This inspection was carried out on 22 and 28 August 2018. The inspection was unannounced on the first day.

Valley View Care Home Ltd is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Valley View Care Home Ltd is registered to provide accommodation, nursing and personal care for up to 33 people. It can accommodate older people and people who live with dementia. There were 25 people living at the service at the time of our inspection.

We last inspected Valley View Care Home Ltd on 19 December 2017 when five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. At the previous inspection we issued requirement notices in relation to the failure to assess or mitigate potential risks to people, failure to ensure people’s basic rights were promoted within the principles of the Mental Capacity Act 2005, care plans were not personalised, staff had not received the knowledge, skills and guidance to meet people’s needs, management of medicines and the auditing systems had not been effective.

The service was run by a company who was the registered provider. 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. In this report ,when we speak about both the company and the registered manager, we refer to them as being ‘the registered persons’.

At the last comprehensive inspection, the service was rated ‘Requires Improvement’ overall with safe rated as Inadequate and caring and responsive being rated as Good. We told the registered persons to send us an action plan stating what improvements they intended to make and by when to address our concerns and to improve the key questions of ‘safe', ‘effective’ and ‘.well-led' back to at least, 'Good'. After the inspection the registered persons sent an action plan and told us that they had made the necessary improvements.

At this inspection, some improvements had been made and two of the five breaches of regulations were now met. However, sufficient steps had still not been taken to address the three remaining breaches of regulations. This was because people had not consistently received safe care and treatment. In particular, potential risks posed to people had not been assessed and mitigated. Some staff had not received the appropriate support, training and supervision to carry out their roles. Furthermore, the registered persons had still not established robust systems and processes. As a result, they had not ensured the smooth running of the service so that people consistently received the high-quality care they needed and had the right to expect.

As a result of continuing breaches of regulations the overall rating for this service is ‘Requires Improvement’. This the was the second consecutive time the service has been rated as ‘Requires Improvement.’

Staff had not always received the training they required to meet people’s needs, including their specialist needs. Some staff had not received supervision in line with the provider’s policy. New staff completed an induction prior to working in the service. Safe recruitment procedures were followed to ensure staff were safe to work with people.

Care plans did not always contain up to date information to inform staff how to meet people’s needs. The systems in place for the review of people’s documentation were not effective. People’s needs were assessed before they moved into the service.

The governance and auditing systems were not effective. They had n

The inspection took place on 19 December 2017. The inspection was unannounced.

Valley View Care Home Limited is registered to provide accommodation and personal care with nursing for up to 33 people. There were 30 people living at the service at the time of our inspection.

People living in the service required registered nurses and care staff to provide their nursing care and support needs. Some people were living with dementia and some people had medical conditions such as diabetes or respiratory conditions and some people were recovering from suffering a stroke. Most people living in the service needed some support to move around. Some required the support of one staff member to move around whilst others required the support of two staff. Some people needed staff to support them to move by using a hoist. Some people were unwell and nursed in bed and others chose to be cared for in bed.

The service was set out over two floors with a passenger lift to take people between floors. A large communal lounge was available for people to sit together if they wished and a spacious dining area where people could eat their meals if they chose to. A small conservatory was also accessible for people.

A registered manager was employed at the service and had been in their role for a number of years. 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 provider had previously been registered with the Care Quality Commission (CQC) at this location. However, they had changed the legal entity of this service and this required them to apply for a new registration with CQC, which commenced on 23 December 2016. The service had continued within the same premises and with the same staff team and registered manager. This was the first inspection under the new registration. However, you can find previous inspection reports on the CQC website.

We found there were areas of the care and support at the service that required improvements to be made.

Some elements of how the administration of people’s medicines was managed needed improvement. Prescribed thickeners to add to people’s drinks to prevent choking were not stored or administered safely. Medicines audits did not highlight concerns found.

Individual risks had not always been fully assessed with the steps and guidance required to keep people safe. Accidents and incidents were not always recorded appropriately by following the processes in place. There were areas of concern regarding security within the premises to ensure people remained safe.

Nurses and staff did not always have the training required to carry out their role. Many staff had not completed the mandatory training required. Some important training had not been undertaken by nurses and staff. Staff had not always had the opportunity to take part in regular supervision sessions to aid their personal development.

People had not been supported appropriately to make decisions and choices when they may lack the capacity to do so. Any decisions made had not been made in their best interests.

Nurses and staff did not keep consistent records of people’s care. Daily recording charts were not always completed. Care plans were in place but not always up to date or consistently capturing people’s individual care and support needs or preferences.

The provider had monitoring and auditing processes in place to check the quality and safety of the nursing care provided. However, these audits were not completed robustly or regularly. They did not identify concerns we had found during the inspection and did not always record the action required when areas for improvement had been found.

Suitable numbers of staff were employed to provide the care and support requir