Victoria House

Victoria House is a residential care home that provides personal care for up to 30 people aged 65 and over. At the time of the inspection there were 18 people using the service.

People’s experience of using this service:

People were positive about living at Victoria House and were complimentary about the staff who cared for them.

Care and support was tailored to each person's needs and preferences. People and their relatives were fully involved in developing and updating their planned care.

There were sufficient staff to meet people’s needs. Staffing levels were kept under review and were due to be increased.

Appropriate recruitment checks were carried out to ensure staff were suitable to work in the service

People were supported to take their medicines safely.

Risks were identified and managed safely. However, risk assessments in place would benefit from further development. Staff understood how to safeguard people from abuse.

Care plans were in place. Overall they included guidance from professionals and details of changes to people’s needs. There were some examples where care plans needed to be further updated to include current information.

Staff were trained and further training was planned to cover any gaps.

Improvements had been made to records relating to The Mental Capacity Act 2005 (MCA). However, further improvements were required. We have made a recommendation about this.

People were satisfied with the food available. Overall staff understood people’s nutritional needs, however we found an example where staff needed clearer information.

People were well cared for by staff who treated them with respect and dignity.

Systems were in place for people to raise complaints and concerns.

People were supported to take part in activities and to access the local community.

Staff liaised with other health care professionals to ensure people's safety and meet their health needs.

The registered manager demonstrated a commitment to providing person centred care for people. Staff felt the registered manager was supportive and approachable.

Audits had been developed to monitor the quality of the service.

We have made a recommendation about the need to analyse accidents and incidents to identify any themes or trends.

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

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (23 November.2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The rating has improved to Good overall.

Follow up:

We will continue to monitor any intelligence we receive about the service until we return to visit as per our inspection schedule. If any concerning information is received we may inspect sooner.

During our last comprehensive inspection in December 2017, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to, non-compliance with the Mental Capacity Act 2005 (MCA), failure to assess and mitigate risk and complete and accurate records. We rated the service as “requires improvement.” Following the last inspection, we asked the provider to complete an action plan. This was to confirm what they would do and by when, to improve the key questions of safe, effective, responsive and well-led to at least a rating of good.

Victoria House 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.

Victoria House accommodates 30 people in one adapted building. The accommodation is based over three floors. At the time of our inspection there were 14 people living at the home.

At this inspection in October 2018 we found that a number of improvements had been implemented. The provider was no longer in breach of Regulation 12 (Safe care and treatment) . However, we identified continued breaches with regards to Regulation 11 (Consent) and Regulation 17 (Records). Although improvements had been made we found that the overall rating for the service remained “requires improvement”.

Overall people and their relative were positive about the care and support they received at Victoria House

Risks were identified and action taken to mitigate further risk. Improvements had been made in relation to records relating to risk, however further work was needed to improve this further.

We found two concerns relating to the safe administration of medicines which were rectified by the registered manager immediately following the inspection. All other aspects of medicines were managed safely.

Staff sought consent from people before providing care and Deprivation of Liberty Safeguards (DoLS) applications had been appropriately. However, records did not always demonstrate that staff had followed the principles of The Mental Capacity Act 2005 (MCA).

People had choices of food and drinks, they were generally complimentary about the food on offer. However, aspects of nutritional risks had not always been managed safely.

Accident and incidents were recorded by staff using individual forms. The registered manager was knowledgeable about any incidents and could demonstrate action had been taken where trends were noted.

There were sufficient staff on duty to meet people’s needs in a timely way. Staffing remained under review and the registered manager told us this would be adjusted accordingly if people’s dependency levels changed. Appropriate recruitment checks had been made to make sure staff were suitable to work with vulnerable people.

The provider had policies in place for safeguarding vulnerable adults. Staff demonstrated a good level of understanding and could explain action they would take to protect people from abuse or harm.

Significant improvements had been made since previous inspections regarding the cleanliness of the building. Appropriate checks were completed on the premises and equipment to ensure they were safe.

Staff were supported to ensure they had the appropriate skills and knowledge to support people effectively. Since the registered manager had been in post they had focused on staff completing mandatory training.

