Archived: Victoria House

Victoria House is a residential 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 is registered to provide accommodation and personal care for up to 22 people aged 65 and over with a range of physical and cognitive support needs. At the time of the inspection 17 people were living at the home.

People’s experience of using this service:

¿ People were happy living at Victoria House. They told us their needs were met in a personalised way by staff who were competent, kind and caring.

¿ Environmental risk assessments had been completed however, these did not cover all risks posed by the environment. Risks in respect of the stairs or the kitchen had not been assessed.

¿ With the exception of risk relating to people receiving blood thinning medicine individual risks had been assessed and were managed appropriately.

¿ Medicines were generally managed safely and, where we identified areas for improvement the manager took immediate action. People received the personal care they required. People were involved in the development of their care plans which were reviewed regularly. Staff worked with local health and social care professionals to ensure health care needs were known and met.

¿ People's rights and freedoms were upheld. People were empowered to make all their own choices and decisions.

¿ There were sufficient numbers of staff who were well trained, felt listened to and worked well together. The manager continually considered ways to improve the service for the benefit people living there. Where we identified areas for improvement they acted immediately.

The service met the characteristics of Good overall. More information is in the full report.

Rating at last inspection: At the last inspection the service was rated Requires Improvement. (Report published 20 March 2018). The overall rating has improved.

Why we inspected: This was a scheduled/planned inspection based on the service’s previous rating.

Follow up: We will continue our routine monitoring of the service.

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

The home accommodates up to 22 people. At the time of our inspection 16 people were living at Victoria House. The home was based on three floors connected by a passenger lift. There was a choice of communal spaces where people were able to socialise and most bedrooms had en-suite facilities.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

This inspection took place on 5 and 8 February 2018 and was unannounced. At our last comprehensive inspection, in August 2017, we identified breaches of Regulations 12, 17, 19 and 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure: that medicines were managed safely; that accurate and complete records or people’s care were maintained; that effective quality assurance systems were operated; that safe recruitment practices were followed; and that the previous performance rating was displayed on the premises or on their website. Following the inspection, we issued warning notices for the breaches of Regulations 17 and 19 and requirement notices for breaches of Regulations 12 and 20A. The provider sent us an action plan detailing how they would become compliant with the Regulations.

At this inspection, we found although significant improvements had been made, further improvement was still required. The registered manager took prompt action to address all the concerns raised during this inspection. However, a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. You can see what action we have taken at the back of the full version of the report.

The provider had significantly enhanced their oversight of the service since the last inspection. However, we found their quality assurance systems were still not operating effectively as there was no system in place to audit people’s care plans to ensure they were up to date and reflected people’s current needs.

Most medicines were managed safely, although no action had been taken when the temperature of the medicines fridge had been too low and risk assessments had not been completed for people prescribed blood thinning medicines.

Action was taken to protect people from the risk of falling. However, people’s risk assessments were not updated after they had experienced falls to ensure staff were aware of additional measures that were needed to prevent further falls.

A recruitment procedure was in place, although the provider did not have a process in place to assess any health issues that might affect their work.

Care plans included information about people’s routines and staff demonstrated an extensive knowledge of people’s current needs. However, some care plans lacked key information about people’s individual needs, including their end of life wishes. This posed a risk that people’s needs and preferences might not be met consistently.

There were enough staff deployed to meet people’s needs. People told us they felt safe at Victoria House and staff understood their responsibilities to safeguard adults at risk of abuse.

Procedures were in place to learn from adverse incidents and there were appropriate systems to protect people from the risk of infection.

People’s needs were met by staff who were skilled and suitably supported by managers. Staff followed legislation to protect people’s rights, promoted choice and empowered them to make as many of their own decisions as possible.

People praised the quality and variety of meals and were supported appropriately to eat and drink enough. They had access to a range of social activities.

People were supported to access healthcare services and there were arrangements in place to help ensure that people received consistent support when they moved to or from Victoria House.

The environment was supportive of the people who lived there and met their needs. People were supported by caring staff who knew them well. Staff encouraged people to remain as independent as possible and involved them in decisions about their care. They protected people’s privacy and dignity at all times.

People told us they enjoyed living at Victoria House and felt it was run well. The provider sought feedback from people. People described an open and transparent culture where they were able to raise concerns or complaints.

Staff spoke enthusiastically about their work and said morale had improved significantly since the last inspection. They expressed a shared commitment to supporting people to the best of their ability.

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 our last inspection, in June 2016, we identified breaches of four regulations. The provider had failed to ensure that care and support were only delivered with the consent of the person; they had failed to ensure risks to people were managed effective; they had failed to ensure that pre-employment checks were always completed before staff started work; and they had failed to ensure staff were suitably trained. At this inspection we found action had been taken, although further improvement was still required.

Staff described the action they took to protect a person from the risk of developing pressure injuries; however, neither a risk assessment nor a care plan had been developed to ensure this was done consistently. Other risks to people, including environmental risks were managed appropriately.

Storage arrangements for medicines that were subject to additional security requirements by law were not adequate. Action was not taken when the temperature of the medicines fridge fell too low and there was no process in place to ensure topical creams were not used beyond their shelf life.

Pre-employment checks were not always completed to help ensure staff were of good character and suitable to work with the people they were supporting.

Although most people’s dietary and nutritional needs were met, we could not be assured that this was the case for one person. Staff were not able to monitor the body mass index (BMI) of people who could not be weighed, as they had not been trained.

