Valleywood Care Limited

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

People were positive about the care and support they received. They received safe care from familiar staff who understood their needs. People told us the service was reliable and staff arrived as expected.

Processes were in place to protect people from avoidable harm. Risks to people had been assessed and improvements had been made in relations to risk assessments. Medicines were managed safely and care plans had improved to include clearer guidance about the support people required with medicines.

People were supported by staff who were experienced, trained and supervised. The provider planned to introduce more specialised training for certain staff roles. Some staff inductions needed to take place in a timelier way.

Staff treated people with dignity and respect and took account of their individual needs when providing care and support. Care plans were in place and included details about people’s likes and preferences. These had all been re-written and were individualised. They had been developed in consultation with people and their relatives. The service worked well with other agencies to promote people’s health and well-being.

Improvements had been made to ensure staff followed The Mental Capacity Act 2005 (MCA) People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People told us the service was well-led, felt well supported overall and felt there had been improvements to the organisation. However, some staff felt that areas could be better managed within the supported living service. A new support living manager had been recruited and improvements had been made to the areas identified at the last inspection. The provider had systems in place to monitor the quality of the service and was aware where further improvements were required.

The provider had made improvements to ensure CQC were notified of incidents as legally required. Systems had been implemented to ensure the service learnt from any incidents or complaints and take action to develop the service further.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 June 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection took place between the 8 and 11 May 2018 and was an announced inspection.

This service provides a combination of support as a domiciliary care agency and supported living service. It provides personal care to people living in their own houses and flats in the community and specialist housing. The supported living service provides care and support to people living in 'supported living' settings, so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support. At the time of the inspection there were 110 people receiving a service.

Not everyone using Valleywood Care Ltd receives the regulated activity of 'personal care'; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

There was 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.

At the last comprehensive inspection on 20 April 2016, the service was rated 'Good'. At this inspection we found the service was now rated overall 'Requires Improvement'. This is the first time the service has been rated 'Requires Improvement'.

Overall people were very positive and complimentary about the service they received.

Where appropriate people’s consent to the care and support was sought. However, the service was not always compliant with Mental Capacity Act 2005 (MCA). This was a breach of Regulation 11 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were enough staff to meet people's individual care and support needs and recruitment processes were generally robust. People told us that the service was reliable and that they felt safe with staff. Staff had received training in safeguarding and were confident the management team would take concerns seriously. Some improvements had been made to the process for reporting and recording safeguarding concerns, but further improvements were required to ensure that all concerns were recorded.

There were individual and general risk assessments in place. However whilst we found that staff had taken action to mitigate risks, appropriate assessments were not always recorded.

People were assisted to take their medication as prescribed. However information within people's care plans over whether people were able to manage their medication themselves or required staff assistance needed to be clearer.

Staff had the appropriate skills and knowledge to support people effectively. Records showed us that staff undertook a range of training which was refreshed annually. Regular supervisions and appraisals were carried out with staff.

We saw evidence of staff working effectively to deliver positive outcomes for people. People were supported by staff to maintain their health and wellbeing through access to a wide range of community healthcare services and specialists.

Staff assisted people in a caring, patient and respectful way. People's dignity and privacy was promoted and maintained by the staff members supporting them. People were also supported to maintain their independence.

People had care plans in place which documented their needs. These plans informed staff about how a person would like their care and support to be given. They contained information about people’s history, likes and preferences. Staff were knowledgeable about people’s needs. People were given choices about their support.

The service promoted inclusion and supported people to take part in activities that reflected their interests. Within the supported living service we saw that people were supported to undertake activities and these were developed to meet people’s individual preferences and needs

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received. However, we noted that some verbal complaints and concerns raised were not consistently being recorded.

People and staff felt the service was well-led and staff spoke positively about the support they received from management. People were given the opportunity to provide feedback about different aspects of the service. There were some quality assurance systems in place, however quality assurance arrangements had not identified all the areas for improvement we found as part of this inspection.

We found one breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to consent. You can see what action we told the provider to take at the back of the full version of this report. The registered provider had also failed to submit relevant statutory notifications to the Commission. A notification is information about important events which the provider is required to tell us about by law. Failure to submit notifications is an offence under the Care Quality Commission (Registration) regulations. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

At the time of our inspection, the service was supporting 15 people in seven 'supported living' properties. Supported living describes the arrangement whereby people are supported to live independently with their own tenancies. In addition to supported living, the service also provided personal care for 100 people in their own homes.

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 people were very positive and complimentary about the service that they received. People using the service told us they felt safe and the relatives we spoke with also agreed people were safe. We found that people were protected from the risk of harm and abuse. All staff spoken with had a good understanding of safeguarding, the signs of abuse, and how to report it. However, the provider did not have a system in place to record safeguarding referrals and the outcomes of these. There had been no safeguarding concerns over the past 12 months.

Staff rotas were based upon the number of hours of support people had been assessed as needing. People, their relatives and carers told us they thought there were enough staff to meet people's needs. The rotas demonstrated that staffing levels were planned and organised, so that people received consistent care staff. Safe recruitment practices were evidenced.

People’s medicines were administered safely. However we found that protocols for as and when required (PRN) medications had not always been recorded in people’s care plans.

Risk assessments were in place and detailed. They were reviewed on regular basis. We found that it had not always been recorded when risk assessments had been reviewed if there had been no changes and it was therefore difficult to evidence that they had been reviewed.

Staff were skilled and knowledgeable. We found that staff completed an induction prior to starting work in the service. Staff received regular and ongoing training.

We found that staff had some awareness and had received training in the Mental Capacity Act 2005 (MCA). However we found that records did not demonstrate that the service had taken account of people’s mental capacity during assessments. It was unclear whether best interest decisions had been made and recorded for people who lacked capacity to consent to aspects of their care and support.

Staff were kind, caring and compassionate. People told us that staff treated them with dignity and respect. We found that staff had developed effective caring relationships with people.

Care plans were in place. They provided sufficient details and were regularly reviewed and updated. The care plans and risk assessments provided person centred information, some were very detailed and included people’s preferences and choices. We found that people were supported to maintain as much independence as possible.

People had access to the complaints procedure and told us that they knew how to make a complaint should they need to. There had been no formal complaints. We found that the management team had regular contact with people and dealt with any issues and concerns as they arose.

The service was well led. People told us that the provider was “excellent” and people felt that the registered manager was approachable. Staff told us that they were well supported. There were some quality assurance systems in place. We spoke with the provider about developing these to improve these further.

We spoke with two professionals about the care provided by Valleywood Care Ltd. All were positive about the service provided and the staff.

We found that care files were well maintained, easy to read and contained detailed person centred information about people who used the service. Care plans had been regularly reviewed and updated.

People told us that they received their medication in a safe manner. Care staff had received medication training as part of the induction programme provided by the service and regular updates had been completed.

We found that staff we spoke with were happy with the company and felt well supported to perform their role.

We were shown the company's complaints policy and found that people who used the service had been given information on how to make a complaint.