The home had recently undergone a period of refurbishment and redecoration in a number of areas, including the communal areas and bedrooms.

Staff treated people with kindness and compassion. Staff took the time to talk and listen to people. They had good knowledge of people’s backgrounds and preferences. Where possible staff supported people to be as independent as they wanted to be. People's diverse needs were considered.

People were encouraged to express their views regarding the service and were involved in decision-making about their care.

People received care that was centred around their individual needs. Work had been undertaken around care plans to ensure they were person centred and contained up to date information, including individual preferences and life histories.

Charts were kept demonstrating that people had received support with for example, food and fluid intake. In the main these were fully completed, however, we noted that some charts were incomplete.

People, relatives and staff were extremely positive about the improvements to the activities on offer. Since coming into post the registered manager had recruited an activity coordinator and focused on enabling people to take part in activities.

People had access to the complaints procedure and were encouraged to make complaints should they wish to.

A new manager had been appointed in January 2018 and had recently registered with the Care Quality Commission. She understood her responsibilities and had built effective links with other professionals and the wider community. She had also taken action to engage people and their relatives with improvements to the service.

People living at the home, relatives and staff were positive about the management of the service. The registered manager had focused on creating a stronger more positive culture which was open and emphasised continuous learning. Staff had been supported with training and development.

There were quality assurance and audit systems in place. However, these were not fully effective, as they had not identified all of the issues highlighted in this inspection relating to medicines administration, risk assessment records and compliance with the MCA. Records were not always complete and accurate.

Victoria House 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.

Victoria House accommodates 30 people in one adapted building. There were 17 people living at the service at the time of the inspection.

There was no registered manager at the service. A new manager had been recruited and was due to start at the service within the next few weeks. 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 our last inspection of the service in July 2017 the service was rated overall as 'Inadequate' and therefore was placed into ‘special measures’. At that inspection we identified several new breaches and continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We identified concerns in relation to the failure to assess risks, the safe management of medicines, maintaining accurate and complete records, meeting people’s nutritional needs, providing person centred care and ensuring that where people’s lacked capacity to make decisions these were made in line with The Mental Capacity Act 2005 (MCA). Other concerns were identified that the registered manager and registered provider were not maintaining the quality of the service, the failure to display the CQC rating, the failure to submit notifications to the Commission, and the cleanliness of the premises. As a result, we imposed a condition on the provider's registration, which stated that they may not admit people to this home without prior written permission from CQC. We also took further action against the provider for repeated and serious failures to meet the regulations. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

At this inspection we found that some improvements had been made within the service, although we were concerned that progress had been slow. The service has been rated as overall ‘Requires Improvement.’ at this inspection. Improvements were seen to the cleanliness of the premises, the provision of person centred care and staffing. This included better monitoring of staff levels and more specific training and support for staff. Some risks to people had been identified within care plans with action taken to mitigate risk. However all potential risks had not always been fully assessed, and recorded within people’s care records. Whilst some improvements were noted to the provision of food, we found that systems for monitoring people’s nutritional needs were inconsistent and confusing. Decisions were not always being made in accordance with the MCA. The acting manager had implemented some quality assurance tools to monitor the service.

Despite care plans being re-written, we found that Information to support staff to provide care and treatment which was person centred and reflected people's needs and preferences lacked detail, guidance and support. There were some improvements noted to the completion of people’s daily monitoring charts.The acting manager told us that they were in the process of re-writing everyone’s care plan which included the development of risk assessments. Systems to record and analyse incidents and accidents had improved

People could not be assured their dietary and nutritional needs were consistently and effectively managed. Actions to follow external healthcare professional recommendations were not always fully recorded in people’s care plans and systems to monitor weight loss remained confusing. However staff spoken with during the inspection were knowledgeable about people’s individual health and care requirements.

We noted some concerns regarding fire safety procedures and the acting manager demonstrated that training was being arranged around this issue. We contacted the local fire service to highlight our findings.

Staffing levels had improved and the acting manager had undertaken recruitment of staff which was ongoing. People’s dependency levels were assessed and linked with the staffing levels.

