This was an unannounced inspection which took place on 25 July followed by an additional day on 27 July 2017 which was announced..

Valerie’s Residential Care Home is registered to provide a service for up to 17 older people. Some people have conditions associated with growing older such as sensory and physical difficulties. There were twelve people living in the home on the day of the visit. The service offered ground and first floor accommodation in individual bedrooms. The first floor accommodation was accessed via a lift.

At the last inspection, on 19 October 2015, the service was rated Good. At this inspection we found the service remained Good in four domains which meant it was still overall Good. However, one domain required improvement.

Why the service is rated Good:

There is a registered manager running the service. 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 staff team’s knowledge and understanding of how to keep people and themselves safe contributed to ensuring people lived in a safe and secure environment. People continued to be protected from any form of abuse or poor practice and any risks were identified and managed to keep people as safe as possible. Staffing ratios were adequate to meet people’s needs safely. The recruitment procedures ensured appointees were suitable and safe to work with people. People were given their medicines in safely.

The staff team usually responded effectively to people current and changing needs. However, some improvements were required in this area. They ensured people’s health and well-being needs were met in a timely way. However there were two occasions, identified, when care plans were not followed and action with regard to health needs was not taken as quickly as it should have been.

People continued to be supported to have maximum choice and control of their lives. Staff offer them care in the least restrictive way possible, the policies and systems in the service support this practice. However, there was some confusion and lack of understanding of the Mental Capacity Act 2005, specifically with regard to Deprivation of Liberty Safeguards.

The relatively small and stable staff team remained kind, caring and committed to caring for people. They were knowledgeable about people’s individual needs. The staff team respected people’s equality and diversity needs.

People received good care from a well led service. The registered manager was experienced and qualified and listened and responded to people, staff and others. The management team were described as open, approachable and supportive. Record keeping needed some improvement as did clarifying the actions taken as a result of quality audits and reviews.

This was an unannounced inspection which took place on 19 October 2015.

Valerie’s Residential care Home is registered to provide care (without nursing) for up to 17 people. There were 12 people resident on the day of the visit. The house offers accommodation over two floors in 14 rooms. Two rooms were ‘doubles’ but they were used for individuals. People had their own bedrooms and five were en-suite. The shared areas within the service have limited space but the staff team made best use of them to suit the needs and wishes of people who live in the home.

There is a registered manager running the service. 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 kept safe by staff who were trained in the safeguarding of vulnerable adults and health and safety. They were able to fully describe their responsibilities with regard to keeping people, in their care, safe from all forms of abuse and harm. The service took all health and safety issues seriously to ensure people, staff and visitors to the service were kept as safe as possible.

There were enough staff, on duty, to ensure people received safe care. The recruitment process was robust and the service was as sure, as possible that staff employed were suitable and safe to work with people who live in the service. People were given their medicines in the right amounts at the right times by properly trained staff.

People’s human and civil rights were upheld. The service had taken any necessary action to ensure they were working in a way which recognised and maintained people’s rights. The staff team understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. DoLS provides a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm. The registered manager had made or was making the appropriate DoLS referrals to the Local Authority.

People’s health and well-being needs were well met. People were helped to make appointments with health professionals when necessary. Food was nutritious and of good quality. Staff were appropriately trained to meet the needs of people in their care.

The service recognised people’s individual needs. Staff had built strong relationships with people and were knowledgeable about and knew how to meet people’s needs. They service respected people’s views and encouraged them to make decisions and choices. People were treated as individuals and they were treated with dignity and respect at all times.

The service was well managed. Meeting people’s needs was the priority for staff and the registered manager. The registered manager was described by staff as very supportive. The service had ways of making sure they maintained and improved the quality of care provided. Improvements had been made as a result of listening to the views of people, their relatives and the staff team.

At an inspection on 9 April 2014 we found the provider had not completed all the required recruitment checks in accordance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Schedule 3.

At our inspection on 16 June 2014 we found the provider had taken action to address this breach of the regulations. We found they had completed all required recruitment checks for staff employed by the service in the five files we looked at.

A full employment history had been recorded for care workers in each of the recruitment files we looked at. We saw evidence that gaps in employment history had been identified and investigated, with an appropriate written explanation recorded. Evidence of previous good conduct in positions of employment in a health and social care environment had been sought and verified. This had not always been possible, for example if the previous employer was no longer operating, or did not retain information about employees who had left the service after a certain length of time. In these cases, the provider documented the actions they had taken to verify the employee’s previous character as far as they were able.

We did not speak with people who use the service during this inspection. We spoke with the head of care and business manager on the day of our inspection. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of our inspection. Their name appears because they were still the Registered Manager for this service on our register at the time. The head of care and business manager explained actions in place to manage the service until a new manager was appointed.

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?

This is a summary of what we found.

Is the service caring?

At the time of our inspection 11 people lived at the home. We saw staff spoke with people respectfully, and provided support and reassurance when this was required. One person told us “Staff care for me well”, and another person said care workers “Ask me what I want”.

Care workers told us they were aware of people’s needs as these were recorded in their care plans. They explained they talked with people to ensure they provided care and support as the person wished, and involved relatives where this was appropriate to help them understand people’s preferences. We saw this reflected in the four care plans we looked at. We saw relatives were encouraged to visit their loved ones, and invited to join them for meals.

