This inspection took place on 20 and 23 November 2018 and was unannounced on the first day. We announced the second day of our inspection to ensure the registered manager was available. We previously inspected Valley View Residential Care Home in February 2018 and rated it overall as requires improvement. We rated our key question ‘safe’ as inadequate and found breaches of regulation concerning care plans not reflecting people’s needs, the principals of the Mental Capacity Act (2005) not being met, risks to people not being fully assessed, concerns around the safe management of medicines and governance systems not being effective in the oversight of the home.

Following the last inspection, we met with the registered provider to discuss their action plan which showed what they would do and by when to improve the key questions, safe, effective, responsive and well-led. The registered provider employed the services of a consultant to provide support to the management team. At this inspection, we found improvements had been made in all areas.

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

Valley View is a purpose-built residential care home. The accommodation provides single rooms with en-suite toilet and shower facilities for up to 59 people. At the time of our inspection, 50 people were living at this home. There are four units; Rose, Poppy, Bluebell and Orchid unit. Poppy unit is dedicated to caring for people living with dementia.

Without exception, people told us they felt safe living at this home. Staff had received safeguarding training and appropriate action was taken in response to allegations of abuse. One safeguarding incident had not been reported to the Care Quality Commission (the Commission), although this had been reported to the local safeguarding authority and all other notifications had been submitted to the Commission. Safe recruitment practices had been followed which reduced the risk of unsuitable staff being employed.

The storage, administration and disposal of medicines was safely managed at this inspection. We discussed an exception with the registered manager and they took immediate action.

Individual risks to people had been identified, assessed and were regularly reviewed. Risk assessments included guidance for staff to follow. The management of infection control, the building and equipment staff used was effective.

Staffing levels had increased since our last inspection and a dependency took was used to ensure this continued to be a valid assessment of need. Extra staff were suitably deployed to areas of the home where people had greater needs.

Lessons were learned from events which did not go as planned and these outcomes were discussed with staff.

A dedicated training and development coordinator was responsible for the training programme which showed high levels of completion. Staff had received a recent supervision and appraisal and spot checks were taking place to ensure good standards of care were provided.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The registered manager used a tracker to ensure these authorisations continually remained up-to-date.

Care plans we looked at showed advice was sought from healthcare professionals when required. People confirmed staff made medical appointments for them as needed.

Staff knew how to maintain people’s privacy and dignity at all times and people confirmed this happened. Staff were seen working at eye level with people, communicating effectively with them and providing reassurance where it was needed. Staff knew people well including their care preferences. Peo

A comprehensive inspection took place at Valley View Residential Care Home on 14 and 16 February 2018. Both days of our inspection were unannounced.

The home had previously been inspected on 25 August 2015 and was rated good overall and in the key questions we inspect against. The registered provider was found to be compliant with the regulations at this service.

Valley View is a purpose built residential care home. The accommodation comprises of single rooms with en-suite toilet and shower facilities for up to 59 people. There are four units on separate floors known as Rose, Poppy, and Bluebell providing accommodation for between 16 to 18 people and Orchid unit for eight people. Poppy Unit is dedicated to caring for people living with dementia. On the day of our inspection there were 49 people living in the home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager in place. 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.

Most people we spoke with told us they felt safe living at this service. Staff were able to recognise abuse and knew who to report this to and most staff had received up to date safeguarding training. Staff training records showed staff were overdue refresher training in subjects such as fire safety, infection control and basic food hygiene. Supervision records we looked at required strengthening to evidence personal development of staff.

Risks to people had not been sufficiently assessed, managed and reviewed. Risk assessments relating to falls and choking were not in place where people were at risk of harm. The management of medicines was not found to be safe as medicines were not always stored and administered appropriately. Medication training and staff competency checks were not completed for all staff responsible for the administration of medicines. Staffing levels were not found to be sufficient to meet the needs of people living in this home. The registered provider did not use a tool to assess people’s dependency levels in order to determine the number of staff support hours needed.

Mental capacity assessments were not kept with care plans. These were kept separately where staff did not have access to these records. These assessments were not specific to a range of decisions. Records of Deprivation of Liberty Safeguards were appropriately managed. This meant people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible as the policies and systems in the service did not support this practice.

Care plans did not always accurately reflect people’s care. People’s end of life care wishes were considered. People looked well dressed and cared for and warm interactions were seen during our inspection. People’s privacy and dignity was usually respected.

Quality assurance audits and provider reports were not fully effective as although they identified concerns, these lacked action plans with timescales and records of actions completed. Records relating to the management of complaints required improvement.

People told us they enjoyed the food they were served and the mealtime experience was seen to be positive. People received access to healthcare and visiting healthcare professionals were complimentary about the care provided at this home. A programme of entertainment and activities was in place.

The registered provider held regular meetings for people, relatives and staff and satisfaction surveys were used to gather feedback. We

The inspection of Valley View Residential Care Home took place on 25 August 2015 and was unannounced. The home was previously inspected in December 2014 and found to require improvement in relation to dignity and respect towards people living in the home, a lack of compliance with the Deprivation of Liberty Safeguards and staffing. We looked at these areas during our inspection and found there had been significant improvement.

Valley View is a purpose built residential care home. The accommodation comprises of single rooms with en-suite toilet and shower facilities for up to 59 people. There are four units, Rose, Poppy, and Bluebell providing accommodation for between 16 to 18 people and Orchid unit for eight people. Poppy Unit is dedicated to caring for people with dementia. On the day of our inspection there were 54 people living in the home.

There was a registered manager in post on the day of our inspection. 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 told us they felt safe and staff demonstrated a sound understanding of what may constitute abuse or neglect, and were fully aware of how to report such concerns. The home was keen to promote independence and the risk assessments encouraged people to do as much for themselves as possible without neglecting their need for support if required.