There had been improvements to the cleanliness of the environment and aspects of the home had been decorated.

Most medicines were managed safely and stored appropriately, however some short falls were identified around the recording of medicines management. Action was being taken to improve audits and we saw that there was increased oversight of medicines.

We found that suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

Regular staff supervisions had commenced and were in progress. Opportunities were available for staff to discuss performance and development and a programme of training was being implemented. Staff told us that they felt more supported by the current manager.

People told us, and we observed, that staff were kind and caring in their approach. People's privacy and dignity was respected most of the time by staff.

Improvements were identified because people had more opportunities to go out into the community, however people continued to have limited opportunities to participate in other activities that met their interest, hobbies and needs. An activities coordinator needed to be recruited.

The registered provider had utilised a consultancy company to help make the necessary improvements to the service. A new permanent manager had also been recruited and was due to start at the service at the beginning of January 2018. A number of quality assurance audits had been undertaken and actions had been identified for further improvement. Any improvements made had not been in place long enough to demonstrate that they could be sustained.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We have found three continued breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

Victoria House provides residential care and support for up to 30 older people. The home is set within its own gardens and has parking facilities. Some people have dementia related needs. There were 20 people living at the home at the time of the inspection.

There was a registered manager in post. 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. However the registered manager had resigned her post and a new manager was due to start on 1 August 2017.

At the last inspection we found six breaches of the legislation including, staffing, good governance, meeting nutritional needs, cleanliness of the premises, person centred care and need for consent. At this inspection we found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following this inspection, we have imposed a condition on the provider's registration, which states that they may not admit people to this home without prior written permission from CQC. We are also taking further action against the provider for repeated and serious failures to meet the regulations. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Monitoring systems were not effective in identifying areas for improvement and as a result, people's safety and the service they received was compromised. We found continuing concerns with the management of medicines, response to health care needs, risk and care planning, adequate nutrition and hydration and the quality of records. The provider had failed to notify us of all significant events in line with their legal obligations and failed to display the most recent rating by the Commission of the performance of the service.

Victoria House provides residential care and support for up to 30 older people. The home is set within its own gardens and has parking facilities. Some people have dementia related needs. There were 24 people living at the home at the time of the inspection.

There was a registered manager in post. 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 six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Sufficient numbers of suitably qualified, competent, skilled and experienced staff were not deployed to meet the needs of the people living in the service. We observed that staff were not always available to respond to people’s needs in a timely manner. The home was very dependent upon the use of agency staff. Staffing levels had been increased slightly and staffing levels at night were due to be increased by an extra carer. The recruitment of new staff was a priority.

We noted that some areas of the home had been redecorated and new carpets and furniture had been purchased. However during our visit we found that some areas of the home were not visibly clean. Equipment such as hoists were also found to be in need of cleaning.

We found there were policies and procedures in place to guide staff in how to safeguard people who used the service from harm and abuse. Staff received safeguarding training and knew how to protect people from abuse. Staff knew where they could report safeguarding concerns to outside of their organisation. Risk assessments were completed to guide staff in how to minimise risks and potential harm, although we found that risk assessments relating to bed rails needed to be more detailed.

During the inspection we found that the principles of the Mental Capacity Act 2005 (MCA) had not been followed to ensure people's rights were protected. MCA assessments and best interest decisions had not always been carried out or recorded correctly where necessary.

Staff received induction and training. A training programme was in place and staff had been encouraged to complete all mandatory refresher training. Staff had supervision meetings and team meetings were held to support them in their role.

People’s views about the food were mixed and some views were negative. The registered manager told us that menus had been changed and they were focused on making necessary improvements. However we found that systems for monitoring people’s nutritional risks were not always effective. Appropriate follow up action had not been taken with regards to a person’s weight loss.

People told us they were treated in a kind and caring manner. We observed that staff treated people with dignity and respect. People were able to make choices about the way they were supported where possible.

Staff were in the process of reviewing and re-writing all of the care plans. We found that these contained some person centred information about people’s preferences and wishes. People told us that their choices were respected.

