We inspected Vallance Residential Care Home on 13 December 2016. The inspection was unannounced.

The home provides residential care for up to 19 people. People required support with their personal care and had additional needs, including frailty associated with old age and poor mobility. Some people were living with dementia.

Vallance Residential Care Home is situated in Hove. There are two communal lounges and dining room and a well-maintained garden. The home is the sole location owned and run by Vallance Organisation Limited.

As part of this inspection, we checked what action had been taken to address the breach of legal requirements we had identified at our last inspection on 16 December 2015. Breaches were identified for staffing levels and training, monitoring of incidents and accidents and systems to monitor or review the quality of the service provided. After our last inspection, the provider wrote to us to say what they would do to meet legal requirements and sent us an action plan detailing how they intended to ensure they met the requirements of the law. At this inspection we found improvements had been made and sustained and the breach previously identified was addressed.

There was a registered manager in post but they delegated the day to day running of the home to the deputy manager. 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.

People and visitors we spoke with were complimentary about the caring nature of staff. The delivery of care was tailored to individual choice. Care plans had sufficient information on people’s likes and dislikes and information about people’s lifestyle choices was available for staff. The provision of meaningful occupation positively influenced people’s well-being. A relative told us, “Carers are very accommodating. [My relative] lives with their condition of dementia which means that she can push people away but they managed to get her into art and other interests and her quality of life has improved.” There were sufficient suitably qualified and experienced staff to deliver care.

People and their relatives told us they felt safe living at Vallance Residential Care Home. The relative of one person said, “[My relative] lived on her own and now we know she’s well looked after. Staff are attentive without a doubt. Mum is safe and happy.” Staff had a good understanding of safeguarding and their responsibilities with regard to maintaining people’s safety.

Care plans reflected people’s assessed level of care needs and care delivery was person specific. For people with health problems, there was guidance in place for staff to deliver safe care. A health care professional told us, “What I really like about [the deputy manager] is whenever they discuss mental health referrals they are extremely practical and forward-thinking in how to look for solutions to behavioural problems, especially within dementia care. She and her team have shown great interest and are keen to learn more about dementia, its symptoms and more practical dementia friendly interventions.”

People’s medicines were stored safely and in line with legal regulations and people received their medicines as prescribed.

The provider was meeting the requirements of the Mental Capacity Act (MCA) 2005. Mental capacity assessments were completed in line with legal requirements. Staff were following the principles of the MCA. Consideration was made of people’s ability to make individual decisions for themselves, as required under the MCA Code of Practice.

Staff received the training and support they needed to be effective in their roles. People said they felt confident in the ability of staff to care for them. One person said, “Staff are trai

We inspected Vallance Residential care Home on the 14 and 16 December 2015. Vallance Residential Care Home is a care home providing care and support for up to 19 people. On both days of the inspection 16 people were living at the home. The age range of people living at the home varied between 60 – 100 years old. Nearly everyone residing at the home was living with dementia or mental health needs. Care and support was also provided to people with diabetes, sensory impairment and long term healthcare needs.

Accommodation was provided over two floors with stairs connecting all floors and a stair lift in situ. The property is two detached Victorian buildings which are conjoined. A garden was available at the back of the home for people to access. The home is centrally located in Hove with good public transport links to the city centre and sea front.

A registered manager was in post but delegated the day to day running of the home to the deputy manager. 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.

People spoke highly of the deputy manager and commented they would recommend the home to others. One person told us, “I would recommend it as it had been to me yes.” Another person told us, “It’s very nice here, they treat you well.”

One concern was that a systematic approach to determining staffing levels was not robustly in place. The provider was unable to demonstrate how only one member of staff at night was sufficient to meet the needs of 16 people, most of whom were living with dementia. People also raised concerns around staffing at night. One person told us, “I’d have thought there should be two carers really.” Another person told us, “I tend not to ring my bell at night time as there’s only one on and you can see they look run ragged so I try and manage.” Consideration had not been given to what would happen if the home needed to be evacuated at night. We have identified this as an area of practice that is of significant concern.

Incidents and accidents were not monitored for any emerging trends, themes or patterns. The management of falls required improvement. People’s call bells were not consistently made available to them when sitting in their chairs. We have identified this as an area of practice that requires improvements.

Robust systems were not in place to analyse, monitor or review the quality of the service provided. The provider was not completing formal audits and there were no formal mechanisms to assess the standards of care. We have therefore identified this as an area of practice that requires improvement.

