considered. People did not receive access to a sufficient range of leisure opportunities that met their individual needs.

People understood how to make a complaint when required. Some relatives did not feel their complaints had been appropriately addressed.

People were not living in a service where a culture of quality improvement had been developed. Quality assurance systems were either not in place or were inadequate. Areas of improvement needed and risk had not been identified. Action was not being taken to drive improvements and the registered manager had not recognised where improvements were needed.

People were not enabled to be fully involved in the development of the service they lived in. People were not cared for by a staff team who were well supported and consistently motivated in their roles.

We found the provider was not meeting the regulations aro

We carried out this unannounced inspection on the 15 and 16 February 2017. Cole Valley Nursing Home provides nursing care and support for up to 44 older people who may also live with dementia. At the time of our inspection 41 people were residing at the home.

We undertook a comprehensive inspection of this home in February 2015. We found that the home had steadily improved since our last inspection. We found that the home was compliant with the requirements of the law and meeting people’s needs well in four of the five key questions we looked at. The registered manager needed to continue to make improvements to ensure people had the support they needed to eat and drink and to ensure that people’s human and civil rights were upheld. This inspection identified that while people received mainly safe care that they were satisfied with, improvements had not all been maintained and continued.

The home has a registered manager who has been in post for 13 years. 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 that they felt safe. However we identified some incidents had occurred between people where people had hurt each other. These incidents had not been identified by staff as possible abuse, and the required support had not been obtained and no review of people's care had taken place. This meant people were not fully protected from the risk of a similar event re-occurring. Since our inspection we have received feedback about the action taken to improve on this.

Staff had been trained in adult safeguarding and when we spoke with them they showed a good level of knowledge about possible signs of abuse and the action they would take in reporting any concerns. However staff had not applied this knowledge into practice as they hadn’t identified and reported the incidents identified during our inspection.

People received their medicines safely and there were effective systems in place to monitor medicines administration.

The feedback we received about staffing was mixed. For the majority of the time we observed adequate numbers of staff on duty, and saw people's needs and requests being met promptly. People were not left for long periods of time without access to staff. However feedback from people and relatives was that this was not always the case, and we were informed that sometimes people did have to wait for care and support, which at times caused them distress. Staff told us they had received induction, sufficient training and on-going support. There were handovers between staff at each shift change.

Staff had some knowledge of the Mental Capacity Act (MCA) (2005) and described how they supported people with making choices. Restrictions to people's liberty had been identified. When necessary the relevant applications had been made and kept under review. Further work was needed to ensure the required legal notifications were sent to the commission, and that alternative, 'less restrictive' options were considered when making decisions with people.

People had access to regular healthcare and specialist healthcare advice. The nursing care provided was generally good and followed published good practice guidelines.

People’s feedback about the food provided was mostly positive. Some people really enjoyed the food and other people thought it was acceptable. We observed that people were supported in a dignified and respectful way when they required help to eat and drink. The provider was taking part in a local good practice project that promoted fluids for people at risk of not drinking enough.

We received consistent feedback that the quality of care provided by individual staff was good and people told us that s

During this inspection we looked at four people’s care files. All of whom had additional nutritional needs. We spoke with three people using the service and four relatives who visited that day.

During this inspection we observed food and drink being offered late morning,lunch time and mid afternoon snacks . Most of the people using the service had conditions which made it difficult for them to communicate with us. However, we spoke with three people who were able to give their opinions about the food. People told us that they were happy with the quality and choice of food provided and that meals were served at the correct temperatures. A person told us “The food is very good, there is plenty of variety, and meat and vegetables.”

People told us that they enjoyed meal times and efforts were made to promote a social and inclusive environment for people during these times. Within the dining room during the meals, music was playing and we saw that people were talking to each other and commenting on the food being served.

People could choose where to eat there meals, some people ate in their bedrooms.. Arrangements were in place so that they too received their meals at the correct temperatures and were supported to eat them where needed.

People using the service had recently participated in a survey in order to put forward their views and suggestions for meals provided at the home. The management was looking to add these to the menu in the near future.

People we met told us they were very happy with the care and support they receive from the staff at Cole Valley Nursing Home. People told us "They take good care of us here" and "They are all very kind." We spoke to three health care professionals who support people at the home. Their comments included, "I think her needs are well met there. I have no concerns" and " I think everyone is safe and very settled."

