Dearne Valley Care Centre is registered to provide accommodation and personal care for up to 34 older people, some of whom may be living with dementia. The home is located in a residential area with access to public services and amenities.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

Our last inspection at Dearne Valley Care Centre took place on 25 August 2015. The service was rated as Requires Improvement. We found breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in regulations 12: Safe care and treatment, 11: Need for consent and Regulation 18: Staffing. Requirement notices were given for these breaches in regulation. The provider sent an action plan detailing how they were going to make improvements. At this inspection we checked improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of these regulations.

This inspection took place on 8 March 2017 and was unannounced. This meant the people who lived at Dearne Valley Care Centre and the staff who worked there did not know we were coming. On the day of our inspection there were 33 people living at Dearne Valley Care Centre.

People spoken with were positive about their experience of living at Dearne Valley Care Centre. They told us they felt safe and they liked the staff.

We found systems were in place to make sure people received their medicines safely so their health was looked after.

Staff recruitment procedures ensured people’s safety was promoted.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role.

Some staff were not provided with supervision and appraisal at identified frequencies for their development and support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the registered provider’s policies and systems supported this practice.

People had access to a range of health care professionals to help maintain their health. A varied diet was provided, which took into account dietary needs and preferences so people’s health was promoted and choices could be respected.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and they were involved in decisions about their care. People’s privacy and dignity were respected and promoted. Staff understood how to support people in a sensitive way.

A programme of activities was in place so people were provided with a range of leisure opportunities.

People said they could speak with staff if they had any worries or concerns and they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

The inspection took place on 25 August 2015 and was unannounced which meant no one at the service knew we would be attending.

The service was last inspected in June 2014 and was found to be meeting the requirements of the regulations we inspected at that time.

Dearne Valley Care Centre accommodates up to 34 older people that require personal care. In March 2015 it ceased providing nursing care. Included within the home is a unit which can accommodate up to 12 people who may be living with dementia. At the time of our inspection there were 27 people using the service; 12 people on the unit for people living with dementia and 15 people in the rest of the home.

Although there was a manager at the home, they were not yet registered with the Care Quality Commission (CQC) but an application form was in progress to become registered. A registered manager is a person who has registered with the CQC 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.

Staffing levels and resources were based on occupancy levels as opposed to people’s individual needs. There were concerns that this could lead to a risk of people not receiving appropriate support. These concerns had been raised at a previous staff meeting.

Medicines were not always being managed in a safe way. We saw a number of times within the last month where the treatment rooms had exceeded safe temperature ranges to store some medicines. People said they got their medicines on time and we observed staff administer medicines in a safe manner. Medication administration records were completed but some topical cream charts had gaps in place.

We saw some care plans had not been reviewed for a several months but ones that had been were person centred. The manager had prioritised which care plans to review and all were in the process of being reviewed. Life histories were not included but this had been identified by the manager and a staff member was assigned responsibility for compiling these.

Staff knew how to report abuse and safeguarding referrals made appropriately. Policies and procedures were in place to guide staff as to how reduce risk of abuse. We saw evidence of decisions being made in people’s best interests but consent was not always sought in accordance with the service’s consent policy and the Mental Capacity Act (MCA) 2005. One person had a Deprivation of Liberty Safeguard (DoLS) authorisation and further assessments were to be considered.

We saw a number of activities take place which included making crafts and karaoke. We saw that people actively enjoyed these. We saw positive interactions between staff and people which included staff chatting with people. People we spoke with commented positively about the staff and how they were cared for. We saw instances of caring interactions between staff and people. We observed staff offer reassurance to people when they were providing support. People’s privacy and dignity was respected and promoted by staff.

We saw evidence of regular ‘residents and relatives’ meetings and feedback surveys were provided annually to people and their relatives.

Regular team meetings took place with all staff. Staff comments about the new manager were very positive. Comments from professionals and feedback from people and relatives were also positive about changes in the home and the new management. We saw audits and quality monitoring of the service were completed routinely and actions were followed up appropriately. Analysis of incidents took place with an aim to reduce further recurrences. The manager made notifications to the commission where required.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Two adult social care inspectors carried out this inspection. This was a scheduled inspection in addition to checking improvements had been made following concerns identified at our last inspection of 19 November 2013. During that inspection we identified concerns with some areas of care and welfare in the home and concerns with records. As well as assessing whether improvements had been made in these areas, the focus of the inspection was to answer five key questions; Is the service safe, effective, caring, responsive and well-led?

At the time of our inspection, 30 people were living at Dearne Valley Care Centre. We spoke with five people who lived at the home, four relatives, the regional manager, the home manager, one nurse, two care workers and a cook. We also reviewed records relating to the management of the home which included four care plans, audits, incident reports, meeting minutes and other relevant documentation.

Below is a summary of what we found. The summary describes what people we spoke with told us, what we observed and the records we looked at.

Is the service safe?

There were risk assessments in place where required for people using the service in relation to their support and care provision. These were reviewed and amended as necessary to ensure that risks were mitigated, whilst still allowing independence, to ensure people’s safety in relation to their care and support.

Most people said they felt there were enough staff at the home. Comments included “I’ve got a buzzer in my room, staff come to help me” and “brilliant staff, they don’t leave [my family member] all day, if he needs anything they will do it, no concerns at all”. However, one person and a staff member had concerns that staffing levels at night were not always sufficient.

Systems were in place to make sure the manager and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. Policies and procedures were in place to make sure unsafe practice was identified and people were protected. This reduced the risk to people and helped the service to continually improve.