Staff were accessible throughout the day and responded to people promptly and efficiently. Medicines were administered and stored in line with the National Institute for Clinical Excellence (NICE) Managing Medicines in Care Homes guidance. Staff had received necessary training and were competent in this role.

People were supported by well trained and knowledgeable staff who had access to regular guidance and information. The home encouraged staff’s personal development and through their appraisal system enabled staff to consider their strengths and development needs.

We saw people received appropriate support with eating and drinking and that choices were on offer. We spoke with the registered manager as to whether consideration of a more ‘restaurant style’ meal provision may be more enabling for some people as meals were pre-plated and denied people the option of portion control.

The home was compliant with the requirements of the Deprivation of Liberty Safeguards ensuring necessary authorisations had been obtained where people’s liberty was restricted in their best interests.

Staff interacted well with people living in the home displaying detailed knowledge about individuals. Staff were helpful, considerate and patient. They were also very accessible all day ensuring people had their needs met promptly and effectively.

We saw people were enabled to do as much as possible for themselves, both physically and mentally, and this promoted a sense of wellbeing in the home.

There was a variety of activities on offer in the home on the day of our inspection for people to join in with as they wished. They helped to promote positive mental health by encouraging interaction and reminiscence.

We found that people’s care needs were responded to as they preferred and that written records endorsed this person-centred approach. Complaints were handled effectively and learning gleaned from them shared with staff as necessary.

The home had an accessible and responsive registered manager and team who demonstrated effective leadership by acknowledging and resolving, where possible, any concerns promptly and had the systems in place to support this.

We carried out this inspection on 08 December 2014 and it was unannounced.

During our last inspection at the home which took place on 28 January 2014, we found the service was meeting the requirements of the regulations we inspected at that time.

Valley View is a purpose built residential care home. The accommodation comprises of single rooms with en-suite toilet and shower facilities for up to 59 people. There are four units, Rose, Poppy, and Bluebell that provide accommodation for between 16 to 18 people and Orchid unit for eight people. Poppy unit is dedicated to caring for people living with dementia.

It is a condition of registration with the Care Quality Commission (CQC) that the home has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. However, at the time of our inspection, the registered manager was not the person who was managing the service. We spoke with the manager about this, who told us they had submitted an application to become the ‘registered manager’ and were awaiting a response from CQC.

We found the service ensured people were protected from abuse and followed adequate and effective safeguarding procedures. However, we found some issues in some areas including; people’s freedom being unlawfully restricted, risk assessments not always being followed by staff, daily notes for people living at the home not being personalised, trend analysis not being carried out on safeguarding concerns, staff members reporting feeling stretched in respect of staffing levels, staff training where updates or refreshers were required and inadequate written, individual staff supervision.

We found issues around staff training and a lack of awareness of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

We found care records were regularly reviewed and monitored with the involvement of people who lived at the home and/or their relatives. We also found evidence that people’s views were actively sought and any issues or concerns identified were addressed by the manager.

We found there was an inclusive and open culture at the service, although we did find some issues as formal staff meetings and individual staff supervisions did not take place.

We found breaches in Regulation 10 Dignity and respect; Regulation 11 Need for consent and Regulation 18(2) Staff support and training.

You can see what action we told the provider to take at the back of the full version of the report.

People's needs were assessed and their care and treatment was planned and delivered in a way which ensured their safety and welfare. We saw evidence that service users and their relatives took an active part in constructing and reviewing care plans.

We found that when people required care and treatment from another provider, such as a doctor or hospital, the provider obtained these services in a timely way. Relatives of people who used the service told us their relatives were supported by staff to have health checks with other providers such as dentists, opticians and doctors. This was confirmed by records we saw in people's care plans.

Medicines were handled appropriately. We inspected medication storage and administration procedures in the home. We found that medicine trolleys and storage cupboards were secure, clean and well organised.

We saw that the provider of service was employing effective staff recruitment and selection systems. We saw there was a clear process that ensured appropriate checks were carried out before staff began work. Our observations and scrutiny of records showed that a robust recruitment process operated at the home.

The provider had a complaints policy for ensuring that complaints were recorded and fully investigated. The policy gave information about how to make a complaint, the timescales for responses and who to go to if the complainant remained dissatisfied.

People who use the service told us that the staff were courteous when carrying out their care and support. People said they were comfortable living at the home and that staff cared for them well. The majority of people provided us with positive responses when we asked them their experiences of the care provided.

On one of the units, we visited, people’s relatives told us that they had been concerned in the past about the lack of visibility of staff on duty particularly at the weekend, but recently they had seen an improvement. Another person told us that the staff were very good and helpful and they were one happy family.

The majority of the people who use the service and or their representatives told us that they get on well with the staff and they cared for them very well. People were comfortable living at the home. We spoke with two visiting relatives both were highly complimentary of the care and compassion demonstrated by staff whilst caring for their relatives.

People who live at the home told us they were happy and that the staff were good. ‘I can go out when I want’ ‘They are very good here’

People were observed relaxed in the lounge and having lunch in an unrushed manner.

Staff said they were happy working in the home and that the managers were supportive.

Many people were happy to talk about their experience of living in Valley View. They said how happy they were and how staff treated them with respect and dignity.

People said they were listened to and involved in their care by staff. They said how staff spend time explaining things with them.

Everyone said they really liked the food at Valley View and were observed enjoying lunch at their own pace. They spoke of how the home is always clean and fresh.

All said they have contact with healthcare professionals when they need them.

People were aware of the complaints procedure, even if they had not had occasion to use it

Everyone commented on how good the environment was and how relaxed they felt living at Valley View