We looked around the home, and found it was clean, and free from unpleasant odours. People told us it was always "Spotlessly clean" and three people had ticked a questionnaire we viewed confirming that the home was clean, tidy and odour free. We found that work was needed to refresh the decor, replace some worn items of furniture and ensure bedroom doors protect people in the event of a fire.

Feedback from people about food was good and one comment at lunchtime included, "It was lovely. Thank you."

We observed that the staff team were very busy throughout the day, but people told us they had a good relationship with the staff and that they did not have to wait long for care. One person said, "They are very good, would do anything for you. Even clean my mucky glasses!" One person when asked about staff gave a big smile and said " The staff are marvellous."

We carried out this review because we received information that indicated that staffing arrangements did not meet the levels of support that people needed. Many of the people who lived at Cole Valley were not able to tell us much about their experience of living at the home, because of their health needs.

On the day of our visit, we saw positive staff interactions with people living at the home. Care staff were polite, respectful and demonstrated that they were able to communicate in a way that people could understand. We observed that care staff were very busy across the morning, but appeared more rushed once preparations for lunchtime commenced.

We spoke with visitors to the home on the day, who were complimentary about the care provided.

We met a large number of the people who live at Cole Valley Nursing home, and observed the care and support staff offered them. We saw lots of examples of staff speaking to people in a calm, friendly and reassuring way, that was respectful of the person's dignity.

We spoke to three people in private, and their feedback about the home was positive.

This inspection took place on 25 February and 04 March 2015, and was unannounced. The service was last inspected in October 2013 and at that time we found the home had breached four regulations of the Health and Social Care 2008, and in these areas was failing to meet the needs of the people living at Cole Valley Nursing Home. In October 2013 the home was not providing the support people needed to meet their social care needs, the premises were not well presented or maintained, staff had not been provided with the supervision and training they required to meet the needs of people living at the home and systems in place to assess and monitor the quality and safety of the service were inadequate.

Following the inspection in October 2013 we met with the provider and they submitted an action plan. This detailed how they would improve the service to meet the requirements of the law and the needs of the people living in the home. At this inspection we found that significant improvements had been made in all areas. We found that the provider was now meeting the requirements of the law and people we met and spoke with reported favourably about the care and support they were receiving.

Cole Valley Nursing Home is registered to provide nursing care and accommodation for up to 44 older people. At the time of our inspection 39 people were residing at the home. Most people had their own bedroom, and the one shared room was occupied by a married couple. People shared communal facilities including three lounges, a dining room, and assisted bathrooms. The home is located over two floors and there is a passenger lift to enable people without full mobility to transfer around the home.

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.

People were supported by staff who had received training on how to protect people from abuse. Safeguarding procedures were in place which the manager was following. Staff we spoke with were able to explain a variety of actions and checks they took both individually and as a team to ensure people received the support they needed and were protected where ever possible from harm.

The Mental Capacity Act 2005(MCA) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to a supervisory body for authority to deprive someone of their liberty. We found that some training had been delivered and that staff had started to undertake work on capacity assessments and DoLS applications where needed. The inspection identified that the manager and staff team did not fully understand their roles and responsibilities, but were taking further action to increase their knowledge and get the support they required.

People were being supported to maintain and improve their health. The manager had developed strong links with a wide variety of health care professionals and medical staff to ensure people were assessed and treated when they were ill.

People told us they enjoyed the food served and we observed people in the dining rooms getting good support to eat a wide variety of foods. We found further support and planning was required to ensure people choosing to eat a meal in their rooms also got the support they required.

We observed and heard caring and compassionate interactions between staff and people throughout our inspection. Staff were quick to notice people required support or to intervene if people became distressed.

The manager had developed systems to respond to concerns and complaints. People we spoke with told us they had been happy with the home and had been able to get any grumbles or concerns dealt with promptly by speaking directly with the manager.

The activities and opportunities available to people had increased, and we found that people were supported to attend events that were important to them in the local community. A wider range of opportunities were available for all people in the home, including the people being cared for in bed.

The systems in place to check on the quality and safety of the service had improved since our last inspection. We found the checks and audits had been effective at identifying issues that required improvement and this had resulted in the home running more smoothly and improved the experience for people living at the home.