Victoria House Residential Home

Victoria House is a residential care home providing personal and nursing care to up to 20 people. The service provides support to older people, people living with dementia and people with physical disabilities. At the time of our inspection there were 11 people using the service.

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

People’s medicines were not always managed safely. There were a number of issues including; the lack of protocols in place for people who received as required medicines and a lack of running totals of some controlled drugs, these are medicines which require specialist storage by law. Storage of some medicines were not in line with legislation.

Risks to people’s safety was not always clearly recorded. There was conflicting information in people’s records about their care needs as changes to their needs occurred. There was a lack of processes to show clear learning from events.

Quality assurance processes were not always robust. This had resulted in some of the findings above. Some audit findings had not been addressed, such as areas of concern highlighted in environmental audits.

More positively, staff were knowledgeable about people’s needs. There was enough staff to support people as the registered manager and their staff team worked extra shifts to ensure people were well supported.

Staff recruitment processes were safe.

People and relatives liked the staff who supported them and felt they were caring and approachable. During our inspection we observed a number of positive interactions between staff, the people they supported and their relatives.

There were processes in place to ensure people were protected from the risks of abuse. People, relatives and staff had confidence the registered manager would deal with any concerns appropriately.

People were protected from the risk of infection as staff followed good infection prevention and control practices to reduce the risks.

People were able to have visitors and relatives told us they felt welcomed into the service.

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 registered manager worked in an open way promoting choice and person-centred care for people. They led by example. People were encouraged to take part in resident meetings and give their opinion of the service via questionnaires.

Staff had received appropriate training to guide them in their roles and were supported with supervision and staff meetings.

The registered manager and their staff team worked with external health professionals to ensure people’s needs were supported.

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 16 January 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We highlighted concerns around the management of risk and governance following our own monitoring processes. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Victoria House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to regulations 12 and 17 of the Health and social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to manage medicines in a safe way and the quality monitoring processes were not robust enough to identify the issues we found in relation to medicines, care plans and the environment at this inspection. Following our inspection, we received information from the provider to show they had addressed the concerns found at inspection.

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

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.

Victoria House Residential Home is a residential care home providing personal care to 17 people aged 65 and over at the time of the inspection. The service can accommodate up to 20 people in one adapted building

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

The provider and staff were kind and caring and supported people’s dignity and independence. There were enough staff to meet people’s needs and staff received the training and supported needed to ensure they provided a high quality of care in line with best practice guidance.

Staff had received training in how to safeguard people from abuse and were confident that the provider would take action if any concerns were raised.

The home was clean and tidy and supported people living at the home to mobilise ad find their own way around the home. Staff knew how to keep people safe from the risk of infection.

People had been involved in planning their care and care plans accurately reflected people’s needs. Risks had been identified and care was planned in line with best practice to keep people safe. People were supported to eat safely with their independence maximised. People’s wishes at the end of their life was respected. The provider worked with other agencies to ensure people were kept comfortable and pain free at the end of their lives.

People’s medicines were safely administered. However, we found some issues with the recording of medicines. The provider took action to resolve these concerns.

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.

There were effective systems in place to audit the quality of care in the home and to drive improvements. Action was taken after accidents and incidents to keep people safe. The provider investigated and responded to any complaints raised.

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 12 April 2017).

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.

This inspection took place on 30 January 2017 and was unannounced.

Victoria House is registered to provide accommodation for personal care for up to 20 older people or people living with dementia or a physical disability. There were 12 people living at the service on the day of our inspection.

The service was managed by the registered provider. Registered providers are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. Six people living at the service had been referred to the local authority DoLS team and were waiting on assessments to have their freedom lawfully restricted under a DoLS authorisation.

Staff undertook appropriate risk assessments for all aspects of a person’s care to keep them safe from harm. Care plans were developed to support people’s individual needs. Staff knew what action to take and who to report to if they were concerned about the safety and welfare of the people in their care. People received their prescribed medicine safely from staff that were competent to do so. The provider ensured that there were always sufficient numbers of staff on duty to keep people safe.

People were supported to have a healthy and nutritious diet and hot and cold drinks and snacks and fresh fruit were available throughout the day. People had their healthcare needs identified and were able to access healthcare professionals such as their GP and dentist. Staff knew how to access specialist professional help when needed.

People were at the centre of the caring process and staff acknowledged them as unique individuals. People who lived at the service told us that staff were kind and caring and we saw examples of good care practice. People were always treated with dignity and respect. People were cared for by staff that were supported to undertake training to improve their knowledge and advance their skills to enable them to perform their roles and responsibilities effectively.

People were supported to have an active life and were encouraged to take part in hobbies and interests of their choice. However, there was not an activity coordinator in post. Relatives commented that their loved ones were well looked after.

People where able, were supported to make decisions about their care and treatment and maintain their independence. People and their relatives had access to information about how to make a complaint. Relatives told us that they could approach staff with concerns and knew how to make a formal complaint to the provider.

The provider had introduced robust systems to monitor the quality of the service and make improvements. Staff had access to professional development, supervision and feedback on their performance. People, their relatives and staff found the provider and their deputy approachable.

Overall, we found that the provider had led their team to introduce and sustain improvements to the service, such as good infection control practices and monitoring the quality and safety of the service.

At this inspection we saw the home had policies in place which were clearly displayed. We saw disposable cloths were available to the housekeeping staff.

At the previous inspection we noted the cleaning rota was written on a scrap piece of paper and was not formalised. At this inspection we saw a cleaning schedule on display in the laundry.

Care plans included a personal profile for each person 'Remember I'm Me' which provided members of staff and visitors with information on each person's social and occupational history as well as information on their preferred daily routines, what type of bedding was preferred, and their spiritual and cultural needs.

We were present whilst lunch was taken. We saw appetising food was served. People who needed assistance to eat their meal were helped by individual members of staff sitting with them.

One care worker commented, 'The food is good, everything is home cooked and prepared well.' One person who lived at home told us, 'The food is very nice, I never go hungry.'

We found the building had been maintained effectively. The standard of decor was good. We saw the carpets and laminate floors in communal areas and in people's rooms were clean and in good condition.

We asked one member of staff for their opinion on the staffing levels, they said, 'The staffing is fine, we never have a problem. One person told us, 'We are very well looked after, nothing is too much trouble. Another person commented, 'The staff are exceptionally friendly.'