Staff were monitoring the amount people drank, but did not know how much each person should be encouraged to drink and did not total the quantities each day to assess if people had drunk enough.

The provider had failed to display their previous inspection performance ratings in their premises and on their website. Neither the provider nor the registered manager had sent us the pre-inspection information we had requested before our visit

A quality assurance process was in place, but this had not always been effective in bringing about improvement. Some of the issues we identified at our last inspection in June 2016 had not been fully addressed and the process for reviewing people’s care plans was not robust. The provider did not take a structured approach to monitoring the quality and safety of the service, but relied on the experience of the registered manager.

Staff expressed mixed views about the way the service was managed and the availability of the registered manager. Some expressed a lack of confidence in the leadership, who they felt they showed a lack of commitment.

All but one staff member had received effective induction and training into their role. The registered manager was taking action to ensure this was completed for the staff member who had not completed this. Staff felt supported in their role on a personal level; they received one-to-one sessions of supervision with a manager, which included observations of their practice.

People told us they felt safe. Staff had received safeguarding training and knew how to identify, prevent and report allegations of abuse. There were usually enough staff employed to meet people’s needs.

Staff sought consent from people before providing care and followed legislation to protect people’s rights and freedom. They also supported people to access healthcare service when needed.

Staff developed caring and positive relationships with people and interacted positively with them. They protected people’s privacy and respected their dignity. They supported people to remain as independent as possible and involved them in decisions about their care.

People told us they received personalised care and support that met their needs. Staff demonstrated a good understanding of people’s individual needs and were led by people’s preferences and choices.

With the exception of one person’s care plan, all other care plans included sufficient information to enable staff to deliver individualised care and support to people. Care plans were reviewed regularly and staff responded promptly when people’s needs changed.

Staff sought and acted on feedback from people. People knew how to make complaints about the service and were confident complaints would be dealt with effectively. They described an open culture where they could visit at any time and could access staff and managers to discuss concerns if needed.

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.

We found people’s safety was compromised in some areas. Not all ancillary staff had received safeguarding training, although this was being rolled out. The registered manager had dealt appropriately with an allegation of abuse, although they had not made a record of the incident.

Appropriate recruitments checks were made, but were not always reviewed before staff were employed to help make sure they were suitable to support people living at Victoria House.

Risks to people were not always managed effectively. Staff were not clear, and there was a lack of information, about how to protect people from the risk of pressure injuries. Assessments of the risks posed by bedrails or stairways, and the fire risk posed by a person who smoked, had not been completed.

Not all staff had received practical training to enable them to support people to move safely. Staff had not been trained to calculate the body mass of people who could not use weighing scales.

The provider had not notified CQC of a serious injury to a person, as required. The registered manager had not followed the provider’s policy by giving the person, or their relative, written information about the incident.

Quality assurance systems were in place but not always effective. They had not ensured that improvements were identified and made promptly.

Staff did not always follow legislation designed to protect people’s rights and ensure they were only supported with their consent.

People received a choice of suitably nutritious meals. However, the amount people drank was not recorded in a way that allowed staff to assess whether people had drunk enough.

Staff knew and met the needs of most people well, although care plans did not always support the delivery of personalised care as they lacked information.

Medicines were managed safely, although storage facilities did not always meet the required specifications and there was a lack of information about an ‘as required’ medicine for one person.

People were encouraged to make choices about how and where they spent their time. They had access to a range of activities, which were being developed further. Staff sought and acted on feedback from people and there was an appropriate complaints procedure in place.

There were enough staff deployed to meet people’s needs. People were supported to access healthcare services when needed. There were suitable arrangements on place to deal with foreseeable emergencies, such as a fire.

People were treated with kindness and compassion by staff who knew them well. Staff showed concern for people’s well-being and involved them in planning the care and support they received. People’s privacy was protected at all times.

Staff described the management as “supportive”. They were clear about their roles and motivated to develop the service for the benefit of people. They were supported in their work through appropriate induction and supervision.

We identified breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

At this inspection we found more efficient auditing of infection control procedures. New systems were in place and these were being used to ensure people were protected from the risk and spread of infection. We looked at all communal bathrooms and toilets and fivel en suite facilities. These were all clean.

We spoke with one person who used the service. They told us, 'it's very clean here. The cleaners are lovely and can do anything'. We spoke with one of the two cleaning staff who demonstrated a good knowledge of infection control procedures.

Communal areas of the home were clean and hygienic. However, some toilets had not been cleaned effectively and thus did not ensure people were protected from infection.

Staff had been subject to essential checks before they commenced work. A thorough induction programme was in place to ensure staff had the necessary skills to care for people appropriately.

A complaints policy was in place. The service had not received any written complaints for several years. Concerns and comments were taken seriously and action was taken to ensure these were addressed.

Care plans and risk assessments were in place and we saw that these were reviewed and updated regularly. Quality assurance procedures were in place, including bi-monthly residents' meetings, monthly staff meetings and supervision. This meant that people were involved in the provision of care.

Systems were in place to train and induct new staff and we saw records showing that all staff received regular training. People we spoke with said they would take any concerns about care to the manager. Staff were familiar with local safeguarding procedures and felt confident that any concerns would be acted on quickly by the manager.

The provider address in this report was correct at the time of preparation. However, since the draft publication of this report we have been informed that the provider address has changed. This will be updated for future reports.