Valmark House

Valmark House is a residential care home providing personal care. The service can support up to 4 people, at the time of the inspection 2 people were using the service. Valmark House is a semi-detached property with single occupancy bedrooms located over three floors. People have access to a kitchen, lounge/diner, and sensory garden.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

Valmark House does not look like a care home and merges in well with the other properties forming part of a local community. People had a choice about their living environment and were supported by staff to personalise their rooms. For 1 person this included the use of interactive and sensory objects to provide a stimulating environment.

People were supported to have maximum choice and control of their lives and in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

Within the house and gardens, people were being supported to do individual activities of their choice. Staff supported people to go out, shopping and visiting the local area. However, with the recent reduction in staffing levels to reflect occupancy, we found people were not always being given the opportunity to pursue individual interests outside the service. The registered manager said they would take action to support this happening and look at opportunities for people to try new activities to enhance and enrich their lives.

Staff enabled people to access specialist health and social care support in the community.

The service worked with people and health professionals to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. Staff knew how people preferred to take their medicines to achieve best possible health outcomes.

Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

Right Care:

People received kind and compassionate care by staff who knew them well. Staff promoted and respected people’s privacy and dignity. Staff understood and responded to people’s individual needs.

Staff received an induction and on-going training, which supported them to get to know the people they were supporting and meet their changing needs.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

We saw people could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People's care, treatment and support plans reflected their range of needs, and this promoted their wellbeing and enjoyment of life.

Right Culture

Governance systems were in place but the oversight of these was not always effective. During the inspection, we identified shortfalls in risk management, and infection control. Although action was taken by the registered manager at the time, it demonstrated a weakness in their checks and audits, which could impact on people’s safety.

Since the last inspection we found the provider had not kept updated with current best practice. The impact of the registered manager working ‘hands on,’ and providing cover for another of the provider’s services had not been assessed. No protected time was in place to support them and the provider to jointly review the quality of the service against best practice and regulations, as part of developing the service.

People benefited from having lived at Valmark House for many years. This had enabled staff to develop a good understanding of people’s communication to support them having a voice. Relatives, stakeholders and staff were all positive about the service and the quality of care people received.

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

Rating at last inspection

The last rating for this service was good (published 19 March 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We have identified a breach in relation to governance procedures at the service.

We have made 2 recommendations in relation to health and safety and infection control, to ensure the staff’s knowledge is up to date.

Please see the action we have told the provider to take at the end of this report.

Prior to this inspection we recognised that the provider had failed to have a registered manager in post. This was a breach of regulation and we issued a fixed penalty notice [FPN]. The provider accepted the FPN and paid this in full. There was now a registered manager in post.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection, we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service good.

The service did not have a registered manager at the time 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. The house manager was in the process of completing an application to apply for registration. The registered provider was also supporting the service day in this interim period.

The service is a semi-detached property with single occupancy bedrooms located over two floors. People have access to a kitchen, lounge/diner and quiet room. The service has a well-maintained garden.

People were safe at the service. Staff knew how to identify abuse and understood the safeguarding procedures to follow to protect people from abuse. Risks to people's health and well-being were assessed and managed. People's needs were met in a safe and timely manner by a sufficient number of staff. The provider followed appropriate recruitment procedures to ensure they employed staff who were suitable to provide care. There was effective infection control procedures in place and people's medicines were managed safely. Equality and diversity priorities were in place to protect people and staff from discrimination. Systems were in place to ensure lessons were learned whenever an incident took place.

Care plans gave staff clear information about people’s physical and emotional needs and the support they required. People had access to a range of health and social care professionals and were provided with a healthy and balanced diet. Staff ensured people had sufficient amounts to eat and drink. 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.

Staff involved people in planning their care and knew their likes, dislikes and preferences. People had developed positive working relationships with the staff who supported them. People were treated with respect and their confidentiality maintained. Staff promoted people's privacy and dignity.

People participated in activities, hobbies and interests on a daily basis. There was a complaints process available and people were asked for their views at review meetings. In addition, people and their relatives were invited to give their feedback in surveys. Care plans were person centred and gave staff clear information about the person's preferences and what was important to them. For those people who were unable to express their needs and wishes verbally, staff had detailed information about the behaviours, gestures and body language people would display to communicate their needs or emotions.

Regular audits and checks were carried out on the quality of care people received. Shortfalls identified were addressed in a timely manner.

Further information is in the detailed findings below.

People's care plans were accurate and informed staff how best to support them. Care plans and risk assessments ensured people could maintain their independence and be involved in the community. One person told us, "I like seeing my dad, he brings me presents and we watch a DVD." The same person also told us, "I love playing on my Xbox, I can play online now."

We found the service to be clean and well maintained. There were appropriate risk assessments in place and the utilities had been inspected and certified.

There were enough skilled, qualified and experienced staff to meet people's needs.

Records were stored securely, and were accurate and fit for purpose.

The staff team were well trained and supported to carry out their role.