Culm Valley Care Centre

Culm Valley Care Centre is a service in a detached building over three floors in the centre of the market town, Cullompton in East Devon. The home is in walking distance of the town centre and local amenities. Since the last inspection the provider has had a large extension with an additional seven bedrooms and an additional communal lounge.

We found the following examples of good practice.

People were supported by staff trained and in line with government COVID-19 guidance. They had completed Infection control and Covid training. The registered manager confirmed they had regular updates and kept staff well informed.

Hand sanitiser and personal protective equipment (PPE) were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands, regular use of hand sanitisers and appropriate social distancing. Staff were observed wearing PPE in line with government guidance throughout our visit.

There had been several small Covid-19 outbreaks at the home during the pandemic. Relatives told us that they were kept informed about any Covid-19 outbreaks at the home. One relative said, “I am informed of any outbreak at the care home. A member of staff rings me, and this is followed up by a letter with any visiting restrictions. As soon as an outbreak ends, I am also informed of this by letter.”

During Covid-19 outbreaks, the provider had needed to follow government guidance to restrict visiting at these times. They had ensured essential care givers had been able to visit and relatives of people receiving end of life care. Relatives gave us mixed feedback about being able to visit the home easily and others felt the provider was doing all they could to facilitate visits. Comments included, “Yes I have been able to keep in contact with my mum throughout the pandemic. She is more responsive to having a face to face visit so as an essential carer I find I can usually visit weekly. This can vary as the care home restricts the number of visitors at any one time and any visits have to be pre booked”. Another said, “The safe visiting of residents by family and friends has continued throughout in some shape or form, ranging from pod visits, to window, and virtual on line, and I know at times they have had to face some difficult and unfair questioning by some, having to justify their actions.”

On the day of our visit, the registered manager had been told by the local authority tactical team they could resume some visiting using a pod at the home. There was a visiting pod that had been created in the entrance hall of the home so that visitors did not have to enter the home itself. The registered manager said they had contacted relatives to advise them to schedule visits quickly in case of another outbreak happening at the home. Relatives visiting the home were required to complete COVID-19 testing, have their temperature taken and complete a questionnaire.

The service actively engaged with a programme of regular testing according to government guidance.

The provider had ensured that staff met vaccination requirements. They had a system to ensure visiting professionals entering the home had been vaccinated.

There was a clear procedure in place, in line with national guidance, to ensure people were admitted to the service safely.

Cleaning schedules had been put in place to ensure high touch surfaces were cleaned regularly. The infection control policy was up to date and audits were in place to monitor IPC at the home.

Culm Valley Care Centre is registered to provide accommodation for 63 people who require nursing and personal care. There were 57 people living at the service, they consisted of 22 people who had been assessed as requiring nursing care were having their nursing needs met by the nurses at the service. There were also 36 people whose nursing needs were met by the community nursing team. One person was admitted on the day of the inspection and one person was discharged.

Culm Valley Care Centre is a service in a detached building over three floors in the centre of the market town, Cullompton in East Devon. The home is in walking distance of the town centre and local amenities. Since the last inspection the provider has had a large extension with an additional seven bedrooms and an additional communal lounge.

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

People felt safe at the home and with the staff who supported them. The staff understood their responsibilities and how to protect people from abuse. There were enough suitably skilled and knowledgeable staff to meet people’s needs. People said their needs were met in a timely way.

Staff were safely recruited and received the training and support they needed to undertake their role. Peoples' medicines were managed safely. Processes were in place for the timely ordering and supply of medicines and medicines administration records indicated people received their medicines regularly. Measures were in place to control and prevent the spread of infection. There were checks and audits in place to protect people from the risks of unsafe and unsuitable premises.

People were cared for by staff who knew them well and were kind and compassionate. Staff were happy in their jobs and wanted to provide the best care they could. Staff were attentive, caring and kind. Staff had received the provider’s mandatory training and had regular supervisions and appraisals with their line manager’s

People’s needs had been assessed prior to going to the home and they had a care plan in place. We discussed with the registered manager that people staying at the home for a period of respite had summary care plans. These did not give enough information to guide staff to support their complex needs. The registered manager said they would review these.

The provider employed an activity co-ordinator who was based in the main communal area to support people’s social needs. The provider also employed a staff member for six hours a week to provide social support to people in their rooms who could not leave for health reasons or because they chose to stay in their rooms.

