About the service: The Valleys Care Home is registered to provide nursing and personal care to 84 older people, including people living with dementia. The service was supporting 63 people at the time of our inspection.

People’s experience of using this service: People did not always receive a service that provided them with safe care. The management of some people’s medicine was not safe. Staff did not consistently follow good infection prevention and control practices to maintain adequate standards of hygiene.

The provider used a range of audits to check quality and safety. There had not been consistent oversight to ensure all improvements were identified and made to the quality of the service people received. We recommend the provider implement a reliable and effective quality monitoring system.

Staff were safely recruited and enough staff were deployed to meet people’s needs. Staff had been trained to respond to safeguarding concerns. The registered manager was proactive investigating and responding to concerns to keep people safe. The service had taken action to address recommendations made.

A new electronic recording system for accidents and incidents had been put in place which showed action was taken to reduce risk when issues occurred. The management team were analysing the information to look for trends and patterns and there had been a reduction in the number of falls in recent months.

Care was planned around people’s choices and preferred routines. People and their relatives were supported to receive information in an accessible way to enable them to be involved in their care and support.

Staff were trained and their skills and knowledge checked through competency assessments. Staff worked closely with healthcare professionals and sought their advice, guidance and support on how to best meet people’s needs.

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

People told us they felt safe and well cared for and staff afforded them respect and dignity. People were supported to maintain their independence and they accessed local facilities and activities.

Recent changes to the management of the home had been positive and resulted in better and consistent care being provided. Staff told us the registered manager was supportive and approachable. People knew the registered manager and told us they trusted them.

People and relatives had the opportunity to provide feedback about the service and there was a system to respond to any complaints.

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

Rating at last inspection: At the last inspection the service was rated Good (report published 8 February 2017).

Why we inspected: This inspection was brought forward in response to incidents that had occurred in the service and concerns that had been raised about the safety and management of the service. At the time of the inspection we were aware of incidents being investigated by another agency.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around safe care and treatment. Details of action we have asked the provider to take can be found at the end of this report.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

The Valleys Care Home is a purpose built home situated in a residential area in Scunthorpe. It is registered to provide nursing and personal care for up to 84 people. The Valleys Care Home is divided into four separate units, Brumby, Crosby, Frodingham and Ashby; each unit has bedrooms for single occupancy, communal rooms, bathrooms and a kitchen servery. Some of the units provide care and support for people living with dementia. The registered provider had taken the decision to close Ashby unit in August 2016 due to low occupancy levels. There are plans to reopen the unit in the near future to provide respite and day care support. There is a garden at the rear of the property and car parking at the front.

We undertook this comprehensive inspection on the 8 and 10 February 2017. At the last inspection on 18 and 19 May 2016 we found the registered provider was in breach of two of the regulations we assessed. We issued two requirement notices as some people were not provided with consistent person centred care and the application of the Mental Capacity Act 2005 (MCA) was inconsistently applied and the best practice principles of MCA regarding restrictions placed on people had not been followed for each person they applied to. We also wrote to the registered provider as we had not been notified of all incidents.

During this comprehensive inspection we found improvements had been made in three domains and have changed the rating for the domains ‘Effective’, ‘Responsive’ and ‘Well-led’ to Good. We have kept the rating for ‘Safe’ and ‘Caring’ as Good. The overall rating for the service has improved and changed to ‘Good’. At the time of the inspection there were a total of 57 people living in The Valleys Care Home and up to four people attended the service for day care support.

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.

We found improvements in the quality of the care records. People had their needs assessed and detailed plans of care were developed which helped to guide staff in how to deliver individualised care to them in line with their preferences. They had been reviewed and updated on a regular basis.

We found the registered manager and staff better understood their responsibilities under MCA. They were aware of the need to gain consent when delivering care and support, and what to do if people lacked capacity to agree to it. People’s abilities to make decisions had been assessed and appropriate support had been provided to ensure that their views were taken into account when making decisions. Relatives and other professionals had been involved when important decisions about care had to be made.

We found the service was safe for people who lived there. Staff had received training in how to safeguard people from the risk of harm and abuse and knew how to raise any concerns. People had risk assessments which helped to guide staff in how to minimise risk whilst helping them to maintain their independence.

We saw people received their medicines as prescribed. Medicines were ordered in a timely way, stored safely and only administered by qualified nurses or staff who had completed training.