People’s care files were stored securely and records of people were reflective of their needs.

The home had policies in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), and staff received training in this. One person at the home had a DoLS authorisation in place and other requests were in progress. The manager understood how to make the applications and in what circumstances they were required. This demonstrated safeguards were in place to protect people’s welfare in line with relevant legislation.

Is the service effective?

People at the home were happy with the care they received and felt this was suitable for their needs. It was evident from speaking with staff they know people well and recognised what support people needed. People at the home told us, “I need help to get about and they [staff] always help me out, they’ve all been good” and “it suits my purposes”. One relative said, “I feel my [family member] wouldn’t be alive today if it wasn’t for this home, they’re brilliant, excellent care”.

People received a varied, well balanced diet and measures were in place to ensure people received adequate nutrition and hydration. Everyone we spoke with was complimentary about the food we saw that that any dietary requirements were taken into account by staff. One person said, “the cook will send things up for me I can eat making sure there’s nothing in I can’t have”.

Is the service caring?

During our visit we saw care workers interacted positively and gave encouragement whilst supporting people. People said, “It’s been great here, the lasses are brilliant”. A relative we spoke with said, “my [family member] physically looks a lot better (than where they were previously), staff are very friendly, very approachable, can’t fault them”.

The three care staff we spoke with all demonstrated they had a detailed understanding of people’s care needs. Each staff member was able to describe actions they would take in relation to specific events and incidents, in a way to ensure the peoples’ safety and welfare.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Care plans were in place for each individual covering a number of areas including mobility, falls, weight, medication and capacity. Information was reviewed regularly and in response to any changes in needs. Updates and amendments were made where required. We saw contact with, and referrals to, other professionals had been made where necessary.

On the day of our inspection we saw people, where they were able to, moved freely about the home. One person spent time gardening in the outside area. Some people chose to spend time in their rooms. Staff told us they tried to spend time with people individually. Three relatives we spoke with told us this took place, one person saying “staff spend one to one time with my [family member]”. People had opportunities for social and mental stimulation and to engage in meaningful activities.

Is the service well-led?

The home worked with other agencies and services to make sure people received their care in a co-ordinated way.

Staff, people and relatives had confidence in the new manager at the home who was being supported by the regional manager.

There was a detailed quality assurance system in place and records seen by us showed that identified shortfalls were addressed. This meant that actions to continuously improve were in place.

Customer satisfaction surveys were sent to people in the home and other stakeholders in order to formalise views of the home. Feedback was also sought by way of daily discussions and relatives and residents meetings.

Discussions on best practice, improved ways of working and incidents reviews were common throughout formal team meetings and informal discussions.

We undertook a responsive inspection as there had been recent concerns relating to the care provision at Dearne Valley Care Centre.

The concerns related to the first floor of the home which is where people lived who may have had dementia and had nursing needs. Our inspection was therefore concentrated on this floor only.

We found that care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

The manager identified on this report was not the manager at the time of our inspection. A new manager had been appointed within the last month who was applying for registered manager status.

We issued a compliance action following our last inspection in November 2012. This was because we could not be satisfied that relevant checks regarding recruitment had been carried out. Dearne Valley Care Centre submitted an action plan following our inspection. This detailed the actions they intended to take in order to achieve compliance in this area.

We visited the service on 9 May 2013 as part of our scheduled inspection programme and also to check the service had become compliant with their action plan. We found that the home had achieved compliance with each outcome area checked.

People were treated with respect and dignity and were given opportunities to be involved. One person said, “we do arts and crafts and reading”. The home employed an activities co-ordinator and we saw minutes of relatives and residents meeting that were held at regular intervals.

People experienced care, treatment and support that met their needs. Staff were knowledgeable about people’s needs. One relative we spoke to said, “I’m really pleased with how they (the staff) look after her”. People had their own individual care records with their care needs documented.

People were cared for by staff who were properly trained, supervised and supported. Staff had the opportunity to acquire further training and skills that would be beneficial to their roles.

People's personal records were accurate, fit for purpose and held securely.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements, but there was a lack of information to evidence how consent to care and treatment had been obtained for those people.

People experienced care, treatment and support that met their needs and protected their rights. The activity worker had a positive affect on people’s wellbeing, because she provided one to one attention for people, which meant some people were much calmer and less agitated.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises, but people and staff were at risk of exposure to a health care associated infection arising from clean and dirty laundry being in close proximity and staff carrying dirty laundry through communal areas.

A full employment history, together with a satisfactory written explanation of any gaps in employment was not in place for staff that had been employed, as part of an effective recruitment procedure to make sure staff were suitable to work with vulnerable adults.

People could be confident that any complaints they had would be listened to. Relatives told us they were not aware of the complaints procedure, but said they would have no hesitations in complaining to the manager.

We had not spoken directly with people who used the service in assessing this essential standard.

We spoke with one relative during our inspection who told us they had not been involved in the development of their relatives care plan, but this had been their choice. However, they also told us they were able to make changes and contribute to their relative’s care if they wished. They also told us their relative’s dignity was respected and confidentiality was always maintained.

People who used the service told us they were happy living at the home and they were well looked after. Five people told us it was nice living at the home and three people told us “It is lovely here”. Staff were described as lovely, helpful and very good.

We spoke with one relative who told us they were happy with the care and their family member was well looked after. They told us “Care is fantastic”.

We spoke with one relative who confirmed they would talk to the manager if they had any concerns. They told us their relative felt safe. People who used the service told us that they felt safe at the home and they would tell staff or the manager if they were worried about anything.