People, their relatives and staff expressed confidence in the registered manager and deputy manager. People’s views were sought on an informal basis, through regular meetings and an annual satisfaction survey. There were effective systems in place to monitor the safety and quality of the service.

People were supported to eat and drink enough to maintain a balanced diet. People were supported to access healthcare services. Staff worked closely with health professionals, including the GP and community nurses and referred people promptly. The home provides end of life care and staff ensured people received the appropriate support which included having appropriate medicines available for people nearing the end of their life, to manage their pain and promote their dignity.

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.

People knew how to make a complaint if necessary. Where the registered manager had received complaints, they had followed the provider’s complaints policy.

More information is in the full report.

Rating at last inspection and update: The last rating for this service was Good overall (published 29 June 2017). At this inspection we found the service remained good.

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

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.

Culm Valley Care Centre is registered to provide accommodation for 56 people who require nursing and personal care. There were 47 people living at the service on the first day of our inspection. They consisted of 22 people who had been assessed as requiring nursing care were having their nursing needs met by the nurses at the service. There were also 25 residential people whose nursing needs were met by the community nursing team. There were two further admissions on the first day of the inspection and a person arrived for a respite visit on the second day of our visit.

There was 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 had previously carried out a comprehensive inspection of this service in June 2016. Three breaches of legal requirement had been found at that inspection. The breaches were because risks assessments were not always completed correctly to assess people’s individual risks. Environmental risks were not always being safely managed, which could put people at risk in the event of a fire. Care plans had not always been put into place to reflect people’s emotional and mental health needs. The provider had a range of quality monitoring systems in place which were used to continually review and improve the service. However these were not fully effective as they had not identified the breaches of regulations found at this inspection. At this inspection we found action had been taken regarding these concerns and the requirements had been met.

There were adequate staffing levels to meet people’s needs. People and staff felt there were adequate numbers of staff on duty to complete people’s personal care but said they were often busy which meant they did not always have time to interact with people. People had mixed views about the response time to call bells with some people saying they did not feel their call bells were responded to promptly. The registered manager regularly assessed the dependency levels of people and adjusted staff levels accordingly to ensure there were sufficient staff on duty. They undertook random bell audits to monitor staff response times which were all promptly responded to. During our visits bells were responded to promptly. We had concerns that people using the outside terrace could not alert staff if they required assistance. The registered manager put in place regular checks and was looking at ways this could be addressed.

Risks assessments were completed correctly to assess people’s individual risks. Care plans were developed when people came to the service following a pre admission assessment involving people and their families. Care plans were personalised and recognised people’s health and social needs. They were regularly reviewed and updated to reflect people’s changing needs. However improvements were needed to ensure there were care plans in place for people’s oral care. Action was taken to put these in place.

Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Staff were following the MCA in regard to people with capacity consenting to their own care at the service. Where a power of attorney (POA) was appointed for a person, there was a system to identify whether the POA was authorised for making care and treatment decisions, financial decisions or both.

People were supported by staff who had the required recruitment checks in place. Staff received an induction and were knowledgeable about the signs of abuse and how to report concerns. Staff received regular training, supervision and appraisals. Staff relationships with people were mostly caring and supportive. However some people said they felt not all staff were polite and friendly.

Medicines were safely managed and procedures were in place to ensure people received their medicines as prescribed. Improvements had been made in relation to people having their prescribed creams applied as required.

People’s views and suggestions were taken into account to improve the service. Advice and guidance was sought from relevant professionals to meet people’s healthcare needs and to ensure the care and treatment was right for them.

People were supported to eat and drink enough and maintain a balanced diet. People were positive about the food at the service.

The provider had a range of quality monitoring systems in place which were used to continually review and improve the service. Where there were concerns or complaints, these were investigated and action taken. The premises and equipment were managed to keep people safe. People’s safety was protected by effective fire and environmental monitoring.

Culm Valley Care Centre is registered to provide accommodation for 56 people who require nursing and personal care. There were 47 people using the service on the first day of our inspection. They consisted of 26 people having their nursing needs met by the nurses at the service and 21 people whose nursing needs were met by the local health authority community nursing team. The registered manager made us aware that four people were receiving intermediate care which was where health professionals also supported people to rehabilitate with the aim of returning home.

There was 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.