Staff were recruited safely and in sufficient numbers to ensure that people’s needs were met, however, the deployment of staff at lunchtime on Crosby unit could be improved to ensure people enjoyed a positive mealtime experience which the registered manager confirmed they would address.

Records showed us staff had access to training, support and supervision. This enabled staff to feel confident when supporting people and knowledgeable about meeting their needs.

People told us staff were kind and caring

The Valleys Care Home is a purpose built home situated in a residential area in Scunthorpe. It is registered to provide nursing and personal care for up to 84 people. The Valleys Care Home is divided into four separate units, Brumby, Crosby, Frodingham and Ashby; each unit has bedrooms for single occupancy, communal rooms, bathrooms and a kitchen servery. Some of the units provide care and support for people living with dementia. There is a garden at the rear of the property and car parking at the front.

The service had a registered manager in post as required by a condition of registration. 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.

We undertook this unannounced inspection on the 18 and 19 May 2016. At the time of the inspection there were a total of 61 people living in The Valleys Care Home and four people receiving day care. At the last inspection on 9 February 2015, the registered provider was compliant with all areas assessed.

We found there was inconsistency regarding the application of the Mental Capacity Act 2005. The registered provider and registered manager had not always followed best practice regarding assessing people’s capacity and discussing and recording decisions made in their best interests. You can see what action we have asked the registered provider to take at the back of the full version of the report.

We found not everyone had a full and up to date care plan and risk assessment to guide staff in how to meet them in a person-centred way. You can see what action we have asked the registered provider to take at the back of the full version of the report.

We found the previous registered manager had not de-registered with the Care Quality Commission (CQC) even though they had left the service in 2014; their certificate was on display in the entrance and the current registered manager did not have their certificate on display. The registered manager is to address this as it is important correct registration details are displayed.

The CQC had not received all notifications for incidents which affected the safety and wellbeing of people who used the service as required by registration regulations. This had been a misunderstanding by the registered provider and registered manager and they told us they would forward all required notifications in future. We have written to the registered provider to remind them of their responsibilities in this area.

We found there was a quality assurance system in place which consisted of audits and seeking people’s views. The registered manager told us they would review some of the audits in place to make sure they were more robust and enabled an analysis of specific areas such as incidents between people who used the service.

We found people who used the service were protected from the risk of harm and abuse. Staff had received safeguarding training and knew what to do if they witnessed abuse or if it was disclosed to them. Staff knew what to do in cases of emergencies and each person who used the service had a personal evacuation plan.

We observed kind and caring approaches from the staff team. People’s privacy and dignity were respected and staff provided people with explanations and information so they could make choices about aspects of their lives. There were positive comments from relatives about the staff team. People who used the service and their relatives were provided with information on notice boards, in meetings and in newsletters. Personal records were stored securely.

We found people’s health care needs were met. Health professionals were contacted to ensure people received treatment and advice when required. People received their medicines as prescribed. Some rec

The inspection was carried out by an adult social care inspector and was completed to follow up actions we asked the registered provider to complete in relation to keeping records of the administration of medicines. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• 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. The summary is based on our observations during the inspection, speaking with people who used the service and the staff who supported them, and from looking at records.

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

• Is the service caring?

Staff were aware of people's preferences and diverse needs; care and support had been provided in accordance with people's wishes.

• Is the service responsive?

People received care according to their needs and wishes.

People’s care plans were personalised and people had been involved in reviewing them to ensure they were still relevant.

• Is the service safe?

Staff had been recruited safely.

People were protected from the risk of infection because appropriate guidance had been followed.

• Is the service effective?

Staff were well trained and had the necessary skills to carry out their role. Staff had been trained in the safe administration and handling of medicines.

• Is the service well led?

The acting manager had introduced a new medicines stock control system to ensure people did not run out of medicines.

A new reporting system designed to ensure people received all of their medicines as prescribed had also been introduced.

You can see our judgements on the front page of this report.

We found the provider had made improvements to the systems to manage medicines and record complaints. We found that staff training, meetings and regular audits had been completed to improve the way medicines were managed. We also saw that complaints were now logged and monitored for patterns and trends.

We found that audits of medicines were completed but actions to address shortfalls had not always been implemented. We also found staff were not clear about when to report incidents to the manager. This meant that the quality monitoring process was not effective and there was limited opportunity for learning and improvement from incidents.

People we spoke with were very limited in their responses due to their complex health needs, they told us or indicated by nodding and smiling that they were happy living at the home. One person told us, "I am happy with the care."