Is the service responsive?

People’s needs were assessed and documented before they moved in to the home, and information was reviewed monthly or as needs changed. The manager asked people for feedback, for example regarding care provision, activities and the menu. We saw people’s comments were acted on. At the time of our inspection new furniture was being placed in the lounge. A relative had previously commented in a survey that the lounge needed “smartening up”.

Is the service safe?

We saw records were completed, reviewed, stored and disposed of appropriately. This ensured information was up to date, and confidential data regarding people and staff was protected in accordance with the Data Protection Act 1998.

Regular quality audits ensured the service was maintained safely. Checks and audits ensured servicing and training were completed in accordance with the manufacturers’ guidance and provider’s policies. For example, all staff had completed fire awareness training and conducted fire drills to ensure they could deal with a fire safely. Fire equipment was serviced regularly. Risks that may harm people were identified, and appropriate actions put in place to reduce the risk of harm. Monthly audits were in place to recognise trends.

Staff recruitment files did not contain all the information required to demonstrate that staff were suitable to work with vulnerable adults. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have had to be submitted, proper policies and procedures were in place. The manager was aware of when an application should be made, and how to do so.

Is the service effective?

We saw care workers supported people in accordance with their care plans. Care workers told us they worked well as a team, and communicated effectively. This ensured all staff were aware of updates to people’s care and support needs. The people we observed during our inspection appeared comfortable with staff, and able to request support when they needed it. We saw requests for support were met promptly. People and their relatives told us they were satisfied with the care provided.

Is the service well led?

We spoke with three people who lived at the home, and three relatives of people. They all told us the manager and staff listened to their requests and responded appropriately. One relative told us “I’m looking for humanity, not perfection. The home is well run, the manager is receptive to comments, it’s calm and peaceful here”.

Staff told us they felt well supported by the manager, and could make suggestions to improve people’s care and support in the home. They told us they felt part of “a family”. The provider sought feedback from people through surveys and meetings, and informally chatted with people to ensure their views were gathered. Quality audits ensured the service provided appropriate and safe care for people.

We spoke with two people who use the service, and two relatives of people who use the service. They all confirmed staff treated people with respect, listened to their comments and acted in accordance with their wishes. One person said “Staff used to get me up at 6am, so I asked them to leave me until later.” They confirmed staff adjusted times according to their request.

We spoke with three care workers. They explained actions they took to encourage people to maintain their independence. One care worker said “I requested an adapted mobility aid to provide more appropriate support for a tall person”. Another care worker explained how they assisted people with tasks they found difficult. For example they ran water for people to an appropriate temperature, but supported them to maintain their independence by encouraging them to attend to tasks they could manage themselves.

We looked at staff rotas, and observed the level of staffing at the time of our inspection. We found staffing levels sufficient to safely meet the needs of people who use the service. For example, staff numbers were sufficient to safely support people with specialised equipment to help them to mobilise. People who use the service told us their care needs were usually met promptly. Staff told us they could spend quality time with people, and felt appropriately trained and supported to deliver care safely.

We found the service was clean, and had suitable procedures and checks in place to ensure infection control was maintained. A relative of a person who uses the service told us “the home seems clean enough to me”.

We observed that actions had been taken to ensure the location was safe for people who use the service. We saw the manager had taken appropriate actions to address concerns raised in a previous fire and rescue authority inspection. We spoke with two care workers, who told us they had attended training for new fire evacuation equipment. They said they had used the equipment to carry out a mock evacuation of care workers, and acted as people in need of rescue, to ensure they were competent in its use.

We saw evidence the provider conducted service quality assessment audits, and the manager had implemented a system of reviews and audits to monitor service provision. When an issue was identified we saw appropriate actions were taken and recorded to ensure the safety of people who use the service.

People we spoke with were satisfied with the care provided at the home. One person said "staff know what they are doing" and “they do their best to look after me."

People were at risk of infection because cleaning procedures were inadequate. We found some areas of the home, such as the kitchen, had not been sufficiently cleaned.

One person we spoke with told us maintenance was an issue for them. A relative of a person who uses the service confirmed they had concerns about the upkeep of the premises. We spoke with the fire authority regarding the fire risks at the premises. The fire authority told us about risks to people who use the service, such as evacuation ability, the fire stairs and the stair lift.

We asked to see people's individual risk assessments and associated care plans to check for accuracy and quality. The manager was not able to show us how they audited care documentation. Although review dates had been recorded in each person's file it was not clear what these were conducted against or what changes were made by the care staff as a result.

We found the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

People told us they were well looked after and liked living at his home. They told us that staff had a caring attitude and attended to them quickly if they needed assistance. We were told that the food was generally good. People told us that they felt safe and that they were treated with respect and kindness. They said that staff were friendly and cheerful, and had the right skills for looking after people. People were pleased that the provider had appointed a deputy manager at the home.

People told us that staff were generally attentive and provided assistance when called, however sometimes they had to wait longer than they would like. They said that staff were caring and kind. Although they welcomed encouragement to be independent, some people said they would like a bit more help.

People told us the food had improved and their health needs were met.

They said that they felt safe.

We were told that the home was mostly clean, but some areas were not cleaned regularly, and that maintenance issues were not always attended to promptly.