At the last inspection in May 2015, a breach of a regulation was found. This was because there were concerns about staffing levels, as the provider did not have a systematic approach to determine the number of staff required in order to meet the needs of people using the service and keep them safe at all times. We found some improvements had been made at this inspection. However people were still not having their needs met promptly.

Staffing levels were regularly assessed and dependency levels of people monitored to ensure there were sufficient staff to meet people’s individual needs and to keep them safe. The registered manager adjusted the staffing levels to meet those needs. People and visitors expressed concerns about the staff response times to call bells, and as a result felt there were not adequate staff to meet people’s needs safely. Following the inspection the provider made us aware that they had increased the volume of the call bell panels. This was because staff had said they could not always hear the bells in all areas of the home. They said they had seen improvements in the response times. We made a recommendation to the provider to monitor call bell response times and staff deployment.

Risks assessments were not always completed correctly to assess people’s individual risks. This meant staff might not take the appropriate action to keep people safe. Care plans were developed when people came to the service following a pre admission assessment involving people and their families. However the nurses were not updating people’s care plans to reflect their changing needs and were not recording health care professionals’ visits and their instructions. Care plans had not always been put into place to reflect people’s emotional and mental health needs.

The provider had a range of quality monitoring systems in place which were used to continually review and improve the service. However these were not fully effective as they had not identified the breaches of regulations found at this inspection. Environmental risks were not always being safely managed, which could put people at risk in the event of a fire.

Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. However staff were not following the MCA in regard to people with capacity consenting to their own care at the service. Where a power of attorney (POA) was appointed for a person, there was no clear system to identify whether the POA was authorised for making care and treatment decisions, finances or both. This increased the risk they may make decisions on behalf of a person they were not legally authorised to make.

People were supported by staff who had the required recruitment checks in place. Staff received an induction and were knowledgeable about the signs of abuse and how to report concerns. Staff had received training and had developed knowledge to meet people’s needs. Further steps were needed to support staff whose first language was not English to improve their communication skills and check they had the communication skills required to perform their role effectively. Staff relationships with people were caring and supportive.

Medicines were safely managed with the exception of prescribed topical creams which records did not demonstrate had always been applied as prescribed.

People said the registered manager was very visible at the service and undertook an active role, most said she was approachable and available to speak with. Staff said they felt supported by the registered manager and the clinical lead nurses.

People’s views and suggestions were taken into account to improve the service. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment required.

People were supported to eat and drink enough and maintain a balanced diet. People were positive about the food at the service. However one person who required a specialist diet was placed at risk because they received inappropriate food.

Where there were concerns or complaints, these were investigated by the registered manager and action taken and lessons learnt.

We found breaches of the regulations at this inspection. You can see what action we told the provider to take at the back of the report.

The inspection was carried out by two inspectors. At the time of our visit there were 37 people living in the home. We looked at six care plan files and tracked the care these six people had received since moving into the home. We spoke with ten people who lived in the home, ten staff, two relatives, a community nurse, a manager from the local Adult Community Care team, the hairdresser, the registered manager and a senior representative of the provider who was visiting the home that day. We also spoke with a number of visitors to the home. We observed people in the lounges and dining rooms throughout the day and saw how staff supported and communicated with them.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The service was safe because people's health and care needs were understood by trained and supported staff. Risks to people's health and welfare were understood and managed in line with their agreement. One of the staff we spoke with told us their priority was 'to keep people safe and to monitor their needs'. Another said, 'We must take safety and security seriously'.

There was monitoring of events and incidents and measures were put in place to minimise a repeat of any issues. This included changes to health care needs and some medication incidents. People's medicines were being managed on their behalf, where appropriate in a competent way.

Care plans included considerations of the Mental Capacity Act (2005) and staff demonstrated an understanding of the Act and Deprivation of Liberty Safeguards (DoLS) and how they applied to their practice. We found the location to be meeting the requirements of the Mental Capacity Act (2005). People's human rights were therefore properly recognised, respected and promoted.

Is the service effective?

The service was effective because people's health and well-being was promoted. Care plans provided instructions to staff about the care each person wanted and needed. We saw evidence of multi-professional visits and appointments, for example GP, speech and language therapist and community nurses.

Is the service caring?

The service was caring because we saw staff communicating in a warm and caring manner. We saw staff asking people for their consent before carrying out tasks, for example by asking 'Would you like to..?' or 'Is it alright if I help you with..?' Where people were unable to verbally communicate staff interpreted facial expressions and behaviours to help them understand the person's intention. We observed staff who explained to people what they were doing and asked people if they wanted help or a drink.

