About the service:

Valentine House provides accommodation and personal care. At the time of the inspection, 46 people were living at the service.

People’s experience of using this service:

People received exceptional, individualised care and support that was responsive to their needs. Care plans were person-centred and were regularly reviewed to ensure they reflected people's changing needs.

Relative's and healthcare professionals gave us extremely positive feedback about the standard of care provided at Valentine House. We also observed staff delivering kind, caring and compassionate support throughout our inspection.

Relatives told us staff treated people exceptionally well, ensuring they were respectful, compassionate and caring. People continued to be supported to maintain meaningful relationships with family members and people that mattered to them. Relatives spoke positively about the communication between themselves and staff and the support they received. They told us they were welcomed into the service and could visit as and when they wished.

The provider had significant oversight of the service. Robust audits ensured all issues identified were acted on in a timely manner. People's views were continually sought through questionnaires, general discussions and meetings. The registered manager placed great importance on partnership working to continually drive improvements.

Staff understood how to recognise signs of abuse and were confident in the action they would take to report any concerns.

The provider had arrangements to ensure only suitable staff were employed, and enough staff were deployed to keep people safe.

The registered manager and regional manager completed regular health and safety checks to ensure the environment was safe.

The service had effective systems in place to ensure people continued to receive their medicines safely and in-line with good practice. Robust medicines audits ensured issues identified were acted on swiftly, minimising the impact on people.

Staff continued to receive a variety of training to enhance their skills and knowledge. Staff reflected on their working practice through annual appraisals and regular supervision sessions with the registered manager.

The service had systems in place to manage and learn from complaints and concerns. Relatives were confident the registered manager would deal with any complaints in a timely manner.

The registered manager was involved in all aspects of the running of the home and provided her team with principled, person-centred leadership. They were well supported by the regional manager which ensured the provider had clear oversight of the service.

Rating at last inspection: Good (published 16 June 2016)

Why we inspected: This was a planned inspection based on the ratings at the last inspection.

Follow up: The service will continue to be monitored through the information we receive.

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

The inspection took place on 22 April and was unannounced. Valentine House is a residential home which provides accommodation and personal care for up to 50 people who have a range of impairments, including people living with dementia. On the day of the inspection there were 43 people living in the service, nine of whom were receiving respite care.

The home is spread across three floors. The ground floor had communal dinning and lounge areas and there was a secure private garden area.

A new manager had recently been appointed. They had submitted an application to the Care Quality Commission (CQC) to become a registered manager; at the time of the inspection their application was being processed. 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 and their relatives told us that they felt safe living at Valentine House. People were cared for by staff who knew how to keep them safe and managed individual risks well. We spent time with people in all areas of the home. We saw that the staff offered people assistance and took the time to speak to people and take up the opportunities they had to interact with them and offer reassurance if needed.

Staff knew how to Safeguard people and were clear about their responsibilities to report safety concerns to the manager and, if required, how to inform outside agencies.

Risk assessments were robust and detailed and included control measures to minimise and manage risk effectively. There were enough staff available to meet people's needs and keep them safe. All necessary checks had been completed before new staff started work at the home to make sure that they were safe to work with the people that lived there.

New and existing staff received training which ensured that they had the skills and knowledge needed to carry out their duties and to support people. Staff received a regular programme of supervision and annual appraisals from management.

People were supported in line with the principles of the Mental Capacity Act (2005) (MCA) and the Deprivation of Liberty Safeguards (DoLS). Where people could not make decisions for themselves, people’s rights were protected because important decisions were made in their ‘best interests’ in consultation with appropriate people. The provider had made applications to the Local Authority in accordance with DoLS and the MCA and at the time of the inspection was awaiting the outcome of those applications.

People's healthcare needs were identified and the service worked with other healthcare professionals to support people's health and well-being. Medicines were appropriately administered by staff who had completed the relevant training.

People's dietary needs were identified and the service offered them a choice of food and drink.

Care plans were personalised and detailed people’s needs, choices and preferences. These were subject to regular review and created with the involvement of the person and their relatives. Where people's needs changed, these were reflected in their care plans. There was an activities co-ordinator in the service who arranged a variety of activities and events in the home. People understood how to make complaints, and their grievances were handled and resolved effectively.

We saw that the staff approached people in a friendly and respectful way. Staff consistently demonstrated a kind and caring attitude to people. It was clear that staff knew about the people living in the home and consequently the care that they delivered was individualised and person-centred. People living there told us that care staff were mindful of their privacy and treated them with respect.

People, their relatives and staff were positive about the managemen

During our inspection we spoke with 13 people who used the service and five visiting relatives and friends. We also spoke with the operations manager, registered manager and eight staff.

Valentine House provided a service for 44 people at the time of our inspection. We looked at the care records for four people who used the service. We also looked at how people consented to their care, the safeguarding of vulnerable adults from abuse records, staffing and quality assurance checks.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

Staff had received a range of training to protect people from harm and were aware of the action they needed to take if they suspected abuse had taken place.

We found that the service had suitable arrangements in place to gain people’s consent and assess their mental capacity to make decisions before acting on their behalf. Mental capacity assessments had been completed appropriately and applications for Deprivation of Liberty Safeguards (DoLS) had been made.

The policy, procedures and quality monitoring of the service included health and safety, fire evacuation and reviews of care planning and delivery. People were provided with care and support that ensured their welfare and safety.

Is the service effective?

People's assessments showed that their care, support and treatment was planned and delivered in a way that ensured that their needs were being met. Individualised care meant that people were fully involved, where possible, in choices and decisions about their lives. This made their care more effective as it enhanced their wellbeing and independence.

One person said, “We are very listened to and have regular meetings – all that I need is here and if they can’t give it, they bring in someone who can.”

Is the service caring?

We saw good interaction between staff and people who used the service. Staff spoke to people respectfully; they were considerate, courteous and kind. People told us that the staff were very caring. One person said, “I can’t fault them, always a smile when they come into me.”

Staff had a good knowledge of people’s likes and dislikes. People told us that the staff treated them respectfully. People’s preferences and diverse needs had been recorded in their care files and care and support had been provided in accordance with their wishes.

Is the service responsive?

Regular checks on the dependency levels of people who used the service were undertaken to ensure there were sufficient staff on duty to respond to people’s needs appropriately.

The service offered a range of activities for people to enjoy. These had been developed from listening to the views of people who used the service and their relatives. One person said, “I can join in if I want, they [the staff] always come and ask me.”

The service worked well with other agencies. A range of health and social professionals from the community were involved in people’s care. This showed that people received their care in a joined up way.

Is the service well-led?

A comprehensive quality monitoring process and improvement plan was in place. Regular care reviews and discussions about people’s quality of life at Valentine House were discussed with them and their families. This ensured that people’s changing needs and preferences were always taken into account.

The service was well-led as it was continually improving in its care provision and in the environment to make Valentine House a good place to live and work.

We found that people were involved with their care planning and were able to continue interests and be involved with the community. One person told us "I like sitting here right by the window, as the natural light helps me to read, which I love to do. I also like looking outside, and watching people."

Care plans were in place and updated regularly. Appropriate risk assessments had been completed and were cross referenced to ensure people's safety and welfare.

Medicines were stored correctly and administered in a timely way. People were asked if they needed 'as required' medication and were given assistance to take medication if they needed it.

There was an effective supervision system in place for staff as well as regular staff meetings. There was an induction plan for new staff and regular training was available.

The service undertook regular audits to ensure the quality of service provision. People were consulted about the service.