Where people had bed rails in place, documentation failed to identify if the person had consented to the bed rails or not. Where people lacked capacity under the Mental Capacity Act (MCA) 2005, the provider was unable to demonstrate how care was delivered in line with legal requirements. We have identified this as an area of practice that needs improvement.

Improvements were needed around the opportunities for people to engage with meaningful activities. Activities were provided which included bingo, quizzes, exercises and arts and crafts; however, activities centred on the person and meaningful to them were not consistently in place. People also had mixed opinions about the opportunity for social engagement. One person told us, “I enjoy singing, there’s not a lot to do I thought there’d be more.” Where people were at risk of social isolation, this had not been addressed. We have made a recommendation for improvement in this area.

The principles of person centred care and good dementia care were not consistently upheld. Not all care workers had received dementia training or training specific to the needs of people they su

When we inspected this service on 8 July 2014 we found people were not always protected against receiving inappropriate or unsafe care, because care was not planned such as to meet individual needs and ensure people’s welfare and safety. People were not protected from risks of pressure damage and needs in respect of activity and stimulation were not identified or planned for.

Following our inspection we received an action plan from the provider that told us processes were in place that ensured compliance with this standard. This inspection was carried out to check that the home had complied with the compliance action made at our previous visit. We read three care records in detail, and spoke with the deputy manager, a member of care staff and a person who lived in the home.

We found the home had updated and improved its risk assessment and care planning processes. This included provision for regular meaningful review of people’s care needs and evaluation of how the service was meeting these. A member of staff told us the staff found the care plans gave them the information and guidance they needed to provide for people’s individual care needs. We saw that people were protected from risks of pressure damage. People's needs in respect of activity and stimulation were identified.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions:

Is the service Safe? Effective? Caring? Responsive? and Well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and what we learnt from the records we looked at. We spoke with four people who lived in the home and two people who were visiting relatives. We talked with three of the care staff, the cook, the deputy manager and a visiting district nurse. Records we looked at included three care records, staff training records, management audits and the service’s quality assurance documentation.

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

Is the service safe?

People living in and visiting the home considered the home provided a safe environment. One person said “They’re ever so good to me. They understand I get frustrated at what I can’t do and that I see things that aren’t there.” Another said safety came from having “no worries here.”

All staff were up to date with training about safeguarding vulnerable people. They had a clear understanding of what constituted abuse and how to refer any concerns as safeguarding or whistle blowing issues. However, they did not have accurate knowledge about the Mental Capacity Act 2005. This was because few staff had been sent on related training. Staff showed an understanding of working with people’s consent. However, there was a shortfall in training, combined with a lack of care planning to assess and therefore review people’s capacity to understand and agree to receipt of care. This meant there was a risk that decisions needing to be made in people’s best interest could be poorly assessed and recorded.

Is the service effective?

People received an assessment of need before moving into the home. This covered a number of standard outcomes, although skin integrity was not specifically addressed. There were risk assessments that gave some guidance on control measures to reduce risk. However, care plans were not developed from the initial assessment or from risk assessments. Staff were not provided with detailed written guidance on how to actually provide care, or what people’s individual needs for social stimulation and activities were. This meant there was no basis on which to use reviews to evaluate if planned care was effective or objectives met. We have asked the provider to take action to improve care planning.

Changes in needs and in how care was to be provided, were recorded through daily care records and written updates. These were brought to staff attention through verbal handovers of information and reminders to read latest additions to care records. We found staff had a good knowledge of the immediate care needs of people living in the home. They said they experienced the handover of information as effective.

Records showed people received medical attention in a timely way when needed. Staff were quick to observe and act on indicators of ill health, including requesting GP visits. A visiting district nurse told us the home’s staff made appropriate referrals and were effective in following care directions provided. However, there was a lack of specific risk assessments or care plans for pressure area care. The home did not use body maps to show clearly where any mark was observed and to track progress of treatment. We also found some information about health related care needs was unreliable. Confusing written records would make staff, especially new staff, reliant on shared knowledge that was not underpinned by clearly planned and reviewed interventions.

Is the service caring?

We saw that staff gave people friendly and individual attention. Care workers showed patience and gave encouragement when supporting people and respected their decisions.

People living in the home told us they made frequent use of the garden in good weather, for fresh air and sunshine. We saw plentiful support to people to be able to use the garden during our inspection. It was clear people experienced natural interaction between each other and staff. People were positive about their experience of meal times.