One person said, 'the staff are very friendly here' and a relative said,' we pop in at least twice a week. We are always welcomed and think the care is very good'.

Is the service responsive?

The service was responsive because people's wishes and their likes and dislikes were taken into account. We saw advice and treatment had been sought appropriately when staff recognised people's needs had changed. For example, a person told us they had been given advice on how to reduce risks to their health. Where they had chosen not to follow the advice their wishes had been respected.

Staff we spoke with understood each person's needs. They were able to describe people's care needs, including the medicines they required and how their medicines should be administered.

Care files were regularly reviewed and updated and provided staff with sufficient information about each person's needs to ensure their health and welfare needs were met safely.

Is the service well-led?

There were good management systems in place to make sure all daily routines were monitored, reviewed and adjusted where necessary. Monthly audits were carried out by the manager.

Residents meetings were held twice a year which included family members and friends if they wished to attend. We were told that informal feedback was encouraged from anyone visiting the home and were told the receptionist on duty was often the first person to pick up on feedback and issues raised by visitors.

Staff meetings were held at least twice a year. Staff handover sessions took place twice a day. One member of staff, employed at the home for many years told us the quality of the service was continually improving. They said 'the quality of care is great now. It's just gone up and up'.

During this inspection we met and spoke with 25 people who used the service and with one visitor. We spoke with 12 staff, the registered manager and one of the providers' senior managers. We spoke with three healthcare professionals who were visiting the home. We looked at records relating to people's care and support and for managing the service. We also obtained information from the local social and healthcare safeguarding teams, including occupational therapists who had reviewed moving and handling practices in the home.

We found that people who lived at Culm Valley were well cared for and were treated with dignity and respect. One person said, 'They treat me very well here, I can't fault them'. A second person said, 'I am well looked after' and a third person said, 'It's all very well organised here'.

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. We found the home were meeting people's personal care needs, confirmed staff managed people's health needs and used safe moving and handling techniques. People were cared for in a clean, hygienic environment and were protected from the risk of infection because appropriate infection control systems were in place and policies and procedures were followed.

We spoke with six relatives, and six visiting health professionals (including members of the Complex care team, two occupation therapists (OT), a GP, a community nurse and a tissue viability nurse). We also spoke with Devon County Council contracts team. Relatives told us they had no concerns about the care of their family members. Comments included, 'We have found that it is first class here', 'We have no complaints or concerns at all', 'It is lovely here. X is settled and we can see that she has improved greatly here over time', and 'The staff appear to be on the ball. We have no worries about X'.

Visiting professionals told us that the service always made appropriate referrals in a timely way. A social services practice manager told us, 'There is no question that care isn't good at Culm Valley'. Comments from OT included, 'The service is brilliant. Couldn't be better at the moment', 'We have noticed a massive improvement over the past months' and 'The service is responsive and well managed'. A GP told us, 'In 20 years of visiting this is the best it has ever been. In the past six months it has been run as we would like'. The tissue viability nurse said 'We have no concerns. They are very attentive and they know what they are doing'. Devon County Councils contracts officer told us they had no concerns about the service, they added, 'The provider has put the effort in to improve the service'.

We spoke with ten members of staff, including the registered manager and the deputy. The majority of staff told us they felt well supported and they felt they had access to a range of training to help them do their job safely and competently. Comments for staff included, 'The home is better organised', 'We have stronger leadership' and 'everyone (staff) knows what they are doing now and what is expected of them'.

We found that Culm Valley Care Centre was meeting of the outcomes we inspected.

During this inspection we spoke with six people living at the home, two relatives and eight staff members. People living at the home told us they were happy and well cared for. Comments included, 'I am ever so happy here', 'I am very happy with the care I get' and 'Everything is fine, much better than it was'. People told us that staff were polite and respectful and that they felt safe at the home.

As part of the inspection we contacted six health and social care professionals, including community nurse, tissue viability nurse, placing social workers and Devon County Council's contract officer. All those contacted made positive comments and spoke about the improvements made at the home. No concerns were raised. Comments included; 'I was happy with their assessment and admission process', 'We are very impressed with the overall improvements' and 'They have made a great effort to achieve compliance'. The present leadership team at the home was highlighted as having a significant and positive impact on the home.