Valley Court is registered to provide accommodation for 69 people who require nursing or personal care. People who live there have health issues related to old age.

This inspection of Valley Court took place on 1 March 2017 and was unannounced. At the time of our inspection 66 people were using the service. At our last inspection in August 2016 we found the provider was meeting all the regulations but we identified that some areas in the key questions of safe and well-led required improvement. We found on this, our most recent inspection; the provider had made the necessary improvements in relation to the issues we previously identified.

The service had a registered 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 2008 and associated Regulations about how the service is run.’

Recruitment practices in relation to criminal records checks were not consistently undertaken in line with the Health and Social Care Act regulations. Staff understood their responsibility to protect people from the risk of abuse and appropriate action was taken in response to any incidents. Risks to people's health and safety were regularly assessed and action taken to reduce the risks. Staff were organised and well deployed and were available in sufficient numbers to meet people's needs in a timely manner. People received their medicines when they needed them and medicines were in the main stored and administered appropriately.

Staff were well supported by the provider in relation to the level of supervision and the quality of the induction provided to them. Systems in place ensured people were not deprived of their liberty unlawfully. People were supported to provide consent for the care they received. Staff were provided with relevant training to effectively meet people's needs. People had access to a good range of food and drink. People were supported to access a range of healthcare services.

There were caring and friendly relationships between staff and the people living at the home. People made decisions about how they lived their lives and staff enabled them to achieve these. People were treated with dignity and respect by staff and their right to privacy was upheld.

People felt that care was person-centred and staff responded well to any changes in people's needs. People’s diversity was embraced and met with sensitivity. Care plans provided up to date and relevant information about people's support needs. Activities were provided that were in line with people’s likes and preference’s. People felt comfortable raising concerns or making a complaint and knew how to do so.

There was an open and transparent culture at the home, people and staff felt comfortable speaking up if they wanted to. The registered manager ensured that staff were provided with clear leadership. People were able to provide their opinion on the quality of the service through surveys, suggestions and meetings. Effective quality monitoring systems were in place and areas requiring improvement were acted upon accordingly.

Valley Court is registered to provide accommodation for 69 people who require nursing or personal care. People who live there have health issues related to old age. The accommodation was made up of both nursing and residential care beds. At the time of our inspection 64 people were using the service. At our last inspection in June 2014 we found that the provider was compliant with the regulations that were considered.

The service had a registered 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 2008 and associated Regulations about how the service is run.’

We found that medicines management within the service was lacking in some areas, including guidance for staff in the administration of medicines directly into the stomach. The provider had systems in place to protect people from abuse and harm. Staff had a clear knowledge of how to protect people and understood their responsibilities for reporting any issues of concern. The provider had a suitable number of staff on duty. Systems in place for recruitment ensured staff working at the service had the right skills, experience and qualities to support the people who used the service.

Staff had access to a range of training to provide them with the level of skills and knowledge to deliver care safely and efficiently. Staff were able to give an account of what a Deprivation of Liberty Safeguard (DoLS) meant for people subject to them. Staff were knowledgeable about how to support people to maintain good health and accessed professional healthcare support for people when necessary. People gave varied feedback about the quality of food; however we observed that the standard and choice of food provided was good.

People were supported in a caring way and reassured in times of distress or discomfort. Staff interacted with people in a positive manner and used encouraging language whilst maintaining their privacy and dignity. People were involved in the decision making about their care. Staff provided support to people in a way that helped them to remain as independent as possible.

People’s needs were assessed and care was planned with them or their representative in line with their preferences. Staff were knowledgeable about people’s personal preferences and what was important to them, including their spiritual or religious needs. Activities available to people were based on the individuals preferences and abilities. The provider responded to complaints received in line with their own policy.

People and staff spoke positively about the leadership skills of the registered manager. Feedback was actively encouraged through surveys, suggestions and meetings; which allowed people and staff to be involved in the development of the service. Systems for monitoring the quality and safety of the service were in place but had failed to identify issues in relation to medicines management.

During our inspection we looked at information to help us gather evidence about the quality of care and support people that lived at the home received.

We spoke with seven people that lived there, seven relatives and observed how people were supported by staff. We also spoke with the registered manager and six other members of staff that were on duty. We reviewed records relating to the management of the home which included, care plans, daily care records, accident and incident records, complaints records, audits, and staff records. We also spoke with the local commissioners of the service.

Our conversations with people helped us to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? and, Is the service well led?

Below is a summary of what we found. The summary is based on our findings during the inspection.

The detailed evidence supporting our summary can be read in our full report

Is the service safe?

Everyone that we spoke with said that they thought the care they were receiving met their needs. They all said they were being looked after, felt safe and well cared for. One person told us, “They are treating me very well. We have different carers, but they are all very nice. They go out of their way to help you.”

We saw that people’s care was planned and any risks associated with providing the care was assessed and managed appropriately. We saw that people’s changing needs were identified and the appropriate medical advice sought to ensure they were cared for in the safest way.

Systems were in place to make sure managers and staff learnt from complaints and concerns and events such as accident and incidents. This reduced the risks to people and helped the service to continually improve.

People were cared for in a clean, hygienic environment where systems for managing the control of infections were well maintained.

Staff were appropriately recruited to ensure they were safe to care for people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. The manager was aware of the process for seeking guidance from the approving authority and polices were in place to guide staff.