Organised activities were part of care staff responsibilities. There were resources for offering quizzes, reminiscence work and crafts. Pet therapy visits from outside were arranged regularly. Staff told us they sometimes supported people individually to go out to local shops, or the seafront. However, care documentation showed little information about people’s interests. The deputy manager said it was difficult to arrange activities geared towards individual needs if they were of little interest to the majority in the home. There was no detailed planning or evaluation of how the home met individual needs for stimulation and social engagement.

Is the service responsive?

Staff were supported in delivering care by an organised training programme. They were encouraged to pursue diploma qualifications. Individual supervision was provided every two months and records demonstrated a consistent approach. This meant the effectiveness of individual staff was monitored and enhanced. In addition, the deputy manager ran a programme of information provision in special interest topics, which we saw as effective in keeping staff interested and motivated in delivering good practice.

There was evidence of effective liaison between the home and outside health and social care services. We saw that GPs were contacted in a timely way in response to medical concerns and there were contact arrangements for community mental health services. Paramedics had left positive feedback about the quality of information provided when a person was transferred to hospital, which provided for continuity of care.

There was an annual survey of people living in the home, their relatives and outside professionals who visited. The results were used by the provider to inform the following year’s planning for the service. Individual matters raised were investigated and shortfalls addressed. People we spoke with, who lived in the home, said staff and management were very responsive to comments and requests.

Staff and management were readily available to people in the home, and to visitors. Staff responded readily to requests to move by people who were not independently mobile. Specialist health, mental health and social care resources were accessed when necessary. Care records showed specialist advice and care directions were incorporated into care records and followed by staff.

Is the service well-led?

The registered manager was also a proprietor of the provider company. They were well known to all people living in the home and were a frequent presence, but they delegated everyday running of care, staffing and quality management to the deputy manager. A person living in the home told us “The owner always makes a point of speaking to me."

There was a maintenance programme for the home, which showed the quality of environment for people in the home received ongoing attention. There were daily and weekly schedules and checks for ensuring all areas of the home were cleaned to a designated standard.

Staff we spoke with felt management listened to their views and kept them well informed of developments and plans. They had a strong identity as a team working together. Quarterly staff meetings covered care and operational issues. A staff member said “We all have an input, it’s good to get things out in the air.” We found, however, that the lack of person centred care planning meant people living and working in the home could not be sure care was provided on the basis of individual and up to date information and assessment.

During this inspection we spoke with four people who used the service and one of their relatives. We also spoke with five staff members; these were the deputy manager, three care workers and a senior care worker / cook.

The people we spoke with told us they were generally happy with the care they had received and with the staff team. One person told us "It’s all very nice here. They treat me well, I can’t complain". A member of staff told us "The quality of care is very good here. We meet the resident’s needs".

Staff we observed had an understanding of the support needs of people who use the service. We found that the documentation used for care planning had been reviewed recently, was detailed and person centred.

We looked at staffing rotas and during our inspection observed levels of staffing. We also spoke with staff members and people who used the service. We saw that the service had enough qualified, skilled and experienced staff to meet people's needs at all times.

We also saw that the service had quality assurance systems in place to monitor the quality of the service provided, and to gain the views of the people who used the service.

There were 17 people who used the service at the time of our inspection. We used a number of different methods to help us understand their views and experiences. We talked to several people who used the service. We observed the care provided and looked at supporting documentation. We spoke with care staff and the deputy manager. People said that they were well cared for, treated with respect and could make choices. We found that their dignity and independence was at times compromised due to inappropriate practices such as not allowing them to have the television remote control.

People considered that they were adequate staffing levels although our own findings were that the service was short staffed.

People were safe and had access to healthcare and other services as appropriate. Their every day care needs were regularly assessed and monitored. However we found that the overall quality of the service had not been assessed.

The people who use this service told us they were happy with the care they received at the home and verbal feedback was positive. They made the following comments:

“The manager can’t do enough for us and I certainly don’t have any complaints”

“I don’t know the formal way to complain but if I need anything I tell the manager and she fixes the problems instantly”

“I get breakfast in bed, I like that”

We also spoke with a number of visiting relatives. They gave us positive feedback about the home and said they felt the standard of care was good.

The majority of people we spoke to gave us good feedback abut the staff. People described staff as being caring and attentive and feel their dignity and privacy were upheld. The feedback included comments such as: “The manager and staff are very good” and “the care here is very good”.