We found that the care provided was not always responsive to people’s changing needs. Where a person’s continence needs had changed significantly we found that they had not been reviewed in a timely manner or re-assessment completed.

People were very complimentary about the activities coordinator. There were regular planned activities and outings.

We found that the home had some systems in place to assess and monitor the quality of service. Peoples’ feedback had been sought through questionnaires and meetings. However, quality assurance systems had not been robust enough to highlight all the issues raised within this inspection.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that risks to people's health and wellbeing had been identified for areas such as falls, nutrition and pressure sores and measures were in place to manage these so the people who lived at the home were safeguarded from unnecessary hazards.

We looked at four staff files to check that effective recruitment procedures had been completed. In all files we found that the appropriate checks had been made in order to ensure that the provider was fully satisfied that the person was suitable to work with vulnerable adults.

There were appropriate procedures in place should anyone need to be subject to a Deprivation of Liberty Safeguard (DoLS) application or plan. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

Is the service effective?

The staff members we spoke with could show that they had a good understanding of the people they were supporting and they were able to meet their various needs. During our visit we observed that staff members were interacting well with people in order to ensure that they received the care and support they needed. The relationships we saw were warm, respectful, dignified and with plenty of smiles and laughter. We observed that staff interacted well with residents.

Is the service caring?

During our inspection we found that the people living at Victoria House looked well cared for and were dressed appropriately for the weather on the day. We saw there was good communication and understanding between the members of staff and the people who were receiving care and support from them. The people appeared relaxed, comfortable and at ease with the staff.

The people using the service who were able to tell us said that they were happy living in the home and comments such as 'it is ok here' 'I can go where I like it is good' and ' it is a nice place to be.'

Is the service responsive?

During our visit to the home in January 2014 we saw that people's bedrooms were fitted with locks. Following our visit the provider told us that they would make arrangements for more keys to be made available to staff. During this visit we found that all care staff had a master key to the bedrooms at the home.

At the last visit to the home in January we found that coded key pads were in use on communal doors around the building. Staff were unable to demonstrate that a risk assessment had been carried out on the use of the door keys and the use of door key pads and the impact that this may have on people who use the service accessing all areas of the home. During our visit on we saw that a full risk assessment had been completed on the door key pads and use of door keys at the home.

At the last visit in January we saw that there was little signage around the building on doors to assist people with their orientation around the building.

At this visit we saw that the home had colourful laminated signs to direct people to dining room, toilets and lounges.

Is the service well led?

In this report the name of a registered manager appears who was not in post and not managing the home at the time of our visit. Their name appears because they were still a registered manager on our register at the time of our inspection.

There is a manager in post and they will apply to be registered with CQC following the deregistration of the former manager.

We looked at quality audits that had been completed at the home. This included checks on medicines, environmental checks and care plans. We found that actions had been identified and completed when required.

Staff spoken with said the home was a good place to work and they felt supported by the manager.

Questionnaires had been sent out to relatives but not many had been returned so the manager was repeating the process.

Relative meetings had been held and minutes had been taken and circulated.

We gathered information from a number of sources which included speaking with people who use the service and relatives of people who use the service. We also spoke with the manager, the deputy manager of the service and members of the staff team. Comment cards were also made available to people who use the service, visitors and staff for them to tell us their experiences.

In addition to the themed inspection programme we also looked at the outcomes for people who use the service in relation to records; supporting workers and the safety and suitability of the premises, areas which had been non-compliant on previous visits to the service.

We observed staff speaking with people with dementias with respect and kindness and an awareness of individual's needs in relation to dementia care.

We saw that some improvements had been made to the environment, record keeping and the supervision of staff. However, further improvements were required in relation to staff training.

During the visit we found that the provider needed to make further improvements in relation to the support that was available to staff in order for them to carry out their role. In addition, improvements were needed to the systems used to record and manage people's personal information.

Throughout our visit we saw that people who used the service had built up positive trusting relationships. We observed staff supporting people in a respectful manner and ways in which maintained people's dignity.

We found that improvements were needed in relation to the environment and the records.

In this report the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because their registration was in the process of being cancelled at the time of our visit.