We found that the provider was meeting the requirements of the regulations that we looked at to ensure that people were cared for safely.

Is the service effective?

All of the people and their relatives spoken with told us that they were receiving the care that they needed. There was a full time activities coordinator in post and people were supported to be involved in social activities if they wished.

We saw that the home sought the views of people that lived there and their relatives and staff to help in improving the care provided. We saw that meetings were held with people that lived at the home, so that they were involved in making decisions about the day to day management of the home and things that affected them.

Care plans were kept under regular review, so that staff had up to date information on how to care for people.

We found that the provider was meeting the requirements of the regulations that we looked at to ensure that people received an effective service.

Is the service caring?

All of the people and their relatives spoken with told us that they felt that the service was caring. One person that lived at the home told us, “Oh yes its’ wonderful. Very caring staff and they will do the simplest thing for you.”

We walked around the home and watched to see how staff treated people. We saw good interactions between people and staff. We saw and people told us that call bells were responded to promptly.

We saw that people were dressed in clothing appropriate to their age, gender and the weather and were well groomed, so that their dignity was maintained.

Is the service responsive?

All the visitors spoken with said they visited the home whenever they wanted to and were kept informed about changes to their relatives care. A relative told us, “To be honest X looks really well and she has put weight on. They did get a dietician out to see her and they keep me informed if things changes.”

All the people that we spoke with were confident that they could speak with the manager about their concerns and they would be acted upon.

We saw from care records looked at and staff told us that the home involved other professionals in supporting people’s care as required.

We found that the provider was meeting the requirements of the regulations that we looked at to ensure that people received a service that was responsive to their needs.

Is the service well led?

All the people and their relatives that we spoke with had no concerns about the service. A relative told us, “They have been marvellous; I can’t see anything better that they can do.” People were confident that their concerns would be listened to and investigated.

People and their relatives were consulted about the quality of service they received. We saw that comments and concerns were analysed and improvements were put in place where they had been identified.

Systems for monitoring the quality of the service were well maintained.

We saw that the home had a staffing structure that enabled the service to be managed appropriately. This included a manager that was registered with us and was responsible for the day to day running of the service. All staff spoken with told us they felt that the home was well managed and they were able to raise concerns about people’s care with the managers.

We found that the provider was meeting the requirements of the regulations that we looked at to ensure that the service was well led.

During the inspection we spoke with 12 people that lived at the home, seven visitors, the manager/nominated person and four staff.

All the people living at the home that we spoke with told us that on a daily basis staff always sought their consent before providing care. We found that where people did not have the capacity to consent to their care, the provider did not act in accordance with legal requirements.

Everyone living at the home and their visitors told us that the care met their needs. One person told us, “I am being cared for well, no complaints. Plenty to eat and drink, enough staff to care for me and if I press the buzzer they come.” We found that people experienced care, treatment and support that met their needs.

People told us that they received their medication when they need it. We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Everyone living at the home told us that they were treated well by the staff. One person told us, “They are all as good as gold.” We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

All the people living at the home and their visitors told us that they were happy with the quality of care provided. One person said, “My mom looks better now than she has looked in the last 18 months. The care is right.” We found that the provider had an effective system to regularly assess and monitor the quality of service that people received.

During our inspection we spoke with nine people who lived at the home and two of their relatives. We observed how people were cared for. We spoke with the manager three members of the staff team and two visiting professionals.

People told us that they had choices and that their privacy and dignity was respected. One person said “I choose to have a bed bath and a shower once a week. If I want anything I tell the nurse what I want.”

We saw that people were cared for and people and their relatives told us they had no concerns about the care they received. One person said “I love it here, a home from home and the staff do anything for you”.

People said they felt safe living at the home. However we found some concerns with the way staff followed the procedure for safeguarding people living at the home.

Systems were in place for people to raise concerns. People told us they had no concerns about the home and felt that staff would listen to and act on their concerns.

We found that the provider was not keeping us informed about incidents that affected the welfare of people living at the home.

We spoke with seven people who used the service, five members of staff and two visiting relatives. People told us they were very happy with life at Valley Court Nursing Home and that staff were very caring and attentive towards them. Visiting relatives told us they were very impressed with the care of their relatives and that staff were very accommodating trying to make sure people had a choice about the way their care was delivered.

We saw that a range of personal choices had been explored and delivered to people. For instance the way one person preferred their breakfast, and specific food choices. We were also told by a visitor that their relative’s consultant was very impressed with the service because staff prepared a summary of the person’s progress and medication which enabled the consultant to have an accurate update on how the person had been at each appointment.

Another visitor told us their relative had visibly improved having only been at the service for a week. We spoke with this person who told us how pleased they were that their previously poor skin was healing. We saw that a regular routine for applying skin care had been followed and that the person’s skin looked well cared for.

On our visit we saw that the majority of people were being supported to take part in a ‘keep fit’ session. The facilitator knew everyone by their first name and people looked happy and keen to take part.

People told us they liked the food that was prepared for them and that they could ask for something different if they did not like what was on offer. We saw that people did have this option.

People described staff as friendly and helpful. One person told how comforted they were during the night when staff kept them company because they could not sleep. Staff told us the staffing levels were sufficient to meet the needs of the people who used the service. We saw on the day that staff responded to the needs of people, and that people did not have to wait for support.

Some of the people that use the service at Valley Court have dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.