A visitor to the home told us, "I visit most days, the care is excellent, staff let me know about any issues. We had a review of the care plan two weeks ago, everything is fine."

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan and delivered in a way that was intended to ensure people’s safety and welfare.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

There were effective systems in place to reduce the risk and spread of infection. We toured the premises and saw that the environment was being kept clean.

We looked at the systems in place for managing medicines in the home and found that there were shortfalls and poor practice in recording, administration and safe handling of medicines.

There was enough equipment to promote the independence and comfort of people who used the service.

Appropriate checks were undertaken before staff began work and effective recruitment processes were in place. One person told us, “The staff are good.”

We found comments and complaints people made were not always responded to appropriately.

People we spoke with were very positive about the care and support they received. They told us they liked living at the home and confirmed they were asked their opinion on the quality of the care provided. Comments included "I have completed a questionnaire” and "They have regular meetings which I go to, you have a say about the food and things in the home."

We spoke with people who lived in the home and they told us that an incident they had reported had been addressed.

As part of our inspection we spoke with people who use the service. They told us that they were well cared for in the home and liked the staff that looked after them. Some of the comments included: “Wonderful staff,” “I’m quite satisfied with everything, I’ve no complaints” and “I’m getting the care that I need.”

People told us that staff encouraged them to be as independent as possible, and if they required help, staff would come quickly.

All the people we spoke with told us that their privacy and dignity were respected by the staff.

They told us they liked the staff that looked after them. Comments included, “Wonderful staff,” “If I’m not very well the staff will help me” and “If I need help the staff come quickly.”

As part of our inspection we spoke with people who use the service. They all spoke positively about the staff and care provided. Comments included “The staff bend over backwards to please”, “I am quite happy, it’s like living in a hotel” and “You don’t have to wait for some one to help you”.

They all spoke positively about the meals provided. Comments included “The food is good and we get enough to eat. You get plenty of tea and coffee”, “You get good cakes” and “I enjoy the meals”.

They told us they felt safe living in the home and would feel comfortable raising concerns.

The Valleys is a purpose built home in Scunthorpe. It is registered to provide accommodation for up to 84 older people, who require nursing or personal care. Many of the people who used the service were living with dementia.

The service had 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.

This inspection was unannounced and took place over two days. The previous inspection of the service took place on 1 October 2013 and was found to be non-compliant with one of the regulations inspected. The service was re-inspected on 15 September 2014 when it was found to have made the necessary improvements.

People who used the service and their relatives told us they felt safe and that there were enough staff on duty to meet people’s needs. Comments included, “Yes, I feel very safe here” and “They (the staff) look after me very well and I feel protected and not worried about anything.”

The registered provider had policies and procedures in place to protect vulnerable people from harm or abuse. Staff had received training in safeguarding vulnerable adults from abuse.

Medicines were stored securely and administered safely. Records showed people received their medicines on time and in accordance with their prescription.

The service was kept clean. The building was well maintained and furnished.

Staff told us they had been recruited into their roles safely and the appropriate checks with the disclosure and barring service (DBS) had been carried out.

People were supported by staff to maintain their privacy, dignity and independence. Everyone looked clean and well-cared for. Staff involved people in choices about their daily living and treated them with compassion, kindness, and respect.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and staff followed the Mental Capacity Act 2005 for people who lacked capacity to make decisions for themselves. These safeguards provide a legal framework to ensure people were only deprived of their liberty when there was no other way to care for them or to safely provide treatment.

People who used the service received regular positive interaction from members of staff.

People’s care plans were written to meet people’s individual needs. People who used the service knew how to make a complaint.

The lunch looked appetising and nutritious. We saw some people were offered assistance with cutting food up and were given plate guards and adapted cutlery which assisted their independence. People were offered a choice of drink at the table and the choice of a different meal if they did not like the one they had chosen.

The two units on the first floor had been designed to accommodate people living with dementia. Although people’s rooms had been identified with different colours, the service had not made other adaptations such as contrasting toilet seat colours and dementia-friendly signage. We were told the registered provider had sought advice on this from a reputable source and this would influence their planning in the future.

People’s care plans were written to meet people’s individual needs. The service was responsive to people’s needs.

Staff told us the leadership and management of the service was good. There were systems in place to effectively monitor the quality of the service although there had been no recent surveys of relatives, staff or external health professionals. We have made a recommendation that the registered manager should carry out these surveys in the future. There had been a recent survey of people who used the service; 11 people had replied and stated they were happy with the care provided.